Abstract
The purpose of this study was to demonstrate a method for increasing the precision
and information yield of postoperative pain assessment. We recorded pain intensity
ratings over 6 days after surgery in 502 elective surgery patients and examined individual
pain trajectories. A linear fit of an individual patient's scores defines a trajectory
with two features: (1) the intercept or initial pain intensity; and (2) the slope,
or rate of pain resolution. Three pain trajectory patterns emerged from examination
of the pain trajectory slopes. Most patients (63% of the sample) demonstrated a negative
slope trajectory characterized by a decline in pain intensity over days after surgery.
Other patients (25% of the sample) demonstrated a flat trajectory with no meaningful
change over 6 days from pain they reported initially. A third patient group (12% of
the sample) had a positive slope trajectory in which pain scores increased over 6
days after surgery. Measures derived from individual pain trajectories yielded much
lower standard errors of measurement and therefore had better measurement precision
than did conventional pain assessment methods. Pain trajectory measures proved sufficiently
precise to characterize pain patterns reliably in individual patients.
Perspective
Progress in acute pain management requires effective pain assessment. The acute pain
trajectory quantifies rate of pain resolution as well as pain intensity. It affords
more precise measurement than conventional pain assessment and can identify abnormal
postoperative pain resolution.
Key words
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References
- Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged.Anesth Analg. 2003; 97: 534-540
- Patient-reported outcomes and the mandate of measurement.Qual Life Res. 2008; 17: 1303-1313
- Psychosocial predictors and correlates for chronic post-surgical pain (CPSP): A systematic review.Eur J Pain. 2009; 13: 719-730
- Chronic post-surgical pain: 10 years on.Br J Anaesth. 2008; 101: 77-86
- Chronic pain as an outcome of surgery: A review of predictive factors.Anesthesiology. 2000; 93: 1123-1133
- Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention.Ann Surg. 2007; 245: 487-494
- Using SAS PROC MIXED to fir multilevel models, hierarchical models, and individual growth models.J Educ Behav Stat. 1998; 23: 323
- Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence.Oxford University Press, Inc, New York2003
- The prevalence of postoperative pain in a sample of 1490 surgical inpatients.Eur J Anaesth. 2008; 25: 267-274
- Multimodal analgesia: Its role in preventing postoperative pain.Curr Opin Investig Drugs. 2008; 9: 76-82
Article info
Publication history
Published online: January 18, 2011
Accepted:
August 4,
2010
Received in revised form:
July 13,
2010
Received:
May 5,
2010
Footnotes
Supported by a grant to Dr Chapman from the National Institutes of Health (R01 NR009542).
The authors have no conflicts of interest.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
