PREDICTION AND ASSESSMENT OF THE SEVERITY OF POSTOPERATIVE PAIN AND OF SATISFACTION WITH MANAGEMENT

A prospective observational study of cohorts of patients undergoing hi p replacement (30), knee replacement (31), and spinal nerve root decom pressive surgery (30) were interviewed pre-operatively to identify fac tors which might correlate with and potentially predict severe post-op erative pain and dissatisfaction with analgesic management. The hip pa tients comprised 33% females and averaged 64 years, while the knee pat ients were 45% female and older (mean 71 years) and the spinal patient s were 33% female and averaged 50 years. The three groups were similar with respect to all other pre-operative variables. Pain intensity was assessed mainly by self-report using the Present Pain Intensity (PPI) and Visual Analogue Scales (VAS) of the McGill Pain Questionnaire. Th e PPI was preferred by patients and nurses and, as there were no analy tical advantages for the VAS, the PPI data are presented. The average post-operative pain during routine management mainly with patient cont rolled intravenous opiate, was mild to moderate and declined over days 1-5, declined further at discharge but rose slightly 1 month after di scharge. The hip replacement patients experienced significantly (P < 0 .01) less pain overall than the patients in the other two groups. Nurs es' assessments of pain severity from observed behaviour were low and agreed poorly with the patients' self reports. Assessed on Likert Scal es (0-6), the patients generally indicated good or excellent pain cont rol, better than expected pain experience, and high levels of satisfac tion with analgesic management. Significant (P less than or equal to 0 .01) multivariate correlates of severe postoperative pain assessed by logistic regression analysis of 11 variables were female gender, high pre-operative pain severity, and younger ace. Significant (P less than or equal to 0.01) multivariate correlates of both worse than expected pain experience and low satisfaction were female gender, high pre-ope rative pain severity, high anxiety about risks and problems, low expec ted pain severity, age (younger) and high willingness to report pain. These variables may reasonably be tested in further studies as potenti al predictors of adverse post-operative pain experience. (C) 1998 Inte rnational Association for the Study of Pain. Published by Elsevier Sci ence B.V.