Research Assistant I
Anesthesiology, Perioperative and Pain Medicine
Angelina R. Franqueiro, Jenna M. Wilson, Jingui He, Jim Rathmell, Mieke Soens, Kristin L. Schreiber
Kristin L. Schreiber
Psychological distress is a known modulator of pain, with previous work showing that baseline levels of anxiety and depression may predict greater postsurgical pain. Women typically report higher levels of both psychological distress and pain severity than men. In this study of video-assisted thoracoscopic surgery (VATS) patients, we examined sex differences in the association between preoperative psychological distress and postoperative pain severity. Patients completed validated measures of anxiety and depression preoperatively, and daily pain scores both preoperatively and in the first postoperative week. Patients (N=105;M=65yrs;57% female) reported average pain scores of 1.4 before surgery and 5.6 in the first postoperative week. Analysis of sex differences revealed no difference in postoperative pain, or levels of anxiety or depression, although men reported slightly greater baseline pain than women (1.9±2.5 vs. 1.0±2.2, p<.05, Mann-Whitney U-test). Greater psychological distress was associated with worse postoperative pain (p<.05). Formal moderation analysis revealed a significant moderating effect of sex in this relationship, such that the association between preoperative psychological distress and postoperative pain was stronger for women than for men (p<.05). These findings indicate that perioperative behavioral interventions aimed at improving postsurgical outcomes may be particularly important for women with higher levels of psychological distress.
Higher levels of anxiety and depressive symptoms before surgery are risk factors for worse pain severity after surgery. Importantly, women often report higher levels of anxiety and depression compared to men, which may influence the pain they experience after surgery. We studied 105 patients undergoing video-assisted thoracoscopic surgery (VATS), asking them to complete surveys about their level of anxiety and depressive symptoms before surgery, as well as their worst level of pain experienced each day over the first week after surgery. We found that men reported higher levels of pain before surgery than women, but not after surgery, and there were no sex differences in levels of anxiety or depression. However, higher levels of anxiety and depression reported before surgery were associated with greater pain severity after surgery. Interestingly, this relationship between greater anxiety and depression before surgery and worse pain after surgery was much stronger among the women in the study than the men. These findings suggest that women, particularly those with higher levels of psychological distress before surgery, may benefit from preventive treatments focused on reducing anxiety and depression before surgery, in order to help improve pain after surgery.