Psychological aspects of postoperative pain control.

This article examines the biological basis of emotional distress during postoperative pain, discussing the causal links between tissue injury and the mechanisms of centrally mediated emotional arousal. Neurologic signals from injured tissues induce spinoreticular transmission and extensive processing in limbic brain. Pain, as an emotion, shares central noradrenergic mechanisms with vigilance, a biologically important process. The emotional dimension of postoperative pain corresponds to perceived threat. Injury-induced activation of central noradrenergic mechanisms equips the patient for "fight or flight" just as in nature it equips a wounded animal for self-preservation actions. Although the brain chemistry of emotion prepares the postoperative patient to undertake some sort of survival-directed activity, most hospital settings do not permit patients to cope for themselves. This biologically mandated need to cope with injury has no avenue for expression. Several basic concepts from clinical psychology apply to the management of patients after surgery: Control, coping and self-efficacy. In light of the psychobiological nature of emotion in postoperative pain, they explain the benefits of therapies that encourage self-control such as patient controlled analgesia (PCA). PCA changes the role of the postoperative patient from passive to active, permitting patients in pain to cope actively for themselves. Moreover, it demonstrates that an integration of technological advances with psychological principles can improve patient satisfaction with care delivery.