The Impact of Anxiety, Depression, and Perceived Social Support on Postoperative Pain After Hysterectomy

Abstract

Research Question: Do women scheduled for benign hysterectomy who score highly on preoperative assessment of anxiety, depression, and perceived low social support report higher pain scores after surgery compared to women who are scheduled for benign hysterectomy who score low on pre-operative assessment of anxiety, depression, and perceived low social support?

Background and Significance: Hysterectomy is a common gynecological procedure that can be done abdominally, laparoscopically, or vaginally, with or without robotic assistance. As with all surgical procedures, chronic postoperative pain is a potential complication. There is a host of factors that can influence post-operative pain, and psychosocial factors are more commonly being identified as risk factors for postoperative pain.

Materials and Methods: In this prospective cohort study, patients scheduled for hysterectomy for benign indications were administered the Patient Health Questionnaire-SADS (PHQ-SADS) and the Multidimensional Scale of Perceived Social Support (MSPSS) surveys to assess their preoperative anxiety, depression, and perceived social support. Patients received a score based on their answers. Patients with severe anxiety and/or depression scores were referred to the appropriate provider and excluded from the study. Intra- operative data was collected retrospectively. Out-patient therapy was standardized, and hydrocodone with acetaminophen was given. Postoperative pain scores were reported on a scale from 1-10. The scores were gathered by telephone at 1 day, 2 weeks, and 6 weeks postoperatively. This study is continuing to accrue subjects.

Results: Preliminary descriptive statistics demonstrate that 31 women consented to the study of which 24 patients enrolled in the study. The average age is 46¿9 and the majority of the population is non-Hispanic black (58%) with at least one prior pregnancy. Approximately twothirds of the population had a BMI classified as obese. The majority (71%) had somatization (10 or more on PHQ-15), 46% had depression (10 or more on PHQ-9) and 54% had anxiety (10 or more on GAD-7). Data collection is ongoing and will be examined for prediction of anxiety, depression, and perceived low social support for postoperative pain after hysterectomy.

Conclusion: Postoperative pain is a feared complication of any surgical procedure. As the psychosocial factors of pain become better understood, providers will be able to adjust therapy to best suit the needs of each patient. A more complete understanding of mental health effects on post-operative pain can help to guide post-operative therapy. If a patient is found to have a mental health status that is high- risk for postoperative pain, either therapy can be adjusted, or the procedure could be postponed until a more favorable mental health status is attained. A more complete understanding of the relationship between psychosocial factors and pain can help providers deliver the most appropriate, tailored care to each patient.