Surgical patients' expectations of pain and discomfort: does accuracy of expectations minimise post-surgical pain and distress?

Abstract

The predictive relationship of expectancies of pain and symptoms to the experience of postoperative pain, symptoms and distress are examined in two studies of adult patients undergoing minor gynaecological surgery. The first hypothesis is based on the clinical wisdom that patients who expect pain to occur will report greater pain intensity than patients who do not hold these expectancies. That is, pain and symptom expectation and experience are positively associated. A second hypothesis based on a cognitive information processing model suggests that the greater the discrepancy between expected and actual pain the greater the experience of postoperative distress. A third hypothesis suggests that the direction of the discrepancy is important such that those patients who expect pain to be more intense than it is in actuality will report being least distressed. Data are presented which partially support all 3 hypotheses. A critical test between the second and third hypotheses did not provide support for either hypothesis. The positive correlations between expected and reported pain and emotional variables suggest that the manipulation of patients' emotional responses may be as effective as manipulating pain expectancies in controlling the pain and distress of surgery. This is supported by the finding that patients who receive accurate preparatory information about their surgery, in comparison to those who had no additional information, reported lower pain intensity but did not differ on expected pain intensity before the operation. However, the experimental manipulation was associated with reduced pain and emotional responses after surgery. The implications for the design of preparatory psychological interventions to reduce the pain and distress of surgery are discussed.