title: Preoperative state anxiety, acute postoperative pain, and analgesic use in persons undergoing lower limb amputation.
abstract: OBJECTIVE
  The current study examined the relationship between preoperative anxiety and acute postoperative phantom limb pain (PLP), residual limb pain (RLP), and analgesic medication use in a sample of persons undergoing lower limb amputation.
  
  
  METHODS
  Participants included 69 adults admitted to a large level 1 trauma hospital for lower limb amputation. Participants' average pain and anxiety during the previous week were assessed before amputation surgery. RLP, PLP, and analgesic medication use were measured on each of the 5 days following amputation surgery.
  
  
  RESULTS
  Results of partial-order correlations indicated that greater preoperative anxiety was significantly associated with greater ratings of average PLP for each of the 5 days following amputation surgery, after controlling for preoperative pain ratings and daily postoperative analgesic medication use. Partial correlation values ranged from 0.30 to 0.62, indicating medium to large effects. Preoperative anxiety was also significantly associated with ratings of average RLP only on postoperative day 1, after controlling for preoperative pain ratings and daily postoperative analgesic medication use (r=0.34, P<0.05). Correlations between preoperative anxiety and daily postoperative analgesic medication dose became nonsignificant when controlling for preamputation and postamputation pain ratings.
  
  
  CONCLUSIONS
  These findings suggest that anxiety may be a risk factor for acute postamputation PLP and RLP, and indicate that further research to examine these associations is warranted. If replicated, the findings would support research to examine the extent to which modifying preoperative anxiety yields a reduction in postoperative acute PLP and RLP.
authors.affiliation: *Department of Psychology, Seattle University †Department of Rehabilitation Medicine, University of Washington ‡Anxiety and Stress Reduction Center of Seattle, Seattle, WA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Raichle
authors.forename: Travis L
authors.initials: TL
authors.lastname: Osborne
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Ehde
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Smith
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Robinson
mesh_terms: D059787:Acute Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000523:psychology; D000700:Analgesics / Q000627:therapeutic use*; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000700:Analgesics