Study: Patients most likely to overestimate pain following surgery

Patients significantly overestimate the anticipated amount of pain they'll experience following surgery, which researchers say can cause unnecessary anxiety in patients, according to a study being presented at the ANESTHESIOLOGY^® 2017 annual meeting. Patients who receive regional anesthesia, such as peripheral nerve blocks, epidurals or spinal anesthesia, were most likely to overestimate their postoperative pain.

"We believe providers need to do a better job of counseling patients on realistic pain expectations," said study co-author Jaime L. Baratta, M.D., director of regional anesthesia at Thomas Jefferson University Hospital in Philadelphia. "This is especially true for patients receiving regional anesthesia who may not fully understand the benefits of nerve blocks and other regional anesthesia procedures aimed at preventing postoperative pain."

During regional anesthesia, the physician anesthesiologist makes an injection near a cluster of nerves to numb the area of the body that requires surgery. The patient may remain awake or be given a sedative. Either way, the patient does not feel the surgery taking place.

Patients receiving regional anesthesia before surgery may experience unnecessary anxiety and have exaggerated pain expectations simply because they do not understand regional anesthesia's pain relieving benefits, the researchers said.

The study included 223 patients, averaging 61 years old, who were undergoing orthopedic, neurosurgical, or general surgery procedures. Of these, 96 received some type of regional anesthesia (spinal, epidural or peripheral nerve block). Of the 96 patients, 80 had no general anesthesia, while 16 had general anesthesia with a peripheral nerve block before or after surgery. The remaining 127 patients received only general anesthesia. Patients completed a questionnaire before surgery to evaluate what level of postoperative pain they expected on a 0-10 scale. Following surgery, they were asked about their level of pain in the post-anesthesia care unit (PACU) one hour following surgery and on the first day after surgery.

Patients' average expected pain rating immediately following surgery was 4.66, compared to an actual pain rating of 2.56. The average expected pain rating on the first day after surgery was 5.45, compared to an actual pain rating of 4.30.

Patients who had regional anesthesia had an average expected pain rating in the PACU of 4.63, compared to an actual pain rating of 0.92. The average expected pain rating for these patients on the first day after surgery was 5.47, compared to an actual pain rating of 3.45.

"With advancements in regional anesthesia, great strides have been made in preventing postoperative pain. Given the clear benefit of patient education and anxiety alleviation on postoperative pain, providers must find ways to effectively manage patient expectations to help improve outcomes," said study co-author Amir C. Dayan, M.D.