Anxiety on the Day of Surgery May Increase Pain Scores, Opioid Use

Anxiety may be a marker for increased risk for pain and opioid use among individuals undergoing surgical procedures, according to results of a prospective cohort study published in Regional Anesthesia Pain Medicine.

Data for this study were sourced from the Analgesic Outcomes Study-II, which was conducted at Michigan Medicine between 2015 and 2018. Patients (N=1771) undergoing elective surgical procedures were evaluated for predictors of increased postoperative pain and opioid use. Clinically significant anxiety on the day of surgery was defined as a 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) score of 55 or greater.

Women made up 65.5% of the study population. Mean age was 58.7 (standard deviation [SD], 13.6) years, 85.8% were White, and 16.7% used opioids at baseline. The most common surgical procedures or locations were knee (31.6%), hysterectomy (20.9%), hip (20.3%), and thoracic (11.0%). Patients with clinically significant anxiety at surgery (n=515) were younger and more were women (both P <.001).

Opioid use was highest at 2 weeks after surgery (47.9%), decreasing to 26.6% at month 1, 11.6% at month 3, and 9.4% at month 6, respectively. On the day of surgery, the mean Brief Pain Inventory (BPI) pain score was 4.3, decreasing to 3.7 at week 2, 2.1 at month 1, 1.0 at month 3, and 0.8 at month 6, respectively.

Predictors for increased opioid use following surgery included knee surgery (adjusted odds ratio [aOR], 26.86; P <.001), breast surgery (aOR, 15.98; P <.001), hip surgery (aOR, 15.62; P <.001), thoracic surgery (aOR, 15.59; P <.001), ankle surgery (aOR, 12.16; P =.04), time since surgery (aOR, 1.52; P <.001), anxiety (aOR, 1.40), surgical site pain (aOR, 1.22; P <.001), and not having a college degree (aOR, 0.36; P <.001).

Surgical site pain was associated with knee surgery (adjusted coefficient, 2.05; P <.001), hip surgery (adjusted coefficient, 1.49; P <.001), hand surgery (adjusted coefficient, 1.16; P <.001), anxiety (adjusted coefficient, 1.14; P <.001), baseline opioid use (adjusted coefficient, 0.67; P <.001), age (adjusted coefficient, -0.01; P =.001), being a college graduate (adjusted coefficient, -0.24; P <.001), male sex (adjusted coefficient, -0.25; P =.001), hysterectomy (adjusted coefficient, -0.36; P =.01), and time since surgery (adjusted coefficient, -0.51; P <.001).

This study may have been limited by not evaluating patients for comorbid mood disorders, pain disorders, substance use disorder, or benzodiazepine use.

These data indicated that anxiety on the day of surgery was associated with consistently higher pain scores and opioid use. The investigators conclude that “[f]uture studies examining targeted behavioral therapies to reduce anxiety during the perioperative period may positively impact postoperative pain and opioid use.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.