Michael Suer1, Nicholas Philips2, Stephanie Kliethermes3, Tamara Scerpella1, Nalini Sehgal1. 1. Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI. 2. Department of Anesthesia, University of Wisconsin, Madison, WI. 3. Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI; Badger Athletic Performance, Department of Orthopedics and Rehabilitation & Division of Intercollegiate Athletics, School of Medicine and Public Health, Madison, WI.
Abstract
BACKGROUND: Chronic postsurgical pain remains a major hurdle in postoperative management, especially in patients undergoing shoulder surgery, for whom persistent pain rates are higher than for any other surgical site. Little is known about pain beliefs and attitudes as preoperative predictors of postoperative pain following nonarthroplasty shoulder surgery. OBJECTIVES: We evaluated predictors of pain following nonarthroplasty shoulder surgery, hypothesizing that preoperative kinesiophobia, pain catastrophizing, and neuropathic pain scores are predictive of greater postoperative pain. STUDY DESIGN: Case control study. SETTING: Division of Sports Medicine at the University of Wisconsin School of Medicine and Public Health. METHODS: Consecutive patients aged 18 and older undergoing a nonarthroplasty shoulder operation were selected. At the preoperative appointment and 3 months postoperative, patients completed the Short-Form McGill Pain Questionnaire-2 to assess severity and quality of pain, the painDetect Questionnaire to screen for neuropathic pain, the Tampa Scale of Kinesiophobia to assess fear of movement and fear-avoidance beliefs, and the Pain Catastrophizing Scale to gauge rumination, magnification, and pessimism. A univariable negative binomial regression model was used to identify associations between preoperative predictors and postoperative scores, reporting risk ratios and 95% confidence intervals. RESULTS: Eighty-one patients completed the preoperative surveys and 43 patients completed at least one postoperative survey. The median pain score decreased from 3 out of 10 (interquartile range [IQR] = 2-5) in the preoperative group to one (IQR = 0-2) in the postoperative group (P < 0.001). Mean kinesiophobia scores decreased from 40.44 (standard deviation [SD] = 5.94) preoperatively to 35.40 (SD = 6.44) postoperatively (P < 0.001). Median pain catastrophizing scores decreased from 7 (IQR = 2-17]) preoperatively to 2 (IQR = 0-11]) postoperatively (P = 0.005). No significant changes in neuropathic pain scores were observed. Higher baseline kinesiophobia scores were associated with greater postoperative pain (risk ratio = 1.09, 95% confidence interval [CI] = 1.01 to 1.18), P = 0.03), as were higher pain catastrophizing scores (risk ratio = 1.05, 95% CI = 1.01 to 1.08), P = 0.01). No association between baseline neuropathic pain and degree of postoperative pain was identified. LIMITATIONS: Limitations of the study include a single institution with multiple surgeons and types of surgery. The study drop-out rate was relatively high. CONCLUSION: This study suggests that greater baseline kinesiophobia and pain catastrophizing are predictive of greater postoperative pain following nonarthroplasty shoulder surgery in an adult population.
BACKGROUND: Chronic postsurgical pain remains a major hurdle in postoperative management, especially in patients undergoing shoulder surgery, for whom persistent pain rates are higher than for any other surgical site. Little is known about pain beliefs and attitudes as preoperative predictors of postoperative pain following nonarthroplasty shoulder surgery. OBJECTIVES: We evaluated predictors of pain following nonarthroplasty shoulder surgery, hypothesizing that preoperative kinesiophobia, pain catastrophizing, and neuropathic pain scores are predictive of greater postoperative pain. STUDY DESIGN: Case control study. SETTING: Division of Sports Medicine at the University of Wisconsin School of Medicine and Public Health. METHODS: Consecutive patients aged 18 and older undergoing a nonarthroplasty shoulder operation were selected. At the preoperative appointment and 3 months postoperative, patients completed the Short-Form McGill Pain Questionnaire-2 to assess severity and quality of pain, the painDetect Questionnaire to screen for neuropathic pain, the Tampa Scale of Kinesiophobia to assess fear of movement and fear-avoidance beliefs, and the Pain Catastrophizing Scale to gauge rumination, magnification, and pessimism. A univariable negative binomial regression model was used to identify associations between preoperative predictors and postoperative scores, reporting risk ratios and 95% confidence intervals. RESULTS: Eighty-one patients completed the preoperative surveys and 43 patients completed at least one postoperative survey. The median pain score decreased from 3 out of 10 (interquartile range [IQR] = 2-5) in the preoperative group to one (IQR = 0-2) in the postoperative group (P < 0.001). Mean kinesiophobia scores decreased from 40.44 (standard deviation [SD] = 5.94) preoperatively to 35.40 (SD = 6.44) postoperatively (P < 0.001). Median pain catastrophizing scores decreased from 7 (IQR = 2-17]) preoperatively to 2 (IQR = 0-11]) postoperatively (P = 0.005). No significant changes in neuropathic pain scores were observed. Higher baseline kinesiophobia scores were associated with greater postoperative pain (risk ratio = 1.09, 95% confidence interval [CI] = 1.01 to 1.18), P = 0.03), as were higher pain catastrophizing scores (risk ratio = 1.05, 95% CI = 1.01 to 1.08), P = 0.01). No association between baseline neuropathic pain and degree of postoperative pain was identified. LIMITATIONS: Limitations of the study include a single institution with multiple surgeons and types of surgery. The study drop-out rate was relatively high. CONCLUSION: This study suggests that greater baseline kinesiophobia and pain catastrophizing are predictive of greater postoperative pain following nonarthroplasty shoulder surgery in an adult population.