Pre-Surgery Catastrophizing Strongly Associated With Post-Operative Outcomes

Pain has been shown to be the most frequent complaint in the hours following surgery1, however, 10-50% of patients report post-surgical pain for up to two months following surgery2. Numerous evidence indicate associations between a psychosocial factor, pre-surgery emotional stress and key post-surgical pain outcomes, including pain intensity, analgesic use and functional impairment. However, the impact of pre-surgery emotional distress varied widely across studies.

In an article3 published earlier this month in the Journal of Pain, investigators conducted a meta-analysis to determine associations between pre-surgery emotional distress and post-operative pain outcomes, as well as factors underlying disparate effect size between studies. Searching across several medical literature databases (PubMed, Web of Science, PsychINFO, Google Scholar and Science Direct), the authors focused on 47 studies of an overall 6207 patients, and studied 10 different inclusion criteria. The meta-analysis was restricted to longitudinal studies including pre- and post-surgery assessments, and used the longest follow-up assessment in analyses. Only studies with 30 patients or more, of 18 years of age or older were included.

Authors found effect sizes for associations between pre-surgery emotional distress and post-surgical outcomes to be small to medium and highly significant for pain intensity and functional impairment (P<.001) and for analgesic use (P<.01). Emotional distress was found to be a significant moderator of post-operative outcomes, with large effect sizes for catastrophizing, anxiety and depression (P<.001), while effect of fear was not significant. Age, gender composition and follow-up interval did not have significant effects on analgesic use.

This meta-analysis study showed pre-surgery emotional distress to be a risk factor for enhanced post-operative pain, analgesic use and disability. Catastrophizing, which include rumination, pain management helplessness and pain magnification or anticipation, had the largest effect size among the emotional distress types, indicating a need to address this factor in pre-surgery protocols.



    1.  Chung F, Un V, Su J. Postoperative symptoms 24 hours after ambulatory anaesthesia. Can J Anaesth. 1996;43(11):1121-7.

    2.  Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-25.

     3. Jackson T, Tian P, Wang Y, Iezzi T, Xie W. Towards Identifying Moderators of Associations Between Pre-Surgery Emotional Distress and Post-Operative Pain Outcomes: A Meta-Analysis of Longitudinal Studies. J Pain. 2016