Anxiety is an independent risk factor for greater opioid usage and elevated pain post-surgery.

The correlation and evolution of perioperative anxiety, pain, and opioid usage after common surgical procedures were investigated in a prospective cohort research.

A total of 1771 individuals undergoing elective surgery were enrolled. On the day of surgery, as well as one month, three months, and six months after surgery, the patient's self-reported opioid usage, pain (as measured by the Brief Pain Inventory), and anxiety (as measured by the Patient-Reported Outcome Measurement Information System [PROMIS] Anxiety) were recorded.

A PROMIS Anxiety T-score of ≥55 was considered clinically meaningful. Using mixed-effects regression models that were adjusted for variables, postoperative opioid usage was explored in terms of surgical site pain and anxiety. Furthermore, anxiety was assessed as a mediator between pain and opioid usage.

Overall, 30% of individuals at baseline reported statistically significant anxiety, and 65% completed all follow-ups. Anxiety and pain at the surgical site peaked on the day of the procedure (anxiety: mean=49.3, Standard Deviation (SD)=9.0; pain: mean=4.3, SD=3.3) and then decreased during the observation period. In comparison to volunteers who did not experience anxiety, volunteers with anxiety reported increased opioid use (Odd ratio=1.40) and a 1.14-point elevation in patient-reported surgical pain. Anxiety did not substantially mediate the relation between opioid usage and pain.

Anxiety appears to exacerbate pain and opioid usage after surgery. Future research on specific behavioral interventions to lower anxiety during perioperative time may have a positive effect on opioid usage and postoperative pain.