Relationship Between Postoperative Pain in Surgery and the Onset of Psychological Symptoms Such as Mental Anxiety and Depression

Abstract

Background: Postoperative pain is not only a primary source of physical discomfort but also a significant risk factor that can trigger or exacerbate mental and psychological symptoms such as anxiety and depression. This study aimed to explore the interrelationship between postoperative pain and mental psychological symptoms, such as anxiety and depression, and analyse the risk factors influencing postoperative mental psychological symptoms.

Methods: This study retrospectively collected clinical data of 411 surgical patients from March 2023 to April 2025 through an electronic medical record system. The Numeric Rating Scale (NRS) was used to assess preoperative and postoperative pains during rest and exercise. Postoperative pain was defined as a resting or exercise-evoked NRS score > 3 (moderate to severe pain). The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety (Hospital Anxiety and Depression Scale-Anxiety [HADS-A]) and depression (Hospital Anxiety and Depression ScaleDepression [HADS-D]). The relationship between postoperative pain and psychological symptoms, such as anxiety and depression, was explored through Spearman’s correlation analysis and univariate and multivariate logistic regression analysis.

Results: After surgery, 59.12% (243/411) of patients had chronic postsurgical pain (CPSP), 36.25% (149/411) had anxiety symptoms (HADS-A > 7) and 31.63% (130/411) had depression symptoms (HADS-D > 7). Regarding surgical specialty, orthopaedic surgery patients had the highest proportion of CPSP, accounting for 63.64% (91/143) of orthopaedic cases, which represented 22.14% (91/411) of the total cohort. Gynaecologic surgery patients showed the highest rates of postoperative anxiety (41.76%, 38/91) and depression (45.05%, 41/91) within their specialty. After surgery, the average resting and exercise NRS scores of patients were significantly reduced compared with preoperative levels (both p < 0.01). However, the average HADS-A and HADS-D scores were significantly higher than before surgery (p < 0.01). Spearman’s correlation analysis showed that postoperative resting NRS score was positively correlated with exercise NRS, HADS-A and HADS-D scores (p < 0.01). The correlation between HADS-A score and HADS-D score was not strong, whereasthe correlation between exercise NRS score and these psychological indicators was strong. Multivariate logistic regression analysis showed that postoperative pain is an independent risk factor for the occurrence of mental symptoms.

Conclusions: A statistically significant mutual association exists between postoperative pain and psychological symptoms in surgery.