The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study

English version

Autoři: Anelise Schifino Wolmeister ^aff001; Carolina Lourenzon Schiavo ^aff001; Kahio César Kuntz Nazário ^aff003; Stela Maris de Jezus Castro ^aff004; Andressa de Souza ^aff002; Rafael Poli Caetani ^aff005; Wolnei Caumo ^aff006; Luciana Cadore Stefani ^aff002
Působiště autorů: Postgraduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ^aff001; Laboratory of Pain & Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil ^aff002; Anaesthesia and Perioperative Medicine Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil ^aff003; Department of Statistics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ^aff004; School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ^aff005; Department of Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil ^aff006
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0227441

Souhrn

Background

Preoperative patients’ vulnerabilities such as physical, social, and psychological are implicated in postoperative pain variability. Nevertheless, it is a challenge to analyze a patient's psychological profile in the preoperative period in a practical and consistent way. Thus, we sought to identify if high preoperative emotional stress, evaluated by the Brief Measure of Emotional Preoperative Stress (B-MEPS) scale is associated with higher postoperative pain levels and poor rehabilitation in patients submitted to intermediate or major surgery. Moreover, the possible neurobiological or neurophysiological mechanisms implicated in high preoperative emotional stress, evaluated through preoperative quantitative sensory pain tests and serum biomarkers BDNF and S100B were investigated.

Methods

We conducted a prospective, observational, cohort study of ASA 2 and 3 adult patients undergoing major urologic, gynecologic, proctologic and orthopedic surgeries from March 2017 to March 2018. B-MEPS and Central Sensitivity Inventory were evaluated preoperatively, followed by a sequence of experimental pain tests and serum biomarkers collection. Postoperative evaluation carried out within the first 48 hours after surgery comprehended pain at rest and movement-evoked pain, and the consumption of morphine. Quality-of-Recovery was also evaluated in the 3rd postoperative day.

Results

23 (15%) out of 150 patients included in the study presented high emotional preoperative stress. Variables significantly related to preoperative stress were: previous psychiatric diagnosis and Central Sensitization Inventory result. Mean movement-evoked pain in the first 12 to 48 hours was 95–105% higher than pain at rest. A mixed model for repeated measures showed a sustainable effect of B-MEPS as a movement-evoked pain predictor. Previous pain, cancer surgery, and preoperative pressure pain tolerance were also independent predictors of postoperative pain. Moderate to severe postoperative movement-evoked pain was predictive of poor rehabilitation in 48 hours after surgery.

Conclusion

We confirmed that a brief screening method of preoperative emotional states could detect individuals prone to experience severe postoperative pain. Specific interventions considering the stress level may be planned in the future to improve perioperative outcomes.

Klíčová slova:

Psychological stress – Emotions – Anxiety – Surgical and invasive medical procedures – Surgical oncology – Pain sensation – Pain psychology – Morphine

Zdroje

1. Maier C, Nestler N, Richter H, Hardinghaus W, Pogatzki-Zahn E, Zenz M, et al. The quality of pain management in German hospitals. Dtsch Arztebl Int. 2010;107: 607–614. doi: 10.3238/arztebl.2010.0607 20948774

2. Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118: 934–944. doi: 10.1097/ALN.0b013e31828866b3 23392233

3. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North America. 2005;23: 21–36. doi: 10.1016/j.atc.2004.11.013 15763409

4. Coluzzi F, Bragazzi L, Di Bussolo E, Pizza G, Mattia C. Determinants of patient satisfaction in postoperative pain management following hand ambulatory day-surgery. Minerva Med. 2011;102: 177–186. 21593720

5. Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: An observational study. Eur J Anaesthesiol. 2015;32: 725–734. doi: 10.1097/EJA.0000000000000319 26241763

6. Khan RS, Ahmed K, Blakeway E, Skapinakis P, Nihoyannopoulos L, Macleod K, et al. Catastrophizing: a predictive factor for postoperative pain. Am J Surg. 2011;201: 122–131. doi: 10.1016/j.amjsurg.2010.02.007 20832052

7. Robleda G, Sillero-Sillero A, Puig T, Gich I, Baños J-E. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery. Rev Lat Am Enfermagem. 2014;22: 785–791. doi: 10.1590/0104-1169.0118.2481 25493674

8. Sommer M, de Rijke JM, van Kleef M, Kessels AGH, Peters ML, Geurts JW, et al. Predictors of acute postoperative pain after elective surgery. Clin J Pain. 2010;26: 87–94. doi: 10.1097/AJP.0b013e3181b43d68 20090433

9. Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012;36: 2261–2267. doi: 10.1007/s00264-012-1623-5 22842653

10. Munafò MR, Stevenson J. Anxiety and surgical recovery. Reinterpreting the literature. J Psychosom Res. 2001;51: 589–596. doi: 10.1016/s0022-3999(01)00258-6 11595247

11. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130: 601–630. doi: 10.1037/0033-2909.130.4.601 15250815

12. Mavros MN, Athanasiou S, Gkegkes ID, Polyzos KA, Peppas G, Falagas ME. Do psychological variables affect early surgical recovery? PLoS ONE. 2011;6: e20306. doi: 10.1371/journal.pone.0020306 21633506

13. Vollmer-Conna U, Bird KD, Yeo BW, Truskett PG, Westbrook RF, Wakefield D. Psychological factors, immune function and recovery from major surgery. Acta Neuropsychiatr. 2009;21: 169–178. doi: 10.1111/j.1601-5215.2009.00398.x 25384630

14. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9: 122–145. doi: 10.1016/j.jpain.2007.09.006 18088561

15. Caumo W, Segabinazi JD, Stefani LPC. Reply: allostatic load as an approach to support the theoretical assumptions of the Brief Measure of Emotional Preoperative Stress (B-MEPS). British Journal of Anaesthesia. 2017;118: 638–640. doi: 10.1093/bja/aex064 28403421

16. Caumo W, Cunha MNF da, Camey S, Castro SM de J, Torres ILS, Stefani LC. Development, psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain†. British Journal of Anaesthesia. 2016;117: 642–649. doi: 10.1093/bja/aew310 27799179

17. Caumo W, Antunes LC, Elkfury JL, Herbstrith EG, Busanello Sipmann R, Souza A, et al. The Central Sensitization Inventory validated and adapted for a Brazilian population: psychometric properties and its relationship with brain-derived neurotrophic factor. J Pain Res. 2017;10: 2109–2122. doi: 10.2147/JPR.S131479 28979158

18. Tousignant-Laflamme Y, Pagé S, Goffaux P, Marchand S. An experimental model to measure excitatory and inhibitory pain mechanisms in humans. Brain Res. 2008;1230: 73–79. doi: 10.1016/j.brainres.2008.06.120 18652808

19. Sá AC, Sousa G, Santos A, Santos C, Abelha FJ. Quality of Recovery after Anesthesia: Validation of the Portuguese Version of the “Quality of Recovery 15” Questionnaire. Acta Med Port. 2015;28: 567–574. doi: 10.20344/amp.6129 26667859

20. Leuner B, Shors TJ. Stress, anxiety, and dendritic spines: what are the connections? Neuroscience. 2013;251: 108–119. doi: 10.1016/j.neuroscience.2012.04.021 22522470

21. Stefani LC, Leite FM, da Graça L Tarragó M, Zanette SA, de Souza A, Castro SM, et al. BDNF and serum S100B levels according the spectrum of structural pathology in chronic pain patients. Neurosci Lett. 2019;706: 105–109. doi: 10.1016/j.neulet.2019.05.021 31100426

22. Cousley A, Martin DSE, Hoy L. Vulnerability in the perioperative patient: a concept analysis. J Perioper Pract. 2014;24: 164–171. doi: 10.1177/1750458914024007-802 25109033

23. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67: 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x 6880820

24. Badner NH, Nielson WR, Munk S, Kwiatkowska C, Gelb AW. Preoperative anxiety: detection and contributing factors. Can J Anaesth. 1990;37: 444–447. doi: 10.1007/BF03005624 2340614

25. Erci B, Sezgin, Serap, Kaçmaz, Zennure. The impact of therapeutic relationship on preoperative and postoperative patient anxiety. Aust J Adv Nurs. 2004;26: 56–66.

26. Yang FM, Kao ST. Item response theory for measurement validity. Shanghai Arch Psychiatry. 2014;26: 171–177. doi: 10.3969/j.issn.1002-0829.2014.03.010 25114494

27. Srikandarajah S, Gilron I. Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. Pain. 2011;152: 1734–1739. doi: 10.1016/j.pain.2011.02.008 21402445

28. Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111: 657–677. doi: 10.1097/ALN.0b013e3181aae87a 19672167

29. Werner MU, Mjöbo HN, Nielsen PR, Rudin A. Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology. 2010;112: 1494–1502. doi: 10.1097/ALN.0b013e3181dcd5a0 20460988

30. Grosen K, Vase L, Pilegaard HK, Pfeiffer-Jensen M, Drewes AM. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study. PLoS ONE. 2014;9: e90185. doi: 10.1371/journal.pone.0090185 24587268

31. van Boekel RLM, Vissers KCP, van der Sande R, Bronkhorst E, Lerou JGC, Steegers MAH. Moving beyond pain scores: Multidimensional pain assessment is essential for adequate pain management after surgery. PLoS ONE. 2017;12: e0177345. doi: 10.1371/journal.pone.0177345 28489926

32. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152: 292–298. doi: 10.1001/jamasurg.2016.4952 28097305

33. van Boekel RLM, Warlé MC, Nielen RGC, Vissers KCP, van der Sande R, Bronkhorst EM, et al. Relationship Between Postoperative Pain and Overall 30-Day Complications in a Broad Surgical Population: An Observational Study. Ann Surg. 2017. doi: 10.1097/SLA.0000000000002583 29135493

34. Pereira L, Figueiredo-Braga M, Carvalho IP. Preoperative anxiety in ambulatory surgery: The impact of an empathic patient-centered approach on psychological and clinical outcomes. Patient Educ Couns. 2016;99: 733–738. doi: 10.1016/j.pec.2015.11.016 26654958

35. Rief W, Shedden-Mora MC, Laferton JAC, Auer C, Petrie KJ, Salzmann S, et al. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Med. 2017;15: 4. doi: 10.1186/s12916-016-0767-3 28069021

36. Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS, et al. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res. 2015;8: 695–702. doi: 10.2147/JPR.S91924 26508886