Psychological Influences on Postoperative Pain Management

Postoperative pain is shaped not only by the extent of tissue injury and pharmacological interventions but also by a constellation of psychological factors. Anxiety, negative expectations, unhelpful pain beliefs and coping styles can amplify pain perception and prolong recovery. Cognitive and emotional processes such as catastrophisation and fear of movement drive central sensitisation, whereby the nervous system becomes hyperresponsive to stimuli. Conversely, adaptive coping strategies, positive outcome expectancies and psychological flexibility attenuate pain intensity and reduce reliance on opioid analgesia. Integrating psychological assessment into perioperative care enables identification of at-risk individuals and the delivery of targeted interventions. Techniques ranging from hypnosis and mindfulness to structured therapies aim to recalibrate stress responses, modulate pain pathways and foster self-efficacy in pain management. Across surgical populations, these approaches have demonstrated the potential to lower acute pain scores, prevent chronic postsurgical pain and improve functional and quality-of-life outcomes on a global scale.

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Psychological Influences on Postoperative Pain Management publication trend

The graph below shows the total number of articles in psychological influences on postoperative pain management across all publications each year (not limited to Nature Index journals).

Technical terms

Catastrophisation: An exaggerated negative mental set during actual or anticipated pain, characterised by rumination, magnification and feelings of helplessness.

Central sensitisation: A state of heightened central nervous system responsiveness to normal or subthreshold sensory input, leading to amplified pain perception.

Cognitive Behavioural Therapy (CBT): A structured psychological treatment that identifies and modifies unhelpful thoughts and behaviours to improve emotional regulation and coping.

Acceptance and Commitment Therapy (ACT): A form of therapy that enhances psychological flexibility by promoting acceptance of difficult experiences and commitment to personal values–guided action.

References

1. Pre- and post-operative psychological interventions to prevent pain and fatigue after breast cancer surgery (PREVENT): Protocol for a randomized controlled trial. PLOS ONE (2022).
2. What Does CATS Have to Do With Cancer? The Cognitive Activation Theory of Stress (CATS) Forms the SURGE Model of Chronic Post-surgical Pain in Women With Breast Cancer. Frontiers in Psychology (2021).
3. Cognitive behavioral therapy to reduce persistent postsurgical pain following internal fixation of extremity fractures (COPE): Rationale for a randomized controlled trial. Canadian Journal of Pain (2019).
4. The Role of Pain Catastrophizing in the Prediction of Acute and Chronic Postoperative Pain. The Open Pain Journal (2013).