Abstract
Injuries and degenerative disease of the skeletal and articular systems are the most common reasons for undergoing orthopaedic surgery. Those diseases are often associated with pain, which is experienced by the patient long before the surgical procedure. Strong stress reaction is the main source of adjustment disorders of patients undergoing surgical treatment. Orthopaedic surgery, like any other surgery, upsets body's homeostasis. The results of the surgery are not completely predictable, but are always closely related to life and health. Patients' strong stress reaction is also connected with anaesthesia (emergence from anaesthesia), being worried of complications caused by central neuraxial anaesthesia – the fear of paresis or death. The factor which influences worse adaptation process is the patients' post-surgery mood. Right after the surgery, patients feel worse than before it, they are weak, move less freely, they are anxious about their consciousness being dimmed due to medicine intake and pain. The expectations concerning the ways of controlling the dynamics of the pain one experiences are crucial. According to the researchers, in the central nervous system there exist neural circuits that may cause physiological reactions according to one's expectations, and due to this fact the pain one experiences may become stronger or alleviated depending on one's expectations. The lack of positive pain-reducing experience may lead to the learned helplessness or no sense of one's control over pain, both of which make the pain stronger. The pain-influencing factors include cognitive processes and emotions. The role of attention processes, one's cognitive appraisal and one's attitude towards pain has been emphasised, as well as the pain-modelling influence of emotions, all of which emphasise the complexity of one's pain experience. Patients, when asked to point out the factors that hinder effective pain therapy, indicate frustration caused by the lack of information, numerous worries concerning the treatment and the stereotypical image of pain. Relieving tension influences the patient's mood positively, whilst stress influences it in a negative way. The stress one experiences and one's emotions lower one's pain threshold, which leads to greater pain experience and thus makes the healing process last longer. The quality of pre- and post-operational care is thus crucial, as it influences the level of the experienced stress. The pain components influence one another, there occur interactions of biological, psychological and situational factors, which makes it advisable to personalise one's pain treatment. The need of an interdisciplinary approach towards a person, especially to their health, has been recently emphasised. Pain is a biopsychosocial occurrence, which makes pain therapy an interdisciplinary problem. This chapter discusses the following issues: 1) The characteristics of pain in conditions that require surgical treatment,2) Surgery-related stress reaction, 3) Psychological factors which influence how one feels pain, 4) The consequences of pain in people's functioning, and 5) Postoperative pain, the assessment of pain level and its relieving.