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Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer

  • Anne Masselin-Dubois
    Affiliations
    INSERM U-987, Boulogne-Billancourt, France

    CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France
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  • Nadine Attal
    Correspondence
    Address reprint requests to Nadine Attal, INSERM U-987 and Centre d'Evaluation et de traitement de la Douleur, Hôpital Ambroise Paré, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
    Affiliations
    INSERM U-987, Boulogne-Billancourt, France

    CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France

    Université Versailles-Saint-Quentin, Versailles, France
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  • Dominique Fletcher
    Affiliations
    INSERM U-987, Boulogne-Billancourt, France

    CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France

    Université Versailles-Saint-Quentin, Versailles, France

    Service d'anesthésie-réanimation chirurgicale, CHU Raymond Poincaré, GH Paris Ile de France Ouest, APHP, Garches, France
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  • Christian Jayr
    Affiliations
    Service de chirurgie générale, Hôpital René Huguenin-Institut Curie, Saint Cloud, France
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  • Aline Albi
    Affiliations
    Service de chirurgie générale, Hôpital René Huguenin-Institut Curie, Saint Cloud, France
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  • Jacques Fermanian
    Affiliations
    Service de biostatistiques, CHU Necker, APHP, Paris, France
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  • Didier Bouhassira
    Affiliations
    INSERM U-987, Boulogne-Billancourt, France

    CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France

    Université Versailles-Saint-Quentin, Versailles, France
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  • Sophie Baudic
    Affiliations
    INSERM U-987, Boulogne-Billancourt, France

    CHU Ambroise Paré, GH Paris Ile de France Ouest, APHP, Boulogne-Billancourt, France

    Université Versailles-Saint-Quentin, Versailles, France
    Search for articles by this author

      Abstract

      Anxiety, depression, and catastrophizing are generally considered to be predictive of chronic postoperative pain, but this may not be the case after all types of surgery, raising the possibility that the results depend on the surgical model. We assessed the predictive value of these factors for chronic postsurgical pain in 2 different surgical models: total knee arthroplasty for osteoarthritis (89 patients, 65% women, age = 69 ± 9 years, baseline pain intensity = 4.7 ± 2.1) and breast surgery for cancer (100 patients, 100% women, age = 55 ± 12 years, no preoperative pain). Data were collected before surgery, then 2 days and 3 months after surgery. Anxiety, depression, and catastrophizing were measured with the Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale, respectively. Pain was assessed with the Brief Pain Inventory. Neuropathic pain was detected with the DN4 questionnaire. Multivariate logistic regression analyses for the total knee arthroplasty and breast surgery models considered together indicated that the presence of clinically meaningful chronic pain at 3 months (pain intensity ≥3/10) was predicted independently by age (P = .04), pain intensity on day 2 (P = .009), and state anxiety (P = .001). Linear regression models also showed that pain magnification, one of the dimensions of catastrophizing, independently predicted chronic pain intensity (P = .04). These results were not affected by the surgical model or by the neuropathic characteristics of the pain. Thus, state anxiety and pain magnification seem to constitute psychological risk factors for chronic postsurgical pain relevant in all surgical models.

      Perspective

      This prospective study performed in patients with total knee arthroplasty or breast surgery for cancer shows that state anxiety, amplification of pain, and acute postoperative pain independently predict postsurgical pain at 3 months and that this does not depend on the surgical model.

      Key words

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