OC.01.3 Pain catastrophizing and pain experience during endoscopic procedures

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<0.05) with women and younger people reporting more pain. Pain catastrophizing was significantly larger for women (p<0.01). Clinician rated pain during the procedure predicted patient self reported pain (Beta = +0.646; p<0.001; R2=0.41). PCS was also associated with self-reported pain (Beta = +0.584; p<0.001; R2=0.34). Mediation analyses revealed that the 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<0.001; R2=0.41) still 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.