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

Preoperative patients' vulnerabilities such as physical, social, and psychological are implicated in postoperative pain variability. Nevertheless, it is a challenge to analyze a patient's psychological profile in the preoperative period in a practical and consistent way. Thus, we sought to...

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Published in:	PloS one 2020-01, Vol.15 (1), p.e0227441-e0227441
Main Authors:	Wolmeister, Anelise Schifino, Schiavo, Carolina Lourenzon, Nazário, Kahio César Kuntz, Castro, Stela Maris de Jezus, de Souza, Andressa, Caetani, Rafael Poli, Caumo, Wolnei, Stefani, Luciana Cadore
Format:	Article
Language:	eng
Subjects:	Aged Anxieties Biological markers Biology and Life Sciences Biomarkers Biomarkers - blood Bone surgery Brain-derived neurotrophic factor Brain-Derived Neurotrophic Factor - blood Consent Drug tolerance Emotions Evaluation Female Hospital patients Hospitals Humans Laboratories Male Medical research Medicine Medicine and Health Sciences Medicine, Experimental Middle Aged Morphine Neurophysiology Orthopedics Pain Pain, Postoperative Pain, Postoperative - blood Pain, Postoperative - etiology Pain, Postoperative - psychology Patients Physiology Postoperative pain Predictive Value of Tests Preoperative Period Prospective Studies Psychological aspects Psychological Distress Questionnaires Rehabilitation S100 Calcium Binding Protein beta Subunit - blood S100b protein Sensitivity analysis Social Sciences Stress Stress (Psychology) Studies Surgery
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Summary:	Preoperative patients' vulnerabilities such as physical, social, and psychological are implicated in postoperative pain variability. Nevertheless, it is a challenge to analyze a patient's psychological profile in the preoperative period in a practical and consistent way. Thus, we sought to identify if high preoperative emotional stress, evaluated by the Brief Measure of Emotional Preoperative Stress (B-MEPS) scale is associated with higher postoperative pain levels and poor rehabilitation in patients submitted to intermediate or major surgery. Moreover, the possible neurobiological or neurophysiological mechanisms implicated in high preoperative emotional stress, evaluated through preoperative quantitative sensory pain tests and serum biomarkers BDNF and S100B were investigated. We conducted a prospective, observational, cohort study of ASA 2 and 3 adult patients undergoing major urologic, gynecologic, proctologic and orthopedic surgeries from March 2017 to March 2018. B-MEPS and Central Sensitivity Inventory were evaluated preoperatively, followed by a sequence of experimental pain tests and serum biomarkers collection. Postoperative evaluation carried out within the first 48 hours after surgery comprehended pain at rest and movement-evoked pain, and the consumption of morphine. Quality-of-Recovery was also evaluated in the 3rd postoperative day. 23 (15%) out of 150 patients included in the study presented high emotional preoperative stress. Variables significantly related to preoperative stress were: previous psychiatric diagnosis and Central Sensitization Inventory result. Mean movement-evoked pain in the first 12 to 48 hours was 95-105% higher than pain at rest. A mixed model for repeated measures showed a sustainable effect of B-MEPS as a movement-evoked pain predictor. Previous pain, cancer surgery, and preoperative pressure pain tolerance were also independent predictors of postoperative pain. Moderate to severe postoperative movement-evoked pain was predictive of poor rehabilitation in 48 hours after surgery. We confirmed that a brief screening method of preoperative emotional states could detect individuals prone to experience severe postoperative pain. Specific interventions considering the stress level may be planned in the future to improve perioperative outcomes.
ISSN:	1932-6203 1932-6203