Identifying neuropathic pain and the effects of perioperative psychological intervention in patients with gastric cancer

Abstract

BACKGROUND

Patients with gastric cancer (GC) often experience complex pain, including a neuropathic component, which may influence their response to perioperative interventions.

AIM

To identify neuropathic pain (NP) components in patients with GC and evaluate the clinical efficacy of perioperative psychological interventions.

METHODS

The study comprised 100 patients with GC who underwent surgical treatment at Jiujiang No. 1 People’s Hospital between April 2022 and April 2025. Using randomized number tables, the participants were allocated into either an observation (n = 50) or control (n = 50) group. The control group received conventional perioperative pain management, while the observation group received additional perioperative psychological interventions. Between-group differences were compared in terms of pain intensity, pain characteristics, anxiety and depression levels, postoperative analgesic consumption, early postoperative recovery, and recovery quality.

RESULTS

On postoperative day 7, both groups exhibited higher Numeric Rating Scale scores for resting and activity pain than that demonstrated on preoperative day 1 (P < 0.05), while Hospital Anxiety and Depression Scale (HADS)-Anxiety and HADS-Depression scores were also lower (P < 0.05). Regarding the primary outcomes, patients in the observation group exhibited lower Numeric Rating Scale scores for resting and activity-related pain and a lower NP-positivity rate than those in the control group (P < 0.05). For the secondary outcomes, patients in the observation group had fewer effective presses for intravenous patient-controlled analgesia, lower morphine equivalents, earlier time to first ambulation, earlier time to first flatus, shorter hospital stays, and higher Quality of Recovery-15 scores compared with the control group (P < 0.05). Moreover, their HADS-Anxiety and HADS-Depression scores were also lower than those in the control group (P < 0.05). Stratified regression analysis revealed significant main effects of group assignment and NP status (P < 0.05), with a significant interaction term between group assignment and NP status (P < 0.05).

CONCLUSION

Effective identification of the NP component in the patients’ pain, coupled with perioperative psychological interventions, significantly reduced pain intensity and NP-positivity rates. This approach improved anxiety and depressive symptoms, decreased postoperative analgesic use, accelerated early recovery, and enhanced quality of recovery.

Keywords: Gastric cancer; Pain; Neuropathic; Perioperative; Psychological intervention

Core Tip: Neuropathic pain (NP) components are common but often overlooked in patients undergoing surgery for gastric cancer. Identifying NP components and combining standard perioperative pain management with psychological interventions can significantly alleviate pain intensity, reduce NP positivity, improve emotional well-being, and decrease analgesic consumption. Moreover, such identification accelerates postoperative recovery and enhances overall recovery quality, emphasizing the clinical value of integrating psychological care into perioperative pain management.