Patient perspective important in postoperative pain management

By Laura Cowen, medwireNews Reporter

Satisfaction with postoperative pain treatment is more strongly associated with patients’ impressions of improvement and appropriateness of care than their actual pain experience, results of a large international study show.

The data indicate that “[i]t would be inappropriate to focus on low pain intensity values as the sole driver and aim of postoperative pain management”, write Matthias Schwenkglenks (University of Basel, Switzerland) and study co-authors in Pain.

Their findings are based on patient responses to the International Pain Outcomes (IPO) Questionnaire, which was administered to all participants of PAIN OUT, a European Union funded registry and research project aimed at improving postoperative pain management.

The current analysis included 16,868 patients (mean age 55 years, 55% women) from 42 clinical centres in 15 countries who had undergone a wide range of surgical procedures, most commonly trauma, orthopaedic, abdominal, gynaecological or thyroid surgery.

On day 1 post surgery, the mean score for treatment satisfaction was 9 (on a scale of 1–10). Higher satisfaction was most strongly associated with higher pain relief received, greater participation in pain treatment decisions and having no desire to have received more pain treatment.

Taken together these three IPO items accounted for 35% of the variation in treatment satisfaction.

Interestingly, the underlying relationships for both pain relief received and participation in pain treatment decisions were U-shaped; patients with very low relief or very low participation reported higher satisfaction than patients with some relief and some satisfaction.

“This may be because these patients experienced only little pain or did not expect any relief [and] may not have considered participation as an option or may not have been interested in participation”, Schwenkglenks et al remark.

Patient factors and additional IPO items reflecting pain experience, pain-related impairment and information on pain treatment received provided little additional explanatory value.

“This was partially due to correlations between covariates,” say the researchers.

In particular, worst pain intensity, time spent in severe pain, pain interference with sleep and emotional impairment showed strong correlation with pain relief received and having no desire to have received more pain treatment.

Of note, Schwenkglenks and team found that their results were “strikingly consistent” across centres from different geographical regions, with the majority of variation occurring at the individual patient level.

“While further research is needed, our findings support that the patient perspective should be assessed and valued in the care process”, they conclude, adding: “To the degree they desire, patients should be provided with information and involved in postoperative pain treatment decisions.”

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