title: Attentional and emotional mechanisms related to pain as predictors of chronic postoperative pain: a comparison with other psychological and physiological predictors.
abstract: The present prospective longitudinal study on chronic postoperative pain was conducted to assess the predictive power of attentional and emotional variables specifically assumed to augment pain, such as pain hypervigilance, pain-related anxiety, pain catastrophizing and attentional biases to pain. Their relevance was determined in comparison with other psychological and physiological predictors (depression, anxiety, somatization, cortisol reactivity, pain sensitivity). In 84 young male patients the predictor variables were assessed one day before surgery (correction of chest malformation). Postoperative outcome (subjective pain intensity and pain-related disability) was assessed three (N=84) and six months (N=78) after surgery. Patients were classified into good and poor outcome groups. Patients with high pain intensity three (25%) or six months (14%) after surgery, differed significantly from those low in pain with regard to their preoperative performance in the dot-probe task (high attentional bias towards positive words). A sizeable portion (54%) of patients still felt disabled due to pain after three months and a few patients after six months (13%). These patients were those with high preoperative ratings in the Pain Vigilance and Awareness Questionnaire. The few subjectively disabled patients after six months could be identified in addition by low pressure pain and high cold pain thresholds before surgery. An attentional bias towards positive stimuli prior to surgery may indicate a maladaptive coping style, which avoids necessary confrontation with pain and predisposes patients to chronic postoperative pain. Lasting subjectively felt pain-related disability occurs predominantly in patients with high levels of pain hypervigilance before surgery.
authors.affiliation: Physiological Psychology, Otto-Friedrich University Bamberg, Germany Pain Center, Friedrich-Alexander University Erlangen, Germany Department of Pediatric Surgery, Friedrich-Alexander University Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lautenbacher
authors.forename: Claudia
authors.initials: C
authors.lastname: Huber
authors.forename: Dorothea
authors.initials: D
authors.lastname: Schöfer
authors.forename: Miriam
authors.initials: M
authors.lastname: Kunz
authors.forename: Andreas
authors.initials: A
authors.lastname: Parthum
authors.forename: Peter G
authors.initials: PG
authors.lastname: Weber
authors.forename: Carbon
authors.initials: C
authors.lastname: Roman
authors.forename: Norbert
authors.initials: N
authors.lastname: Griessinger
authors.forename: Reinhard
authors.initials: R
authors.lastname: Sittl
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology; D001288:Attention; D058443:Catastrophization / Q000523:psychology*; D002908:Chronic Disease / Q000523:psychology; D003863:Depression / Q000523:psychology; D004644:Emotions; D005660:Funnel Chest / Q000601:surgery; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017288:Pain Threshold / Q000523:psychology; D010149:Postoperative Pain / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011795:Surveys and Questionnaires