Potential effect of bias in the association of pain catastrophizing and postsurgical pain after hysterectomy

摘要

The study of Pinto et al., "The mediating role of pain catastro-phizing in the relationship between presurgical anxiety and acute postsurgical pain after hysterectomy," published in the January issue [4], contains methodological problems that may greatly affect any conclusions that may be drawn regarding the association of pain catastrophizing and postsurgical pain after hysterectomy.The authors did not standardize the postoperative pain management of subjects—a major confounding factor that might invalidate the authors' findings. This was probably responsible for the authors' conclusion that the surgical route was not a significant predictor of postsurgical pain. It is well known in the obstetric literature that vaginal and laparoscopic hysterectomy leads to a better postoperative recovery than abdominal hysterectomy [2,3]. Women undergoing abdominal hysterectomy probably received postoperative epidural analgesia, and women undergoing vagi-nal/laparoscopic hysterectomy probably did not. This was likely responsible for the lack of association between the surgical route and postoperative pain. It is also well known that neuraxial analgesia/anesthesia leads to less postoperative pain than systemic analgesia in patients undergoing hysterectomy [1].