Is postoperative pain a self-fulfilling prophecy? Expectancy effects on postoperative pain and patient-controlled analgesia use among adolescent surgical patients

Objective To explore relationships among anxiety, anticipated pain, coping styles, postoperative pain, and patient-controlled analgesia (PCA) use among adolescent surgical patients and their parents. Methods Sixty-five 12- to 18-year-old surgical patients undergoing surgery with postoperative PCA pain management were included. Before surgery, adolescents and parents reported anxiety and expected levels of postoperative pain. Pain catastrophizing and coping style were assessed within 48 hr after surgery, with pain scores and PCA use recorded through the end of the second postoperative day. Results Adolescents' preoperative psychological characteristics (anxiety and anticipated pain) predicted postoperative pain scores, number of PCA injections and demands, and the PCA injections:demands ratio, with reports of anticipated pain associating most closely with these postoperative pain outcomes. Parental anxiety and anticipated pain did not predict teens' postoperative pain. Coping style did not moderate the relationship between anticipated pain and pain outcomes. Conclusions Findings are interpreted as suggesting a self-fulfilling prophecy in adolescents' postoperative pain experience wherein teens who expect to have high levels of postoperative pain ultimately report more pain and use more opioid PCA medication than those who report lower levels of pain.