50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

The Influence of Pain Catastrophizing and Prior Painful Experiences on Procedural Pain and Post-Block Resolution Pain

Introduction

•Regional Anesthesia plays a vital role in multimodal perioperative pain management

•However, some patients can experience procedural pain, as well as dramatic increases in pain at time of nerve block resolution.

•Pain catastrophizing, which is the degree to which a patient may feel helpless, magnify, and ruminate about pain when they experience it, has been associated with worse procedural, acute, and chronic pain. Baseline trait pain catastrophizing can be measured using the Pain Catastrophizing Scale score (PCS; range 0-52), which asks people to reflect on times they have had pain and rate how much these thoughts occur.

•Previous painful experiences may also impact how individuals experience pain.

Aims

Among a cohort of patients who received enhanced education and reassurance (no sedation) during nerve block placement:

1.To understand factors that are related to procedural pain

•pain catastrophizing

•procedural catastrophizing

•previous most painful experience

•pain after nerve block resolution

2. To understand factors that are related to pain after nerve block resolution

•pain catastrophizing

•previous most painful experience

•procedural pain

•procedural catastrophizing

3. To explore themes in patients’ description of their most painful experience

Methods/Study Flow

Study Sample Characteristics

Procedural Pain

Figure 1A :

Greater PCS was associated with higher procedural pain during the nerve block

Figure 1B :

Greater catastrophizing thoughts during the nerve block procedure (SPCS) were associated with higher procedural pain during the nerve block

Pain after Block Resolution

Figure 2A :

Greater PCS was associated with higher maximum pain after nerve block resolution, assessed on postoperative day 1

Figure 2B :

A higher pain rating for one’s “most painful experience” was associated with higher maximum pain after nerve block resolution, assessed on postoperative day 1

Quotes from patients describing their most painful experience

Results/ Conclusions:

•Higher catastrophizing about pain at baseline was related to both greater procedural pain, and higher pain after nerve block resolution.

•Most patients have a memorable previous most painful experience, and how they remember and relate to it may impact their experience with pain after nerve block resolution.

•Understanding both pain catastrophizing and previous pain experiences may give providers insight as to how to manage patients during painful procedures.

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

THE INFLUENCE OF PAIN CATASTROPHIZING AND PRIOR PAINFUL EXPERIENCES ON PROCEDURAL PAIN AND POST-BLOCK RESOLUTION PAIN

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