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Yun-Yun Chen, MD












Yun-Yun K. Chen MD, Philipp Lirk MD PhD, K. Mikayla Flowers MA, Jenna Wilson PhD, Carin A. Colebaugh BS, Kamen Vlassakov MD, Jose Zeballos MD, Kristin L. Schreiber MD PhD

Expectations vs. Reality: How Psychosocial and Physical Pain Profiles Affect the Regional Anesthesia Experience

As an new attending anesthesiologist, I have had a tremendous opportunity to combine my interest in regional anesthesia, acute pain, and clinical research. My research was made possible through the mentorship of a strong female Physician Scientist and Anesthesiologist, Dr. Kristin Schreiber. My participation in the Women in Medicine & Science Symposium will hopefully help encourage other young attendings to pursue a research career with the support of excellent mentors and departmental support.

Background: Regional anesthesia (RA) plays an important role in multimodal perioperative pain management for patients undergoing surgery. Preoperative evaluation of a patient’s pain catastrophizing may provide insight into their experience with RA. This mixed-methods study assessed perceptions around peripheral nerve block placement and its relationship to psychosocial and pain profiles.

Methods: Healthy volunteers completed the situational pain catastrophizing scale (SPCS), underwent quantitative sensory testing of pain, and rated injection pain with subcutaneous lidocaine. A semi-structured interview evaluated subjects’ preconceptions and experience with receiving a nerve block.

Results: 42 subjects participated in the study. Greater SPCS scores (higher pain sensitivity) were inversely related to pressure pain threshold and tolerance at the forearm and trapezius (p’s<0.01), and baseline pressure pain thresholds at the leg (p<0.001). Higher SPCS was also associated with higher injection pain ratings (p=0.023). Greater effective (positive or neutral) to negative experience ratio with sciatic nerve block was correlated with higher pain threshold and/or tolerance at the forearm, trapezius, and leg (p’s < 0.05). Common qualitative themes regarding preconceptions about the nerve block included anxiety/worry, concern about pain and unknown (what to expect).

Conclusion: Patients’ mental processing of pain may be evaluated using the SPCS. An effective experience during the nerve block was correlated with higher pressure pain threshold and tolerances. Further studies are needed to study the use and effect of preconceptions, psychosocial and psychophysical evaluations to improve a patient’s experience with RA.