Pain Catastrophizing Scale as a predictor for acute postoperative pain following video-assisted thoracoscopic surgery lobectomy

Abstract OBJECTIVES Postoperative pain after thoracic surgery remains a significant challenge, underscoring the need to identify patients at risk of severe pain. While prior research across various surgical types highlights the Pain Catastrophizing Scale (PCS) as a key psychological predictor of acute postoperative pain, evidence specific to thoracic surgery is limited. This study aimed to investigate the association between PCS and postoperative pain in patients undergoing multiportal video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS We conducted a prospective observational study including consecutive patients scheduled for VATS lobectomy. Patients completed the PCS-questionnaire preoperatively and pain scores (Numeric Rating Scale) were collected twice daily for the first 2 postoperative days under 4 conditions: resting, coughing, using a positive expiratory pressure (PEP) device and 5-meter walk-test. RESULTS In total, 100 patients were included. Median age was 72 [interquartile range (IQR): 64, 76] years, and 57% of patients were female. Median PCS score for all patients was 11 (IQR: 319). The minimum observed PCS score was 0, and the maximum was 43. Twenty-two (24.7%) of the patients presented with a PCS score ≥ 20 and were considered high-pain responders. High-pain responders reported significantly higher pain scores during coughing (6.00 vs 5.00, P = 0.02) and 5-meter-walk test (3.42 vs 1.75, P = 0.034) and were more likely to experience moderate-severe pain (95.5% vs 71.6%, P = 0.02) during the first 2 postoperative days. Linear regression confirmed that higher PCS scores were significantly associated with increased pain across most conditions, particularly coughing and 5-meter-walk-test. CONCLUSIONS Higher PCS scores were associated with increased risk of acute postoperative pain following VATS lobectomy. The PCS is a simple, rapid and reliable predictor of acute postoperative pain.