Peri-operative Psychology and Post-operative Pain Study
Peri-operative Psychology and Post-operative Pain Study
The experience of pain is common among hospital inpatients. Orthopaedic surgery often results
 in significant pain, which may last for some time. About one in eight people will experience
 long-term or chronic pain after surgery, which can impact on quality of life and mood. Some
 risk factors are known for chronic post surgical pain (CPSP) and these include patient
 factors, surgical factors and anaesthetic factors. We know that mood problems (anxiety and
 depression) increase the risk of CPSP. What is not known is how short term changes in mood
 are related to the experience of pain after surgery and how this impacts on CPSP. This study
 is designed to investigate the relationship between both short and long-term mood problems
 and short and long-term pain and quality of life after orthopaedic surgery. The study will
 provide valuable information to allow us to design a psychological intervention, which might
 reduce the risk of short-term post surgical pain and CPSP.

 This study also aims to measure a number of other variables, which may be related to CPSP
 including medication use, other medically unexplained symptoms and catastrophic thinking in
 response to pain.

 All patients having planned orthopaedic surgery will be asked to enter the trial. Those
 consenting to involvement will complete a questionnaire assessing the variables described
 above. They will be divided into two groups depending on whether they have significant pain
 on the day after their surgery. As the primary aim of the study, the rates of significant
 anxiety or depression will then be compared between these two groups.

 Secondary outcomes will be assessed by a questionnaire sent to the patients at 6 months after
 their surgery. Descriptive statistics will be produced for all the variables and use to model
 a future study, which would assess the effect of a psychological intervention on acute and
 chronic post surgical pain.

 Our hypothesis is that patients are more likely to experience acute anxiety and depression or
 display catastrophic thinking if they suffer significant post-surgical pain. The study is
 powered to reliably detect a three-fold difference in the prevalence of psychopathology
 between patients with and without acute pain on day 1 after elective orthopaedic surgery.
This is a prospective case-control observational study. The primary aim is to determine
 whether patients with poor pain control on day 1 following surgery have higher levels of
 anxiety / depression or catastrophising than those without acute pain. The cases are patients
 with significant pain on day one after surgery and the controls are sex, age and operation
 matched individuals without pain.

 Several other variables are measured which may provide information for the design of future
 studies. The presence of pain or psychopathology prior to surgery will be recorded, as this
 is likely to impact on these variables in the post-operative period. Analgesic use pre and
 post surgery is also of interest as a surrogate measure of pain severity.

 In addition to day one data, pain severity will also be recorded on day 2 and 3
 post-operatively. This is of interest as although most patients will be expected to
 demonstrate reducing pain severity with time, a proportion will not improve and a small
 number will experience increasing pain with time. This adverse "pain trajectory" might be
 associated with an increased incidence of CPSP 28.

 Long-term outcomes such as pain and quality of life at 6 months post-discharge will also be
 assessed by postal questionnaire.

 The eventual aim of this series of studies is to assess the interaction between acute
 psychological problems and post-surgical pain and the impact that this has on longer-term
 outcomes such as CPSP, mood and quality of life. Short-term pre- and post-operative
 psychological interventions will then be developed to modify the impact of psychological
 factors on long-term surgical outcomes. Further studies will assess the efficacy of these
 interventions. Pre-study audit will be carried out to confirm the feasibility of matching.
Inclusion Criteria:

 -  All inpatients on Sharp, Shaugh or Stannon ward following elective orthopaedic surgery
 carried out on Monday to Thursday each week.

 Exclusion Criteria:

 -  Patient refusal, Age <18, Emergency / trauma surgery, Day case surgery, unable to read
 or understand written instructions, No contact address, Not registered with a General
 Practitioner (GP)