[Chronic postoperative pain and psychological factors]. / Chronische, postoperative Schmerzen.

Chronic postoperative pain and psychological factors Abstract. Chronic postsurgical pain is highly prevalent, also or particularly in hand surgical patients. Considerable progress has been made in identifying risk and protective factors for chronic postsurgical pain. Psychological - that is cognitive, affective and behavioral - aspects including depression, anxiety, pain catastrophizing and patient trust in physician also play a key role in determining the probability of developing chronic pain after surgery. These factors are measurable and serve as important targets for specific psychological interventions by the surgeon or an interdisciplinary team. Empirical evaluation of these treatments demonstrates that psychological as well as interdisciplinary multimodal interventions are accepted by surgical patients and able to reduce postsurgical pain and disability.

[Guideline for the planning of personalized, interdisciplinary multimodal pain treatment]. / Wegleitung zur Planung einer personalisierten, interdisziplinären multimodalen Schmerztherapie.

Interdisciplinary multimodal pain therapy (IMPT) should be delivered in a personalized, mechanism- and goal-oriented manner on the basis of an individual case conception. To the authors' knowledge, a practical instrument for planning IMPT does not exist. The model and guideline presented here for treatment should help practitioners to optimize the planning of IMPT and execute it efficiently. Based on the relevant interference mechanisms, goals for change and treatment are set and possible interventions are proposed. This involves explicitly including the patient's existing resources.

Heart Rate Recovery After Exercise in Outpatients with Coronary Heart Disease: Role of Depressive Symptoms and Positive Affect.

Heart rate recovery after 1 min of exercise cessation (HRR-1) is an important prognostic factor in patients with cardiovascular disease (CVD). We aimed to further elucidate the association between HRR-1 and known psychosocial risk factors in patients referred for comprehensive cardiac rehabilitation. We examined 521 patients with coronary heart disease in the first week of an outpatient cardiac rehabilitation program. Depressive and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale, and positive (PA) and negative affect were rated with the Global Mood Scale. Depressive symptoms showed a significant inverse relationship with HRR-1 (p < .05), controlling for sociodemographic and medical covariates, whereas anxiety symptoms did not show a significant association. PA made a significant contribution to HRR-1 as well (p < .05). Our findings suggest an independent association between HRR-1 and psychosocial risk factors of CVD.

Psychosocial outcome in cardiovascular rehabilitation of peripheral artery disease and coronary artery disease patients.

We investigated patients with a primary diagnosis of peripheral artery disease (n = 69) and coronary heart disease (CAD; n = 520) at baseline and on changes in psychosocial risk factors (depression, anxiety, quality of life, negative and positive affect) during a cardiovascular rehabilitation program. Patients completed psychosocial questionnaires at the beginning and at discharge of a 12-week rehabilitation program. Depression and anxiety were measured with the Hospital Anxiety and Depression Scale (HADS), positive and negative affect with the Global Mood Scale, and health-related quality of life with the SF-36 Health Survey. Patients with PAD showed improvements in anxiety (p < 0.001), negative affect (p < 0.001) and bodily pain (p < 0.001). Patients with CAD reported significant improvements in all measured dimensions (all p-values < 0.001).

Change in positive affect during outpatient cardiac rehabilitation predicts vital exhaustion in patients with coronary heart disease.

Vital exhaustion is an acknowledged psychosocial risk factor of incident coronary heart disease (CHD) and recurrent CHD events. Little is known about trajectories in vital exhaustion in patients with CHD and the factors predicting this change. We hypothesized that vital exhaustion would decrease during outpatient cardiac rehabilitation and that an increase in positive affect over time would be associated with decreased vital exhaustion at discharge from cardiac rehabilitation. We also explored the role of the patient's sex in this context. Vital exhaustion was reduced during outpatient cardiac rehabilitation, especially in patients who experienced an increase in positive affect over time (p < .001). This relationship was significant in men (p < .001) but not in women (p = .11).

Health-related quality of life is associated with positive affect in patients with coronary heart disease entering cardiac rehabilitation.

Health-related quality of life (QoL) is an important and widely used outcome measure in cardiac populations. We examined the relationship between positive affect and health-related quality of life, controlling for traditional cardiovascular risk factors, clinical variables and negative affect. We further investigated the role of gender in this relationship given the well-known gender differences in cardiovascular health. We enrolled 746 patients with coronary heart disease (CHD) before they entered outpatient cardiac rehabilitation. All patients completed the Global Mood Scale and the SF-36 Health Survey. Positive affect was independently associated with mental (p < .001) and physical QoL (p < .001) after controlling for control variables. Gender moderated the relationship between positive affect and physical QoL (p = .009) but not mental QoL (p = .60). Positive affect was positively associated with physical QoL in men (p < .001) but not in women (p = .44). The health-related QoL of patients with CHD is associated with a person's level of positive affect.

Psychosocial Risk Factors in Cardiac Rehabilitation: Time to Screen Beyond Anxiety and Depression.

Background: Although it is well acknowledged that psychosocial risk factors (PSRF) such as low socio-economic status, stress, social isolation, negative emotions and negative personality patterns may contribute to the development and adverse outcome of cardiovascular disease (CVD), screening for PSRF in CVD patients is usually limited to anxiety and depression, mainly for feasibility reasons. We therefore aimed to develop a user-friendly screening battery for routine assessment of PSRFs and to evaluate this instrument regarding feasibility of application, PSRF results and attendance of psychological counselling if recommended to cardiac rehabilitation (CR) patients. Methods: This is a prospective single center cohort study including 609 consecutive CR patients. We first developed a screening instrument based on seven validated scales for the most relevant PSRFs with totally 90 questions presented in a uniform graphical design to facilitate completion called Psychocardiogram® (PCG) and applied the instrument in consecutive patients attending CR. Patients with positive screening results were invited to a psychological counseling session. Results: Six hundred and nine consecutive patients, aged 34 to 86 years (mean 60.7 years), 85% men, entering the CR program at the Bern University Hospital with ischemic heart failure (CHF), coronary artery disease (CAD) or peripheral artery disease, were included in this study. Eighty-three point three percent of the patients completed the PCG within 40 minutes. Vital exhaustion and Type-D personality were the most prevalent PSRFs (56.9% and 51.1%, respectively), whereas low social support (14.4%) and elevated depressive symptoms (15.9%), were the least prevalent ones. After screening, 120 patients (52.86%) with at least one PSRF made use of psychological counseling. Conclusions: We found the PCG to be a useful screening tool for PSRF in CR patients with the potential to get new insights into the prevalence of particular PSRF in specific populations and to better study their impact on occurrence and outcome of CVD.

A comparison of psychosocial risk factors between 3 groups of cardiovascular disease patients referred for outpatient cardiac rehabilitation.

PURPOSE: Few studies have examined psychosocial risk factors for cardiovascular disease (CVD) between diagnostic groups of CVD patients. We compared levels of depression, anxiety, hostility, exhaustion, positive affect, and social support, and the prevalence of type D personality between patient groups with a primary diagnosis of coronary heart disease (CHD), chronic heart failure (CHF), or peripheral arterial disease (PAD). METHODS: We examined 548 CHD patients, 105 CHF patients, and 79 PAD patients who completed the Hospital Anxiety and Depression Scale, the cynical hostility subscale of the Minnesota Multiphasic Personality Inventory-2, the short form of the Maastricht Vital Exhaustion Questionnaire, the type D personality questionnaire, the positive mood scale of the Global Mood Scale, and the Enhancing Recovery in CHD Social Support Inventory, all in the first week of cardiac rehabilitation. Group differences in psychosocial factors were adjusted for sociodemographic factors, previous myocardial infarction, traditional cardiovascular risk factors, and medications. RESULTS: Relative to patients with PAD, those with CHD and those with CHF both showed greater exhaustion (P ≤ .001) and lower positive affect (P ≤ .03). The effect sizes of these differences were clinically relevant (Cohen's d between 0.32 and 0.49). There were no significant differences in psychosocial risk factors between CHD and CHF patients. CONCLUSIONS: The profile of psychosocial risk factors for CVD revealed clinically relevant variability between different diagnostic groups of CVD patients. The findings imply that patients with distinct cardiac diagnosis might additionally benefit from comprehensive cardiac rehabilitation if the program includes psychosocial risk factor-specific interventions.