The Effect of Preoperative Fear of Pain on Postoperative Pain Levels and the Amount of Analgesic Consumption

Metabolic Changes in Myocardium and Skeletal Muscles of C57BL/6 Mice after Noncardiac Surgery

Approximately 10% of patients without cardiovascular disorders suffer myocardial injury and have a 10% risk of death within 30 days after noncardiac surgery. Preoperative stress increases the risk of myocardial injury after noncardiac surgery (MINS). The mechanisms of MINS are poorly understood. Lack of physical activity and the development of weakness and fatigue are consequences of many noncardiac surgery types. The relationship between surgery and changes in the morphofunctional state of muscles in the postoperative period is still unclear now. The study showed for the first time that metabolic and hormonal changes caused by preoperative stress + surgery or surgery alone underlie MINC in the postoperative period in C57BL/6 mice. Minor increases in triglyceride-glucose (TyG) index were for the first time identified as indicative of ischemic/hypoxic damage to the myocardium and skeletal muscles. More research is necessary to perform to better understand the effects of preoperative stress and noncardiac surgery on the myocardium and muscle performance, as well as the risks and benefits of perioperative treatment.

Patient Fear of Pain: The Pre-Operative Period in the Neurosurgery Clinic

PURPOSE

This study was conducted as a descriptive study to determine the pain fears of patients undergoing surgery in the neurosurgery clinic.

MATERIAL AND METHOD

The study was conducted with 151 patients hospitalized in the neurosurgery clinic who met the inclusion criteria. Data were collected with the patient information form and the fear of pain scale-III. Ethics committee approval, institutional permission, and written consent from individuals were obtained before the study.

RESULTS

It was determined that the mean fear of pain score was 64.59 ± 18.43, 41.7% of the patient were fear of surgical incisional pain. Fear of surgical incisional pain is responsible for 22.0% and female gender is responsible for 29% of the change in fear of pain scores.

CONCLUSION

As a result, it was determined that the pain fear level of the patients in the pre-operative period was moderate. Increasing the practices to reduce the patients' fear of pain should be recommended.

The interplay of fear of pain, emotional states, and pain perception in medical and nursing students: A cross-sectional study

BACKGROUND

Fear of pain is known to influence pain perception and worsen pain outcomes. However, its relationship with pain threshold remains unclear. Negative emotional states, namely depression, anxiety, and stress, have been found to increase fear of pain. Previous pain experiences, both undergone and observed, can also influence fear of pain. Furthermore, healthcare students' interactions with pain patients may be influenced by fear of pain and pain perception. This study aimed to assess fear of pain among Portuguese medical and nursing students, analyse its association with sex, negative emotional states, previous pain experiences, and curricular year, and evaluate the influence of fear of pain on heat pain threshold.

METHODS

A survey based on validated Portuguese questionnaires was carried out. Participants were then invited for quantitative sensory tests to assess heat pain threshold.

RESULTS

Fear of pain was similar for medical and nursing students. Female students presented a higher fear of medical pain. Stress was associated with an increased fear of severe pain. Previous painful experiences, particularly those involving medical procedures, have been found to be variably associated with fear of pain, depending on the type and characteristics of these experiences. No associations were found between fear of pain and curricular year, nor between heat pain threshold and sex or fear of pain.

CONCLUSIONS

This study highlights relevant aspects of the emotional and cognitive modulation of fear of pain and pain perception in medical and nursing students. The influence of previous pain experiences on fear of pain is also essential because healthcare students are frequently exposed to painful medical situations during their courses. As altered pain perception can influence their role as future healthcare professionals, the study of fear of pain and its modulators in healthcare students represents an important research field.

The Persian version of the fear of pain questionnaire mong Iranian post-surgery patients: a translation and psychometrics

INTRODUCTION

The Fear of Pain Questionnaire (FOPQ) is a self-report tool designed to measure an individual's fear of pain (FOP). While the Persian version of the FOPQ (FOPQ-P) has been developed, its validity and reliability have not yet been assessed in the Iranian context. This study aims to evaluate the psychometric properties of the FOPQ-P among Iranian patients after surgery.

METHODS

A methodological study was conducted in 2023 involving 400 post-surgery patients selected with a convenience sampling. The FOPQ was translated into Persian, and its psychometric properties were analyzed using network analysis, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), as well as assessments of convergent and discriminant validity. Internal consistency was measured using Cronbach's alpha, McDonald's Omega, average inter-item correlation coefficient, Composite Reliability, and Maximal Reliability.

RESULTS

The EFA results with Promax and Kaiser Normalization rotation identified two factors that explained 54.32% of the variance, comprising seven items. The CFA confirmed the model's validity. Both convergent and discriminant validity were established. The reliability analyses showed that Cronbach's alpha, McDonald's omega, composite reliability, and MaxR for all constructs were above 0.7. Additionally, the average inter-item correlation coefficient was greater than 0.5, indicating strong internal consistency and construct reliability.

CONCLUSION

The findings suggest that the FOPQ-P possesses a valid structure and was acceptable reliability in patients cultural context of Iran post-surgery, making it a suitable instrument for measuring fear of pain in this population.

Establishment and Validation of Risk Prediction Models for Postoperative Pain After Endoscopic Submucosal Dissection: A Retrospective Clinical Study

Objective

Postoperative pain is a common complication in endoscopic submucosal dissection (ESD) patients. This study aimed to develop and validate predictive models for postoperative pain associated ESD.

Methods

We retrospectively constructed a development cohort comprising 2162 patients who underwent ESD at our hospital between January 2015 and April 2022. The dataset was randomly divided into a training set (n = 1541) and a validation set (n = 621) in a 7:3 ratio. The bidirectional stepwise regression with Akaike's information criterion (AIC) and multivariate logistic regression analysis were used to screen the predictors of post-ESD pain and construct three nomograms. We evaluated the model's discrimination, precision and clinical benefit through receiver operating characteristic (ROC) curves, calibration plots, Hosmer-Lemeshow (HL) goodness-of-fit test and decision curve analysis (DCA) in internal validation.

Results

The proportion of patients developing postoperative pain in the training and testing data set was 25.6% and 28.5%, respectively. Three nomograms were constructed according to the final logistic regression models. The clinical prediction models for preoperative risks, preoperative and intraoperative risks, and perioperative risks consisted of seven, nine and six independent predictors, respectively, after bidirectional stepwise elimination. The models demonstrated the AUC of 0.794 (95% CI 0.768-0.820), 0.823 (95% CI 0.799-0.847) and 0.817 (95% CI 0.792-0.842) in the training cohort and 0.702 (95% CI 0.655-0.748), 0.705 (95% CI 0.659-0.752) and 0.747 (95% CI 0.703-0.790) in the validation cohort. The calibration plot, HL and DCA demonstrated the model's favorable clinical applicability.

Conclusion

We developed and validated three robust nomogram models, which might identify patients at risk of post-ESD pain and promising for clinical applications.

Pain Sensitivity and Acute Postoperative Pain in Patients Undergoing Abdominal Surgery: The Mediating Roles of Pain Self-Efficacy and Pain Catastrophizing

BACKGROUND

Inadequately managed postoperative pain remains a common issue. Examining factors like pain sensitivity, pain catastrophizing, and pain self-efficacy can help improve postoperative pain management. While these factors have been identified as potential predictors of acute postoperative pain, their effects have been inconsistent. Few studies have explored the interactions between these factors.

AIM

To investigate the influence of preoperative pain sensitivity, pain catastrophizing, and pain self-efficacy on acute postoperative pain in abdominal surgery patients and to determine the mediating roles of pain catastrophizing and pain self-efficacy in the relationship between pain sensitivity and acute postoperative pain, as per the gate control theory.

METHODS

A total of 246 patients were enrolled in this study. General information was collected before surgery, and the Pain Sensitivity Questionnaire (PSQ), Pain Catastrophizing Scale (PCS), and Pain Self-Efficacy Questionnaire (PSEQ) were administered. After surgery, patients' average pain scores over the 24 hours were reported using the Numerical Rating Scale (NRS). Correlation analyses and a structural equation model were used to examine the relationships among these variables.

RESULTS

NRS scores over 3 during the 24 hours post-surgery were reported by 21.54% of patients. Postoperative acute pain was found to be associated with pain sensitivity (rs = 0.463, p < .001), pain catastrophizing (rs = 0.328, p < .001), and pain self-efficacy (rs = -0.558, p < .001). A direct effect on postoperative acute pain was exerted by pain sensitivity (effect = 0.250, p = .001), along with indirect effects through: (A) pain catastrophizing (effect = 0.028, p = .001); (B) pain self-efficacy (effect = 0.132, p = .001); and (C) the chain mediation of pain self-efficacy and pain catastrophizing (effect = 0.021, p = .008).

CONCLUSIONS

The severity of postoperative acute pain can be predicted by pain self-efficacy and pain catastrophizing, and the connection between moderate pain sensitivity and postoperative acute pain severity is mediated by them. Therefore, intervention programs aimed at boosting pain self-efficacy and reducing pain catastrophizing can enhance postoperative pain outcomes for abdominal surgery patients.