The role of pain catastrophizing in the provision of rescue analgesia by healthcare providers following major joint arthroplasty

Abstract

After surgery, patient reports or health care professional evaluations of heightened acute pain intensity should lead to extra analgesia provision, which is designated by rescue analgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient but rather on clinical decisions, which should be based on pain management guidelines. There is a general lack of studies focusing on pain-related decision-making regarding RA provision. OBJECTIVES: This study aimed to examine which pre and post-surgical factors, beyond acute post-surgical pain intensity, might influence clinical decisions on RA administration after major joint arthroplasties (MJA). METHODS: A consecutive sample of 110 patients undergoing MJA was fully assessed 24 hours before (T1) and 48 hours after (T2) surgery. Before surgery, baseline demographic, clinical, and psychological variables were evaluated and after surgery the main outcome was RA provision, with acute post-surgical pain intensity being also registered. STUDY DESIGN: Prospective observational cohort study. SETTING: Central hospital in northern Portugal. RESULTS: Logistic regression analysis revealed that RA provision, after MJA, is influenced by a patient-related psychological factor, pain catastrophizing (OR = 1.143; 95% CI 1.044 - 1.253, P = 0.004), above and beyond acute post-surgical pain intensity. Additionally, the type of arthroplasty (OR = 2.806; 95% CI 1.002 - 7.857, P = 0.050) also affected RA provision. Other patient-related factors such as gender, previous pain states, pre-surgical optimism, and post-surgical anxiety did not reveal any predictive role in RA administration. LIMITATIONS: This is a single-site study, only confined to MJA patients. CONCLUSIONS: The findings of this study shed light on the importance of psychological factors in determining RA provision following MJA. This encourages further reflection on acute post-surgical pain management by health care providers, namely by raising clinicians' awareness about the factors that influence patient-provider interactions, as well as their impact on decision-making regarding RA provision. A global assessment of patients, wherein psychological variables are taken into account, is warranted in order to improve the quality of surgical pain management. Finally, these findings provide support for the design of acute post-surgical pain management interventions directed at clinicians, in order to augment professionals' awareness about the potential influence of patient-related psychological factors on RA decisions.