People who blame others for their suffering and think setbacks in their lives are irreparable tend to report more pain after surgery, according to a new study.
This is not the first time feelings of personal injustice have been tied to longer recovery times and increased disability after injury, the authors write.
“Pain is a complex phenomenon that is influenced by biological, social, and psychological factors,” says lead author Esther Yakobov, a doctoral student in clinical psychology at McGill University in Montreal.
“Studies conducted with patients who suffer from chronic pain because of an injury demonstrated that individuals who judge their experience as unfair, focus on their losses, and blame others for their painful condition also tend to experience more pain and recover from their injuries slower than individuals who do not,” she says.
But those studies had been with victims of injuries, where blaming is easier compared to degenerative conditions like osteoarthritis, she notes.
For the new study, older adults both men and women with severe osteoarthritis, and scheduled for knee replacement surgery, were asked to fill out questionnaires on their perceived injustice, how much they think about or worry about pain and their fear of movement or re-injury.
They were then rated based on statements like, “It all seems so unfair” and “I am suffering because of someone else’s negligence.” Another clinical questionnaire was given where the patients gauged their pain levels and physical functioning.
After the knee replacement surgeries, the patients rated their pain and function again.
The more a patient agreed before surgery that life seems unfair and others are to be blamed for their problems, the more pain they reported experiencing one year after surgery. That was true even when age, sex, other health conditions and pre-surgery pain levels were accounted for, according to the results in the journal Pain.
The more the patient thought about pain and felt helpless because of it before surgery, the more severe their disability during recovery seemed to be.
“A decade ago, we reported that preoperative anxiety and depression influenced the outcome after surgery,” says Dr Victoria Brander, a physical medicine and rehabilitation specialist at Northwestern Orthopaedic Institute in Chicago.
This new study adds to the effort to refine the concept, identifying specific psychological characteristics that serve as risk factors for complicated or painful recovery, Brander, who was not part of the new study, says.
“All of these psychological factors point to the fact that patients who perceive themselves as helpless, those who are afraid, those who feel loss of control, have a more difficult time,” Brander adds.
“The contrary is also true - patients who exhibit high levels of ‘self-efficacy’ (that is, patients who have a high degree of confidence in their own ability to achieve a goal) appear to do best after knee replacement,” she says.
How individuals perceive pain as just or unjust can vary widely between patients, and it can be influenced by many factors, so it’s hard to say if having a more negative outlook is common or uncommon, Yabokov says.
Researchers don’t yet know if people with more negative outlooks only perceive their pain as worse than others or if their psychological state affects the physiology of healing and actually leads to more pain, she says. Nevertheless, findings like this suggest patients should be screened for their psychosocial outlook before surgery, she explains.
“This might suggest the usefulness of screening patients in terms of ‘catastrophising,’ perceived injustice, fear of movement, and recovery expectancies before treatment or surgery,” she says. “With this screening information, appropriate psychological intervention that targets specific risk factors of each patient can then be matched to patients’ needs.” – Reuters
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