The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study

Rogério Boff Borges; Wolnei Caumo; Caroline Bavaresco; Luciana Paula Cadore Stefani; Vinicius Souza dos Santos; Stela Maris de Jezus Castro

doi:10.1016/j.bjane.2023.02.004

Original Investigation

The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study

Rogério Boff Borges, Wolnei Caumo, Caroline Bavaresco, Luciana Paula Cadore Stefani, Vinicius Souza dos Santos, Stela Maris de Jezus Castro

http://dx.doi.org/10.1016/j.bjane.2023.02.004 Braz J Anesthesiol, Ahead of Print, 2023

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Abstract

Background

The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use.

Methods

This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery.

Results

We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%–90.3%) and specificity of 93.5% (91.5–95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity.

Conclusions

These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

Keywords

Acute pain, Catastrophization, Psychological distress, Latent class analysis, Analgesics, Opioid, Perioperative care

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Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures

Complement Ther Med, 21 (2013), pp. 697-711
2

A Visioni, R Shah, E Gabriel, et al.

Enhanced recovery after surgery for noncolorectal surgery?: A systematic review and meta-analysis of major abdominal surgery

Ann Surg, 267 (2018), pp. 57-65
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MN Mavros, S Athanasiou, ID Gkegkes, et al.

Do psychological variables affect early surgical recovery?

PLoS One, 6 (2011), p. e20306
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R Geoffrion, NA Koenig, M Zheng, et al.

Preoperative depression and anxietyimpact on inpatient surgery outcomes: a prospective cohort study

Ann Surg Open, 2 (2021), p. e049
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H Takagi, T Ando, T Umemoto, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis

Heart Vessels, 32 (2017), pp. 1458-1468
6

S Birch, M Stilling, I Mechlenburg, et al.

The association between pain catastrophizing, physical function and pain in a cohort of patients undergoing knee arthroplasty

BMC Musculoskelet Disord, 20 (2019), p. 421
7

W Caumo, M Nazare Furtado da Cunha, S Camey, et al.

Development psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain

Br J Anaesth, 117 (2016), pp. 642-649
8

HYV Ip, A Abrishami, PWH Peng, et al.

Predictors of postoperative pain and analgesic consumption: a qualitative systematic review

Anesthesiology, 111 (2009), pp. 657-677
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W Caumo, AP Schmidt, CN Schneider, et al.

Risk factors for preoperative anxiety in adults: Preoperative anxiety in adults

Acta Anaesthesiol Scand, 45 (2001), pp. 298-307
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AS Wolmeister, CL Schiavo, KCK Nazário, et al.

The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study

PLoS One, 15 (2020), Article e0227441
11

CL Schiavo, RB Borges, SMJ Castro, et al.

Measuring emotional preoperative stress by an app approach and its applicability to predict postoperative pain

PLoS One, 17 (2022), Article e0263275
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C Bavaresco

Preditores para a dor aguda pós-operatória evocada por movimento em pacientes submetidos à cirurgia eletiva em hospital público de alta complexidade no Sul do Brasil

Federal University of Rio Grande do Sul (2022)

Master Thesis2020
13

RB Borges, ACB Mancuso, SA Camey, et al.

Power and Sample Size for Health Researchers: uma ferramenta para cálculo de tamanho amostral e poder do teste voltado a pesquisadores da área da saúde

Clin Biomed Res, 40 (2021), pp. 267-274
14

G Villa, I Lanini, T Amass, et al.

Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Perioper Med, 9 (2020), pp. 1-8
15

LH Høvik, SB Winther, OA Foss, et al.

Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up

BMC Musculoskelet Disord, 17 (2016), pp. 1-7
16

RS Khan, K Ahmed, E Blakeway, et al.

Catastrophizing: a predictive factor for postoperative pain

American J Surg, 201 (2011), pp. 122-131
17

J Doménech, V Sanchis-Alfonso, B. Espejo

Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain

Knee Surg Sports Traumatol Arthrosc, 22 (2014), pp. 2295-2300
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J Katz, A Weinrib, S Fashler, et al.

The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain

J Pain Res, 8 (2015), pp. 695-702
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W Caumo, AP Schmidt, CN Schneider, et al.

Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery: Acute postoperative pain

Acta Anaesthesiol Scand, 46 (2002), pp. 1265-1271
20

G De Cosmo, E Congedo, C Lai, et al.

Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia

Clin J Pain, 24 (2008), pp. 399-405
21

LF Kerper, CD Spies, P Buspavanich, et al.

Preoperative depression, and hospital length of stay in surgical patients

Minerva Anestesiol, 80 (2014), pp. 984-991
22

A Jalilvand, J Dewire, A Detty, et al.

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Surg Endosc, 33 (2019), pp. 1661-1666
23

RS Pompe, A Krüger, F Preisser, et al.

The impact of anxiety and depression on surgical and functional outcomes in patients who underwent radical prostatectomy

Eur Urol Focus, 6 (2020), pp. 1199-1204
24

Z-Y Luo, L-L Li, D Wang, et al.

Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study

J Orthop Surg Res, 14 (2019), pp. 1-10
25

S Machado F de, S Souza RC da, VB Poveda, et al.

Non-pharmacological interventions to promote the sleep of patients after cardiac surgery: a systematic review

Rev Lat Am Enfermagem, 25 (2017), p. e2926
26

M Scarpa, E Pinto, E Saraceni, et al.

Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy

Br J Surg, 104 (2017), pp. 1307-1314
27

CJ. Woolf

Central sensitization: Implications for the diagnosis and treatment of pain

Pain, 152 (2011), pp. S2-S15
28

R. Neblett

The central sensitization inventory: A user's manual

J Appl Biobehav Res, 23 (2018), p. e12123
29

EA Lingard, DL. Riddle

Impact of psychological distress on pain and function following knee arthroplasty

J Bone Joint Surg Am, 89 (2007), pp. 1161-1169
30
Kaunisto MA, Jokela R, Tallgren M, et al. Pain in 1,000 Women Treated for Breast Cancer: A Prospective Study of Pain Sensitivity and Postoperative Pain Anesthes. 2013;119:1410–21.

[1] 1

A Nelson Elizabeth, M Dowsey Michelle, R Knowles Simon, et al.

Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures

Complement Ther Med, 21 (2013), pp. 697-711

[2] 2

A Visioni, R Shah, E Gabriel, et al.

Enhanced recovery after surgery for noncolorectal surgery?: A systematic review and meta-analysis of major abdominal surgery

Ann Surg, 267 (2018), pp. 57-65

[3] 3

MN Mavros, S Athanasiou, ID Gkegkes, et al.

Do psychological variables affect early surgical recovery?

PLoS One, 6 (2011), p. e20306

[4] 4

R Geoffrion, NA Koenig, M Zheng, et al.

Preoperative depression and anxietyimpact on inpatient surgery outcomes: a prospective cohort study

Ann Surg Open, 2 (2021), p. e049

[5] 5

H Takagi, T Ando, T Umemoto, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis

Heart Vessels, 32 (2017), pp. 1458-1468

[6] 6

S Birch, M Stilling, I Mechlenburg, et al.

The association between pain catastrophizing, physical function and pain in a cohort of patients undergoing knee arthroplasty

BMC Musculoskelet Disord, 20 (2019), p. 421

[7] 7

W Caumo, M Nazare Furtado da Cunha, S Camey, et al.

Development psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain

Br J Anaesth, 117 (2016), pp. 642-649

[8] 8

HYV Ip, A Abrishami, PWH Peng, et al.

Predictors of postoperative pain and analgesic consumption: a qualitative systematic review

Anesthesiology, 111 (2009), pp. 657-677

[9] 9

W Caumo, AP Schmidt, CN Schneider, et al.

Risk factors for preoperative anxiety in adults: Preoperative anxiety in adults

Acta Anaesthesiol Scand, 45 (2001), pp. 298-307

[10] 10

AS Wolmeister, CL Schiavo, KCK Nazário, et al.

The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study

PLoS One, 15 (2020), Article e0227441

[11] 11

CL Schiavo, RB Borges, SMJ Castro, et al.

Measuring emotional preoperative stress by an app approach and its applicability to predict postoperative pain

PLoS One, 17 (2022), Article e0263275

[12] 12

C Bavaresco

Preditores para a dor aguda pós-operatória evocada por movimento em pacientes submetidos à cirurgia eletiva em hospital público de alta complexidade no Sul do Brasil

Federal University of Rio Grande do Sul (2022)

Master Thesis2020

[13] 13

RB Borges, ACB Mancuso, SA Camey, et al.

Power and Sample Size for Health Researchers: uma ferramenta para cálculo de tamanho amostral e poder do teste voltado a pesquisadores da área da saúde

Clin Biomed Res, 40 (2021), pp. 267-274

[14] 14

G Villa, I Lanini, T Amass, et al.

Effects of psychological interventions on anxiety and pain in patients undergoing major elective abdominal surgery: a systematic review

Perioper Med, 9 (2020), pp. 1-8

[15] 15

LH Høvik, SB Winther, OA Foss, et al.

Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up

BMC Musculoskelet Disord, 17 (2016), pp. 1-7

[16] 16

RS Khan, K Ahmed, E Blakeway, et al.

Catastrophizing: a predictive factor for postoperative pain

American J Surg, 201 (2011), pp. 122-131

[17] 17

J Doménech, V Sanchis-Alfonso, B. Espejo

Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain

Knee Surg Sports Traumatol Arthrosc, 22 (2014), pp. 2295-2300

[18] 18

J Katz, A Weinrib, S Fashler, et al.

The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain

J Pain Res, 8 (2015), pp. 695-702

[19] 19

W Caumo, AP Schmidt, CN Schneider, et al.

Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery: Acute postoperative pain

Acta Anaesthesiol Scand, 46 (2002), pp. 1265-1271

[20] 20

G De Cosmo, E Congedo, C Lai, et al.

Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia

Clin J Pain, 24 (2008), pp. 399-405

[21] 21

LF Kerper, CD Spies, P Buspavanich, et al.

Preoperative depression, and hospital length of stay in surgical patients

Minerva Anestesiol, 80 (2014), pp. 984-991

[22] 22

A Jalilvand, J Dewire, A Detty, et al.

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Surg Endosc, 33 (2019), pp. 1661-1666

[23] 23

RS Pompe, A Krüger, F Preisser, et al.

The impact of anxiety and depression on surgical and functional outcomes in patients who underwent radical prostatectomy

Eur Urol Focus, 6 (2020), pp. 1199-1204

[24] 24

Z-Y Luo, L-L Li, D Wang, et al.

Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study

J Orthop Surg Res, 14 (2019), pp. 1-10

[25] 25

S Machado F de, S Souza RC da, VB Poveda, et al.

Non-pharmacological interventions to promote the sleep of patients after cardiac surgery: a systematic review

Rev Lat Am Enfermagem, 25 (2017), p. e2926

[26] 26

M Scarpa, E Pinto, E Saraceni, et al.

Randomized clinical trial of psychological support and sleep adjuvant measures for postoperative sleep disturbance in patients undergoing oesophagectomy

Br J Surg, 104 (2017), pp. 1307-1314

[27] 27

CJ. Woolf

Central sensitization: Implications for the diagnosis and treatment of pain

Pain, 152 (2011), pp. S2-S15

[28] 28

R. Neblett

The central sensitization inventory: A user's manual

J Appl Biobehav Res, 23 (2018), p. e12123

[29] 29

EA Lingard, DL. Riddle

Impact of psychological distress on pain and function following knee arthroplasty

J Bone Joint Surg Am, 89 (2007), pp. 1161-1169

[30] 30
Kaunisto MA, Jokela R, Tallgren M, et al. Pain in 1,000 Women Treated for Breast Cancer: A Prospective Study of Pain Sensitivity and Postoperative Pain Anesthes. 2013;119:1410–21.

The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study

Rogério Boff Borges, Wolnei Caumo, Caroline Bavaresco, Luciana Paula Cadore Stefani, Vinicius Souza dos Santos, Stela Maris de Jezus Castro

Abstract

Background

Methods

Results

Conclusions

Keywords

References

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