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Perioperative Pain Correlates and Prolonged Postoperative Pain Predictors: Demographic and Psychometric Questionnaires.

ABSTRACT: INTRODUCTION:Perioperatively, patients are near-guaranteed to experience acute pain by virtue of the surgical tissue insult. The transition of acute pain to pathological chronic pain is a complex and poorly understood process. To study this, the prevalence of pain was examined preoperatively, and at 6 weeks and 3 months postoperatively. METHODS:Fifty-four patients undergoing moderate-major gynaecological surgery at Christchurch Women's Hospital (Christchurch, New Zealand) were recruited over a period of 11 weeks. Follow-up by telephone was conducted at 6 weeks and 3 months following surgery. Demographic information including age, gender, ethnicity, work, and education status were collected, as well as aspects of medical history. Participants were subjected to psychometric questionnaires at each time-point. RESULTS:Of the participants, 15.7% experienced significant pain at 6 weeks postoperatively; 8.2% of participants experienced significant pain at 3 months postoperatively. The psychometric questionnaires used found differences between those experiencing pain and those not experiencing pain at given observation points. Only the Brief Illness Perception Questionnaire (BIPQ) appeared predictive of developing prolonged postoperative pain. The mean difference (7.4 on a 0-50) scale should assist in clinical decision-making regarding analgesia. CONCLUSION:Only the BIPQ was predictive of developing prolonged postoperative pain. While none of the demographic factors observed significantly predicted the development of 'prolonged pain', the not significant data followed expected trends. Several relationships were detected in this study that should further efforts in developing preoperative predictors to promote the secondary prevention of postoperative pain states.

SUBMITTER: MacLachlan C

PROVIDER: S-EPMC4470970 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:OBJECTIVES:Inadequate postoperative pain control is common and is associated with poor clinical outcomes. This study aimed to identify preoperative predictors of poor postoperative pain control in adults undergoing inpatient surgery. DESIGN:Systematic review and meta-analysis DATA SOURCES: MEDLINE, Embase, CINAHL and PsycINFO were searched through October 2017. ELIGIBILITY CRITERIA:Studies in any language were included if they evaluated postoperative pain using a validated instrument in adults (≥18 years) and reported a measure of association between poor postoperative pain control (defined by study authors) and at least one preoperative predictor during the hospital stay. DATA EXTRACTION AND SYNTHESIS:Two reviewers screened articles, extracted data and assessed study quality. Measures of association for each preoperative predictor were pooled using random effects models. RESULTS:Thirty-three studies representing 53 362 patients were included in this review. Significant preoperative predictors of poor postoperative pain control included younger age (OR 1.18 [95% CI 1.05 to 1.32], number of studies, n=14), female sex (OR 1.29 [95% CI 1.17 to 1.43], n=20), smoking (OR 1.33 [95% CI 1.09 to 1.61], n=9), history of depressive symptoms (OR 1.71 [95% CI 1.32 to 2.22], n=8), history of anxiety symptoms (OR 1.22 [95% CI 1.09 to 1.36], n=10), sleep difficulties (OR 2.32 [95% CI 1.46 to 3.69], n=2), higher body mass index (OR 1.02 [95% CI 1.01 to 1.03], n=2), presence of preoperative pain (OR 1.21 [95% CI 1.10 to 1.32], n=13) and use of preoperative analgesia (OR 1.54 [95% CI 1.18 to 2.03], n=6). Pain catastrophising, American Society of Anesthesiologists status, chronic pain, marital status, socioeconomic status, education, surgical history, preoperative pressure pain tolerance and orthopaedic surgery (vs abdominal surgery) were not associated with increased odds of poor pain control. Study quality was generally high, although appropriate blinding of predictor during outcome ascertainment was often limited. CONCLUSIONS:Nine predictors of poor postoperative pain control were identified. These should be recognised as potentially important factors when developing discipline-specific clinical care pathways to improve pain outcomes and to guide future surgical pain research. PROSPERO REGISTRATION NUMBER:CRD42017080682.

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Perioperative Pain Correlates and Prolonged Postoperative Pain Predictors: Demographic and Psychometric Questionnaires.

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