Dr.Lalgudi Ganesh Vaitheeswaran, V18501, Dr.Saurabh Ramuka, Dr.Ravish Ghanshyam Vaishnav, Dr.Rohit Shetty
ABSTRACT:
Aim:
To assess correlation of patient’s personality and his/her idea ofpost-operative pain to the actual reported post-operative pain following photorefractive keratectomy(PRK) and Cross-Linking(CXL) assessed by Wong-Baker(WB) pain score
Methods:
100 patients of PRK/CXL were pre-operatively administered a psychometrically validated Big5 questionnaire and a Pain Catastrophising scale(PCS) questionnaire.On post-op day 1, pain was assessed by WB pain score ranging from 0-10
Results:
Big5 and PCS scores revealed statistically significant differences in PCS total, M, H subscales, extraversion and agreeableness scores (p<0.05) between those with high and low WB scores. Cut off of PCS M 14, agreeableness 12, extraversion 11 was able to differentiate those with low and high post op pain with good predictability
Conclusion:
Personality and PCS assessment pre-operatively in a routine practice can definitively predict patients who will experience greater post-operative painand help better pain management.
INTRODUCTION & BACKGROUND:
Patients personality has been proven to be associated with several ophthalmic diseases as glaucoma(1), central serous retinopathy(2) and dry eye.(3)The role personality of a patient plays in the disease process is huge, but falsely under-estimated in current day clinical practice. The same surgery performed by the same surgeon on two different patients leads to significantly different post-operative outcomes in spite of the pre-operative and intra-operative variables being similar.
Currently, there is a significant percentage of adolescents who have untreated depression, anxiety and multiple personality disorders. Unknowingly, as ophthalmologists, we are treating them just like how we treat patients routinely.
The outcomes these patients are expected to have are going to be significantly different and the blame is going to be on the treating ophthalmologist. Therefore, it is imperative for us to be able to understand our patients minds and personality to a basic extent before we treat them.
Several questionnaires including the one used in our study, the Big5 inventory has been evaluated before and has been shown in previous studies to influence a range of functionalities from undergraduate student’s performance(4) to old age cognitive function.(5)
Of the questionnaires used, the Big5 questionnaire is easy to administer, less time consuming and does not require the help of a psychologist or psychiatrist for interpretation of the results.
Post-operative pain, as we all understand has a definite subjective component apart from the surgery induced factors and has been shown that, a PCS scale (Pain catastrophizing scale) derived scores positively correlates to patient perceived pain post-operatively.(6)
Therefore, we utilised Big5 and PCS questionnaire to assess correlation of patient personality type and idea of perceived post-operative pain to the actual patient reported post-operative pain following photorefractive keratectomy (PRK) and Cross-Linking (CXL) assessed by Wong Baker (WB) pain score.
METHODOLOGY:
100 patients planned for any type of PRK/CXL for refractive correction or keratoconus were pre-operatively administered a psychometrically validated Big5 questionnaire and a Pain Catastrophising scale (PCS) questionnaire after Institute Ethics committee approval and informed consent. Serum Vitamin D levels were also assessed pre-operatively.
Big5 questionnaire contains 44 questions with responses from 1 through 5 based on how strongly the respondent agrees to the statement. Analysis of the questionnaire gives the scoring of 5 aspects of patients’ personality viz. Extraversion(E), agreeableness(A), neuroticism(N), openness(O) and conscientiousness(C).
PCS score contains 13 questions with responses from 0 through 4 based on agreement level. This scores patients pain perception under 3 sub categories viz. Rumination (R), Magnification(M) and Helplessness (H).Following the standard surgery, on post-operative day 1, the patients actual perceived pain is assessed by WB pain score ranging from 0-10.
We then correlated the post-operative pain assessed by WB scale to the pre-operatively assessed patient personality scores of Big5 and pain perception scores of PCS scale using appropriate statistical tools.
Those patients whose reporting of these questionnaires was felt to be unsatisfactory or incomplete were excluded from the study.
RESULTS:
Correlation of Big5 and PCS scores with WB scores revealed statistically significant differences in PCS total, M, H subscales and extraversion and agreeableness scores (p<0.05) between those with high WB and low WB scores. Cut off of PCS M >14, agreeableness< 12, extraversion < 11 was able to differentiate those with low and high post op pain (p<0.05) with good predictability. Table 1 shows cut-off values of different subscales that were able to differentiate between those with low vs moderate-high pain scores with good predictability.
Table 1: Cut-off values of different subscales that were able to differentiate between those with low vs moderate-high pain scores with good predictability
| Mod to high pain group (WB >4) | Low pain group
(WB <4) |
| PCS Magnification <14 | PCS Magnification > 14 |
| Big 5 Extraversion <11 | Big 5 Extraversion >11 |
| Big 5 Agreeableness<12 | Big 5 Agreeableness >12 |
| Vitamin D < 10 ng/ ml | Vitamin D >10 ng/ ml |
DISCUSSION:
There is no study done in ophthalmology correlating post-operative pain to patient’s personality and pain perception scoring. Previous studies using PCS scale in ophthalmic major surgeries had reported positive correlation between post-operative pain and PCS scores(6), but did not come up with a cut off value of the sub scales to differentiate between the subsets of patients.
Thus, our study is novel and provides new insights to ophthalmologists on understanding the personality and mind of our patients objectively and predict the outcomes better.
CONCLUSION:
Personality assessment and PCS assessment pre-operatively without the help of a psychologist in a routine ophthalmic practice can definitively predict those patients who will experience greater post-operative pain and in turn require greater attention post-operatively. This can help the ophthalmologist plan effective pre-operative regimen to manage such patients and combat post-op pain better. This can be the essential bridging knowledge of psychiatry for an ophthalmologist to catapult to greater levels of doctor patient relationship in future.
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- Lesin M, DzajaLozo M, Duplancic-Sundov Z, Dzaja I, Davidovic N, Banozic A, et al. Risk factors associated with postoperative pain after ophthalmic surgery: a prospective study. Therapeutics and clinical risk management. 2016;12:93-102.
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