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Angelina Franqueiro



Research Staff


Brigham and Women's Hospital


Anesthesiology, Perioperative and Pain Medicine


Angelina R. Franqueiro*, Jenna M. Wilson*, Jingui He*, Carin Colebaugh*, Kelsey Flowers*, Jim Rathmell*, Mieke Soens*, Kristin L. Schreiber*

Principal Investigator

Kristin Schreiber


Psychological Distress Predicts Acute Postsurgical Pain Severity among Patients undergoing Video-Assisted Thoracoscopic Surgery: The Moderating Effect of Sex


Psychological distress pre-surgery has been shown to predict subsequent acute postsurgical pain. Notably, women report both higher levels of psychological distress and pain severity than men. We examined whether sex moderated the association between preoperative psychological distress and postoperative pain severity during the first week after thoracic surgery. This prospective study included patients scheduled for video-assisted thoracoscopic surgery (VATS). Preoperatively, patients reported their baseline pain and completed validated measures of anxiety and depression (PROMIS). Patients then reported their daily worst pain, and an index score of week 1 postoperative pain severity was created by averaging daily scores. Mann-Whitney U tests examined sex differences in both psychological distress and pain. Moderation analysis was used to assess sex differences in the association between baseline psychological distress and postoperative pain severity. Patients (N=105; mean±SD:65yrs±11) were 57% female and reported an average baseline pain score of 1.4 and postoperative pain score of 5.6. Men reported greater baseline pain than women (1.9±2.5 vs. 1.0±2.2, p<.05), but there were no sex differences in baseline levels of psychological distress (p>.05). Baseline psychological distress was associated with worse baseline pain and subsequent postoperative pain (p<.05). Results revealed a significant moderation effect of sex in the association between baseline psychological distress and postoperative pain (p<.05). Specifically, the association between psychological distress and postoperative pain was stronger for women than for men. These findings may have implications for interventions aimed at improving postsurgical outcomes, particularly for women with high psychological distress.

Research Context

Our work investigated sex differences in the association between preoperative psychological distress and acute postoperative pain severity after thoracic surgery. Interestingly, self-reported anxiety and depression pre-surgery were significantly associated with worse postoperative pain severity among women, but not among men. These findings underscore the importance of including sex as a moderator in both observational and interventional studies in the perioperative period; such analyses may help inform the tailoring of interventions aimed at decreasing acute postoperative pain, particularly for women reporting higher psychological distress. Because acute postsurgical pain is a risk factor for the development of chronic pain and opioid use, treatments aimed at reducing psychological distress (e.g., cognitive behavioral therapy) during the preoperative period may be particularly beneficial among women.