Some pain after a major operation is expected -- but some patients suffer more than others. More than 60% of surgical patients have moderate-to-severe postoperative pain, potentially predisposing them to persistent postsurgical pain.
But who falls into which category?
To better predict patients’ pain -- and thereby provide better treatment -- researchers at the University of Florida studied a large group of surgical patients to identify different pain trajectories.
The team’s work published in _Anesthesiolog_y revealed five distinct patterns determined in large part by patient-specific factors such as age, sex, and psychologic features.
The researchers monitored patents’ pain reports for 7 days in 360 patients recovering from a variety of different surgeries. Pain was evaluated using the [Brief Pain Inventory], which asks for a patient’s average, worst, and least pain in the last 24 hours on a scale from zero to 10.
The team also collected clinical and sociodemographic information and data on the patients’ preoperative mental and behavioral health.
The researchers then used that information to perform group-based trajectory modeling and identify clusters of patients with similar pain trajectories. The best-fitting model pulled out 5 different trajectory groups: patients with low, moderate-to-low, moderate-to-high, and high pain over time, and one in which pain decreased rapidly.
Nearly**_ half_** of patients belonged to the moderate-to-high pain group, while only 6 percent of patients fell into the rapidly decreasing pain group.
Generally, younger patients and women were more likely to belong to the higher-pain groups, and those in the highest pain group had higher anxiety and depression and greater pain behaviors before surgery.
Patients in the moderate-to-high and high pain groups also took more opioids following surgery, although opioids taken before or during surgery were not associated with the pain trajectory group.
Perhaps surprisingly, there was no link between the surgical procedure type and the trajectory groups. That’s despite the patient cohort including multiple surgery types associated with severe and prolonged pain, such as spinal, thoracic, and orthopedic surgeries.
Additionally, there was no connection between the pain trajectory group and whether patients received regional anesthesia.
The findings suggest that patient sociodemographic and behavioral factors may be more important than procedural factors in determining how a person experiences post-surgical pain over time.