People have different levels of pain tolerance. We know this. But why? Is it how we are wired? Do we have different levels of pain receptors? Are some more sensitive? Is it an issue of the mind? Do some people think it WILL hurt, so then it does?
A study in The Journal of Pain (yes, yes. great title for a journal) published a study out of France. The study included 89 total knee arthroplasty patients and 100 breast cancer surgery patients. They measured the pain values: before surgery, 2 days after, and 3 months after surgery. They looked at a panel of tests which measure anxiety, depression, and “catastrophizing.” They also measured brief pain inventory and neropathic pain.
*NOTE: Catastrophizing: “Is an irrational thought a lot of us have in believing that something is far worse than it actually is. It has two forms… the second is more mental and more future oriented. This kind of catastrophizing occurs when we look to the future and anticipate all the things that are going to go wrong. We then create a reality around those things “its bound to all go wrong for me…: Because we believe something will go wrong, we make it go wrong.”
Findings:
- for all patients, the presence of clinically meaningful pain >= to 3/10 was predicted significantly by
- age
- pain intensity on day 2
- anxiety state
- Pain magnification (“catastrophizing”) independently predicted chronic pain intensity.
So what does this mean?
This means if you are ANXIOUS about surgery, and if you MAGNIFY PAIN then you are at higher risk for higher post surgery pain at day 2 and at 3 months. This isn’t a totally surprising finding to me. There are many studies done on post operative pain. One study I learned in medical school a long time ago showed patients of doctors who were honest with their patients about recovery and pain took fewer pain meds after surgery, reported lower pain scores, and were less anxious. Why? It is thought these patients knew what they were experiencing was “normal,” which reduced their anxiety. Less anxiety= less pain. They also had a good trust relationship with their doctor. Their doctor was telling them as it is.
So take home message?
Relax. Surgery hurts, but we will give you medication. Communicate with your doctor. What this study clearly shows is worrying about surgery and pain only makes it worse.