How might postoperative pain affect mental health?
Written by:When it comes to having a surgical procedure it is understandable to have some concerns. The consent process helps many people answer their questions and address their fears, including their concerns about postoperative pain. However, for a proportion of people, postsurgical pain becomes debilitating and can affect their quality of life. We spoke to leading consultant clinical psychologist, Dr Sarah Barker, about how postsurgical pain might affect a patient’s mental health in the short and long-term, and asked how therapy can help to recover this.
How common is postoperative pain?
When it comes to postoperative pain, it is important to distinguish between acute and chronic pain. Acute pain is normal and occurs after tissue injury associated with surgery. It resolves during the healing process, which can take up to three months. Pain that continues after three months is considered chronic.
The rates of pain immediately after surgery depend on the type of surgery performed. The Perioperative Quality Improvement Programme (PQIP) 2018–2019 annual report included data from 79 hospital sites across the UK. It highlighted that 48 and 19 per cent of patients reported moderate or severe pain respectively at the surgical site within 24-hours of surgery.
How might postoperative pain and the experience of surgery affect a patient's mental health?
The surgical injury triggers a myriad of responses in the pain matrix. Sensitisation of peripheral and central pain pathways occurs, and feelings of fear, anxiety and frustration can develop. These emotional responses can amplify the pain response and contribute to an increased disability, which in turn affects mental health.
Experiences in the hospital can add to distress if, for example, the patient was in the intensive care unit (ICU). Some risk factors may include the length of time the patient was sedated, and if they have a disturbing memory of the time that was spent in ICU. Some patients who have been in ICU meet the criteria for PTSD (post-traumatic stress disorder), which can be helped through psychological therapy.
Dental procedures can also impact mental health and result in facial pain. Recognising that pain is multidimensional and has an emotional component, can help target treatment appropriately (Penlington, Urbanek and Barker, 2019).
Can patients associate the pain that is experienced post-surgery as something being wrong?
It is important to take into consideration the length of time that pain lasts. When pain becomes chronic, people start to have more problems emotionally as they are expecting to be fully healed and don’t expect the pain to persist.
As psychologists, we can help prepare patients for this persistent pain and help them to recover their quality of life afterwards. The patient can work with a physiotherapist and a psychologist both post and pre-surgery, which helps them to prepare both physically and emotionally. Treating psychological issues before surgery can be prudent and a psychological assessment can be useful to explore patient strengths and vulnerabilities (Marek, Block and Ben-Porath, 2017; Sawyer and Heinberg, 2020).
Is there a danger of patients becoming addicted to pain medication?
Roughly 97 per cent of patients don’t have problems with pain medication, but there is a difference between dependency and addiction. With opioids taken for 30 days or longer, there might be symptoms of withdrawal if they are stopped abruptly.
The risk of addiction is higher in people with untreated health problems like PTSD and depression and if they have had an addiction in the past. A presurgical psychological assessment can again be useful in identifying and addressing these vulnerabilities. Your doctor, however, will take a careful history of your medical background and will take into account these factors when prescribing pain medication.
How can a psychologist help those who feel very distressed by postoperative pain?
The key is physical and emotional preparation both before and after surgery. Psychological therapy can help target factors such as fear of pain, which can prevent some people from moving forward with their surgery and physiotherapy. Helping a patient to achieve a balance between avoidance and overdoing can be integral to their recovery. This sounds straightforward, but expectations and past experiences can have a bearing on this.
If you are worried about your upcoming surgical procedure and need someone to talk to, do not hesitate to book an appointment with Dr Barker by visiting her Top Doctor’s profile.
References
Penlington, C; Urbanek, M. and Barker, S. (2019) Psychological Theories of Pain. Primary Dental journal 7 (4) 24-29.
Ryan J. Marek, Andrew R. Block, Yossef S. Ben-Porath. (2019) Validation of a Psychological Screening Algorithm for Predicting Spine Surgery Outcomes. Assessment. Volume: 26 issue: 5, page(s): 915-928
Sarwer, D.B., & Heinberg, L.J., American Psychologist, 2020. A Review of the Psychosocial Aspects of Clinically Severe Obesity and Bariatric Surgery. American Psychologist. Vol 75(2), Feb-Mar 2020, 252-264
