The Biobehavioral Relationship between Pain and Stress in Postoperative Oropharyngeal Cancer Patients

Abstract

Pain is a common and distressful symptom in patients with head and neck cancer (HNC) and continues to be present during the postoperative period after otolaryngological surgery. Increased and unrelieved postoperative pain and stress can alter immune function than can lead to medical complications such as impaired wound healing and increased metastasis susceptibility. The goal of this pilot study is to explore the relationship of pain and stress postoperatively in HNC patients who have undergone otolaryngological surgery. This study utilizes the psychoneuroimmunological (PNI) framework and will measure pain and stress using behavioral, psychological and biological measures consisting of the Wong-Baker FACES or Numerical Rating Scale for pain, the Distress Checklist, and salivary cortisol and alpha amylase. Methods and Design: A repeated-measures descriptive correlational study included 13 hospitalized HNC patients who had undergone otolaryngological surgery with a split-thickness skin graft. This pilot study is part of a larger, two year study investigating the effects of wound healing using two different types of post surgical dressing in HNC patients. Methods consisted of collecting the pain and stress data within a specific four hour time period for one pain episode in the evening of postoperative days two and four, and in the morning of postoperative days three and five. Analysis: The data collected was analyzed using descriptive statistics, correlations and repeated measures ANOVA. Results: Data from this pilot study indicate that acute postoperative head and neck patients do experience clinically significant levels of pain and stress, even though statistical significance was unable to be shown with the small sample size and limited methods of measurement. Implications: Providing another link in the continued understanding of the pain and stress relationship could lead to improved treatments specifically targeted for head and neck cancer patients undergoing otolaryngological surgery.