Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design.

Objectives: To determine whether psychological variables such as preoperative anxiety can serve as predictors for the postoperative pain response. Methods: The study sample included women who underwent elective abdominal hysterectomy (n=53). Two weeks prior to surgery, characteristics such as trait anxiety, coping style, and perceived stress were evaluated. Throughout the perioperative period, state anxiety, pain, as well as analgesic consumption were assessed at multiple time points. The anesthetic and surgical management were carefully controlled for and postoperative pain management was standardized. Results: Path analysis demonstrated that there are both direct and indirect effects of preoperative state anxiety on postoperative pain. Preoperative state anxiety is a significant positive predictor of the immediate postoperative pain (β=0.30), which, in turn, is a positive predictor of pain on the wards (β=0.54). Pain on the ward, in turn, is predictive for pain at home (β=0.30). Conclusion: The results of this study indicate that preoperative anxiety may have a critical role in the chain-of-events that controls the postoperative pain response.