I work as a nurse in a day-surgery clinic. People come in for all kinds of procedures that don’t require an overnight stay. I don’t ever see them afterwards. But I wonder about some of them and how they do in their recovery process. Is there any data that shows whether the patients who are so fearful recover more slowly than the easy-going patients?

Fearful patients may engage in behavior called catastrophizing. This refers to a person who feels helpless and tends to think the worst when in pain. They seem unable to cope, and they focus on their symptoms in detail.

It turns out that these folks are more likely to become chronic pain patients after surgery or in association with conditions like fibromyalgia or low back pain. And researchers are making headway in figuring out what’s the mechanism behind the behavior and the physiologic response.

Some experts have suggested catastrophizing might enhance or turn up the pain barometer. There may be social or emotional factors. There might be a specific neural (nerve) pathway that gets turned on. Or, as the results of a recent study showed, there could be an inflammatory process at the heart of the problem.

In that study, people who catastrophized had higher levels of an inflammatory messenger called interleukin-6 or IL-6. The results of blood tests measuring cortisol and IL-6 after painful stimuli suggest that mental and emotional responses during pain experiences can lead to inflammatory immune responses. This sets up a cycle of inflammation, pain, and further catastrophizing.

So your easy-going patients may very well have an easier recovery while the fearful folks are at increased risk for chronic pain after a physical trauma or injury (including surgery).