HealthDay News– Anxiety is psychological risk factor for chronic post-surgical pain, regardless of the type of surgery performed, study results published in the Journal of Pain suggest.

Although anxiety, depression and catastrophizing are thought to play a role in predicting chronic postoperative pain, whether the specific type of surgery influences pain outcomes is not understood.

So Anne Masselin-Dubois, from INSERM U-987 in Boulogne-Billancourt, France, and colleagues, analyzed data from 89 patients who underwent total knee arthroplasty for osteoarthritis and 100 patients who underwent breast surgery for cancer to determine the predictive value of these psychological factors in pain amplification.

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Among knee surgery recipients 65% were women, mean age was 69 years and mean baseline pain intensity was 4.7, as measured on the Brief Pain Inventory. Among those who underwent breast surgery 100% were women mean age was 5 years and none experienced preoperative pain. 

Values were measured before surgery, then two days and three months after surgery. The researchers used the Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory and Pain Catastrophizing Scale to measure anxiety, depression and catastrophizing, respectively, at baseline, and again at two days and then three months. Neuropathic pain as measured with the Douleur Neuropathique 4 questionnaire.

State anxiety and acute postoperative pain independently predict post-surgical pain at three months, the researchers found.

For all patients (surgeries combined for analysis), the presence of clinically meaningful chronic pain at three months (pain intensity, ≥3/10) was significantly predicted independently by age (P = .04), pain intensity on day two (P=0.009) and state anxiety (P=0.001).

Pain magnification, one of the dimensions of catastrophizing, independently predicted chronic pain intensity (P=0 .04). Surgical model and neuropathic characteristics of the pain did not affect the results.

“Thus, state anxiety and pain magnification seem to constitute psychological risk factors for chronic post-surgical pain relevant in all surgical models,” the researchers wrote.


  1. Masselin-Dubois A et al. J Pain. 2013;14(8):854-864.