The Role of Pain Catastrophizing in the Provision of Rescue Analgesia by Health Care Providers Following Major Joint Arthroplasty

Background: After surgery, patient reports or health care professional evaluations of heightenedacute pain intensity should lead to extra analgesia provision, which is designated by rescueanalgesia (RA). Whether RA is administered or not, it is not directly dependent on the patient butrather on clinical decisions, which should be based on pain management guidelines. There is ageneral lack of studies focusing on pain-related decision-making regarding RA provision.Objectives: This study aimed to examine which pre and post-surgical factors, beyond acute postsurgical pain intensity, might influence clinical decisions on RA administration after major jointarthroplasties (MJA).Methods: A consecutive sample of 110 patients undergoing MJA was fully assessed 24 hoursbefore (T1) and 48 hours after (T2) surgery. Before surgery, baseline demographic, clinical, andpsychological variables were evaluated and after surgery the main outcome was RA provision, withacute post-surgical pain intensity being also registered.Study Design: Prospective observational cohort study.Setting: Central hospital in northern Portugal.Results: Logistic regression analysis revealed that RA provision, after MJA, is influenced by apatient-related psychological factor, pain catastrophizing (OR = 1.143; 95% CI 1.044 – 1.253, P =0.004), above and beyond acute post-surgical pain intensity. Additionally, the type of arthroplasty(OR = 2.806; 95% CI 1.002 – 7.857, P = 0.050) also affected RA provision. Other patient-relatedfactors such as gender, previous pain states, pre-surgical optimism, and post-surgical anxiety didnot reveal any predictive role in RA administration.Limitations: This is a single-site study, only confined to MJA patients.Conclusions: The findings of this study shed light on the importance of psychological factorsin determining RA provision following MJA. This encourages further reflection on acute postsurgical pain management by health care providers, namely by raising clinicians’ awareness aboutthe factors that influence patient-provider interactions, as well as their impact on decision-makingregarding RA provision. A global assessment of patients, wherein psychological variables are takeninto account, is warranted in order to improve the quality of surgical pain management. Finally,these findings provide support for the design of acute post-surgical pain management interventionsdirected at clinicians, in order to augment professionals’ awareness about the potential influenceof patient-related psychological factors on RA decisions.Key words: Rescue analgesia, major joint arthroplasty, post-surgical pain intensity, psychologicalfactors, pre-surgical pain catastrophizing, patient-provider interactions, pain-related decisionmaking, predictive analysis