Ricerc@Sapienza

Background and aim: Endoscopic procedures are unpleasant and
in most cases painful. Identifying the factors that may contribute
to their acceptance might be beneficial for the patient and helpful
for the phyisician. We investigate the role of Pain Catastrophizing
(PCS) and its relation to patient reported and clinician rated pain.
Its role in the experience of pain during medical procedures has not
yet being investigated.
Material and methods: 143 consecutive outpatients undergoing
endoscopy from September to May, 2017 were enroled. Gender (57%
females), age (M =57.83; SD =17.17), body mass index (M =25.28;
SD =4.22) and previous endoscopic experiences (56%). During endoscopy,
operators evaluated the patient using the Pain Assessment
in Advanced Dementia (PAINAD) Scale. The Ramsay Sedation Scale
(RSS) was used to assess patient’s level of consciousness and
sedation effectiveness. After endoscopy and before discharge patients
reported about pain and discomfort during the procedure.
A total score for self-reported pain was derived through principal
component analysis of visual-analogue, verbal, numerical and face
scales. The Pain Catastrophizing Scale (PCS) was also administered
to retrospectively assess patient’s aptitude for catastrophic pain.We
carried out regression and mediation analyses to test study’s main
hypotheses.
Results: Age, gender, BMI and previous endoscopic experiences
were uncorrelated with clinician reported pain. As it regards self reported
pain, the analysis revealed marginally significant differences
by gender (p=0.05) and age (p people reporting more pain. Pain catastrophizing was significantly
larger for women (p predicted patient self reported pain (Beta = +0.646; p R2=0.41). PCS was also associated with self-reported pain (Beta =
+0.584; p relationship between clinician rated pain and self reported pain
was accounted for by PCS (Indirect Effect of clinician rated pain on
self reported pain through PCS = +0.191; [+0.142; +0.258]). Nevertheless,
clinician rated pain (Beta = +0.264; p was predictive of self reported pain controlling for PCS. Mediation
analyses results were robust controlling for gender, age and body
mass index as well as for previous endoscopic experiences and
types of endoscopic procedure.
Conclusions: PC was found to play a central role in the experience
of pain during both upper and lower endoscopy. While similar
findings have been reported in the context of chronic pain studies,
this is the first study showing that catastrophizing is also important
in the experience of pain during medical procedure. In order to
make endoscopic procedures more acceptable and to facilitate the
medical examination by the operator, non farmacological interventions
on PCS might disclose an avenue for future research and
clinical practice.