Socially connected people do better after surgery

NEW YORK (Reuters Health) - People who have a strong social network feel less pain and anxiety before having surgery than their more isolated peers, according to a new study in VA patients. This translates to less pain and anxiety after the operation, less use of pain medication, and fewer days spent in the hospital, researchers report.

“Our hope is to try to put a spotlight on this for surgeons,” Dr. Daniel B. Hinshaw told Reuters Health. The findings make it clear, he explained, that surgeons should ask patients about their level of social support, and anticipate that people with less support may fare worse.

“The old John Donne reference ‘no man is an island’ is extremely relevant to our health,” he commented.

Hinshaw, at the VA Ann Arbor Healthcare System and the University of Michigan in Ann Arbor, and his colleagues had been conducting a study of massage therapy in 605 patients who underwent major surgery of the chest or abdominal area, and performed the current analysis to determine how social connectedness affected a variety of outcomes.

The researchers gauged social connectedness by counting how many close friends and relatives study participants had, how often they saw them, and whether they attended a place of worship or other social function at least once a week. Nearly 88 percent of the study participants reported having three or more friends or relatives they saw at least once a month, while 12 percent had less than three.

Individuals with larger social networks were less likely to have anxious personalities, and they felt less pain and anxiety before surgery, Hinshaw and his team report in the Journal of the American College of Surgeons.

Furthermore, in the five days after surgery, anxiety and depression were lower and sense of inner peace and relaxation were higher for the patients with larger social networks; these patients also felt less pain and felt that their pain was less unpleasant, and required fewer opiate drugs.

Patients with bigger social networks were also 16 percent less likely to spend seven or more days in the hospital.

Once the researchers used statistical methods to adjust for patients’ level of pain and anxiety before surgery, they found no relationship between outcomes and social network size. “This suggests that there is a strong association between social network size and preoperative pain and anxiety levels,” Hinshaw and his colleagues write.

This raises the “chicken and egg question,” the researcher said, of whether “people who are anxious personalities and may or may not have chronic pain tend to become socially isolated, or is the social isolation itself contributing to it. I think it may be very difficult to tease those apart because they’re thoroughly intertwined.”

Massage therapy could actually help provide the human connection that isolated people need to feel better, Hinshaw noted. His study found that massage had a pain relieving effect equivalent to a 1 milligram dose of morphine.

Nurses and doctors should be aware, he added, that they may play a unique role in the recovery of isolated patients. “For people who have limited social contact, it is the nurses, physicians, and other providers in the hospital setting who may be essentially their family.”

SOURCE: Journal of the American College of Surgeons, February 2008.