Assessment of pain experiences after elective surgery

Pain in the postoperative period has remained a clinical problem in spite o f major progress in pain assessment and management. The aim of the present study was to describe in detail the time course of pain experiences of surg ical patients (n = 200) following elective surgical procedures. Visual anal ogue scale (VAS, 0-100 mm) was used for pain intensity ratings at 4, 24, 48 , and 72 hours after surgery. Interviews were carried out to assess the occ urrence of intermittent worst pain episodes during each 24-hour period and to relate such experiences to clinical events. At 4, 24, 48, and 72 hours p ostoperatively, 39%, 43%, 27%, and 16% of the patients, respectively, exper ienced moderate or even severe pain (VAS greater than or equal to 40 mm) at rest. During the first 24 hours after surgery, 88% of the patients had exp erienced moderate or severe pain at some time (VAS greater than or equal to 40 mm). corresponding figures for the following 24 hour periods were 81% a nd 72%, respectively. spontaneous pain breakthrough and movement/mobilizati on were identified as reasons for the worst pain episodes during the first 72-hour period after surgery. The probability of pain intensity of VAS >40 mm was calculated from individual regression functions. The probability was found to be much higher for patients receiving parental analgesics than fo r patients receiving prolonged epidural analgesia. Despite major improvemen ts in pain assessment and management, postoperative patients often experien ce moderate to severe pain, and worst pain episodes occur even in the late postoperative phase. The present study emphasizes that in the clinical rout ine management of pain, further quality assurance efforts are necessary J. Pain Symptom Manage 2000; 20: 193-201. (C) U.S. Cancer Pain Relief Committe e, 2000.