• Ming Cheng, Huan Liu, Chenxi Pu, Guoying Chen, Yaer Zhang, and Li Yan.
• Department of Nursing, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Electronic address: 19558151824@163.com.
• Pain Manag Nurs. 2024 Aug 2.

BackgroundBoth cognitive (pain catastrophizing [PC]) and emotional factors (anxiety, depression, and optimism) play vital roles in acute postoperative pain (APOP) management among patients with traumatic orthopedic injuries (TOIs). It remains uncertain if these psychological factors independently or collectively impact APOP in patients with TOIs, and the underlying mechanisms by which various psychological factors impact APOP in patients with TOIs are also ambiguous.PurposeThe aims of the current research were to analyze the effects of PC and emotional factors (anxiety, depression, and optimism) on APOP in patients with TOIs and explore the potential mechanisms by which PC and emotional factors influence APOP based on a hypothetical moderated mediation pathway mediated by pain-related fear.MethodsThis was an observational cross-sectional study.ResultsPC was a significantly positive predictor of APOP regardless of coexistence with emotional factors. TOI patients who had higher PC had more severe APOP (β = 0.57, standard error [SE] = 0.005, p < .01, adjusted R2 = 0.78; β = 0.84, SE = 0.003, p < .01, adjusted R2 = 0.77, respectively). Furthermore, when positive and negative emotions coexisted (adjusted R2 = 0.74), anxiety levels were a significant positive predictor of APOP (β = 0.71, SE = 0.009, p < .01) and optimism was a significant negative predictor of APOP (β = -0.24, SE = 0.008, p < .01). Pain-related fear played a mediating role in the association between the level of PC (effect = 0.044, 95% confidence interval [CI] = 0.027 to 0.062), anxiety (effect = 0.102, 95% CI = 0.075 to 0.137), and APOP in patients with TOIs. Optimism moderated the strength of the relationship between PC (95% CI = -0.020 to -0.010), anxiety (95% CI = -0.045 to -0.003), and APOP mediated by pain-related fear.ConclusionsClinical staff should assess the level of PC and emotional factors to identify TOI patients at high risk for APOP, subsequently facilitating the optimization of pain management and efficient utilization of nursing resources through early discussion.Copyright © 2024 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

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