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Desire to Receive More Pain Treatment – A Relevant Patient-Reported Outcome Measure to Assess Quality of Post-Operative Pain Management? Results From 79,996 Patients Enrolled in the Pain Registry QUIPS from 2016 to 2019

Published:January 19, 2021DOI:https://doi.org/10.1016/j.jpain.2021.01.002

      Highlights

      • Pain intensity alone cannot fully capture the complexity of postsurgical pain.
      • Desire to receive more pain treatment is a helpful patient-reported outcome measure.
      • Desire to receive more pain treatment adds new perspective to pain treatment quality.
      • Patient information and participation decrease the need for pain treatment.

      Abstract

      Acute postoperative pain is frequently evaluated by pain intensity scores. However, interpretation of the results is difficult and thresholds requiring treatment are not well defined. Additional patient-reported outcome measures (PROMs) might be helpful to better understand individual pain experience and quality of pain management after surgery. We used data from the QUIPS pain registry for a cross-sectional study in order to investigate associations between the desire to receive more pain treatment (D2RMPT) with pain intensity ratings and other PROMs. Responses from 79,996 patients were analyzed, of whom 10.7% reported D2RMPT. A generalized estimating equation Poisson model showed that women had a lower risk ratio (RR) to answer this question with “yes” (RR: .92, P < .001). Factors that increased the risk most were “maximal pain intensity ≥ 6/10 on a numerical rating scale” (RR: 2.48, P < .001) and “any pain interference” (RR: 2.48, P < .001). The largest reduction in risk was observed if patients were “allowed to participate in pain treatment decisions” (RR: .41, P < .001) and if they felt that they “received sufficient treatment information” (RR: .58, P < .001). Our results indicate that the (easily assessed) question D2RMPT gives additional information to other PROMs like pain intensity. The small proportion of patients with D2RMPT (even for high pain scores) opens the discussion about clinicians’ understanding of over- und under-treatment and questions the exclusive use of pain intensity as quality indicator. Future studies need to investigate whether asking about D2RMPT in clinical routine can improve postoperative pain outcome.

      Perspective

      This article presents characteristics of the patient-reported outcome measure “Desire to receive more pain treatment.” This measure could be used to apply pain treatment in a more individualized way and lead to improved treatment strategies and quality.

      Key Words

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      References

        • Adamczyk AK
        • Ligeza TS
        • Wyczesany M.
        The dynamics of pain reappraisal: the joint contribution of cognitive change and mental load.
        Cogn Affect Behav Ne. 2020; 20: 276-293
        • Cooper SA
        • Desjardins PJ
        • Turk DC
        • Dworkin RH
        • Katz NP
        • Kehlet H
        • Ballantyne JC
        • Burke LB
        • Carragee E
        • Cowan P
        • Croll S
        • Dionne RA
        • Farrar JT
        • Gilron I
        • Gordon DB
        • Iyengar S
        • Jay GW
        • Kalso EA
        • Kerns RD
        • McDermott MP
        • Raja SN
        • Rappaport BA
        • Rauschkolb C
        • Royal MA
        • Segerdahl M
        • Stauffer JW
        • Todd KH
        • Vanhove GF
        • Wallace MS
        • West C
        • White RE
        • Wu C.
        Research design considerations for single-dose analgesic clinical trials in acute pain: IMMPACT recommendations.
        Pain. 2016; 157: 288-301
        • Correll DJ
        • Vlassakov KV
        • Kissin I.
        No evidence of real progress in treatment of acute pain, 1993-2012: scientometric analysis.
        J Pain Res. 2014; 7: 199-210
        • Gerbershagen HJ
        • Aduckathil S
        • van Wijck AJ
        • Peelen LM
        • Kalkman CJ
        • Meissner W.
        Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.
        Anesthesiology. 2013; 118: 934-944
        • Gerbershagen HJ
        • Rothaug J
        • Kalkman CJ
        • Meissner W.
        Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods.
        Brit J Anaesth. 2011; 107: 619-626
        • Gordon DB
        • Polomano RC
        • Pellino TA
        • Turk DC
        • McCracken LM
        • Sherwood G
        • Paice JA
        • Wallace MS
        • Strassels SA
        • Farrar JT.
        Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: preliminary psychometric evaluation.
        J Pain. 2010; 11: 1172-1186
        • Gruss S
        • Treister R
        • Werner P
        • Traue HC
        • Crawcour S
        • Andrade A
        • Walter S.
        Pain intensity recognition rates via biopotential feature patterns with support vector machines.
        PLoS One. 2015; 10
        • Halekoh U
        • Hojsgaard S
        • Yan J.
        The R Package geepack for generalized estimating equations.
        J Stat Softw. 2006; 15: 1-11
        • Henderson LA
        • Di Pietro F
        • Youssef AM
        • Lee S
        • Tam S
        • Akhter R
        • Mills EP
        • Murray GM
        • Peck CC
        • Macey PM.
        Effect of expectation on pain processing: A psychophysics and functional MRI analysis.
        Front Neurosci-Switz. 2020; 14: 6
        • Ip HYV
        • Abrishami A
        • Peng PWH
        • Wong J
        • Chung F.
        Predictors of postoperative pain and analgesic consumption a qualitative systematic review.
        Anesthesiology. 2009; 111: 657-677
        • Joshi GP
        • Van de Velde M
        • Kehlet H
        • Collaborators PWG.
        Development of evidence-based recommendations for procedure-specific pain management: PROSPECT methodology.
        Anaesthesia. 2019; 74: 1298-1304
        • Koyama T
        • McHaffie JG
        • Laurienti PJ
        • Coghill RC.
        The subjective experience of pain: Where expectations become reality.
        P Natl Acad Sci USA. 2005; 102: 12950-12955
        • Liang KY
        • Zeger SL.
        Longitudinal data-analysis using generalized linear-models.
        Biometrika. 1986; 73: 13-22
        • Marcus H
        • Gerbershagen HJ
        • Peelen LM
        • Aduckathil S
        • Kappen TH
        • Kalkman CJ
        • Meissner W
        • Stamer UM.
        Quality of pain treatment after caesarean section: Results of a multicentre cohort study.
        Eur J Pain. 2015; 19: 929-939
        • Meissner W
        • Mescha S
        • Rothaug J
        • Zwacka S
        • Goettermann A
        • Ulrich K
        • Schleppers A.
        Quality improvement in postoperative pain management results from the QUIPS Project.
        Dtsch Arztebl Int. 2008; 105 (865-U868)
        • Meissner W
        • Zaslansky R.
        A survey of postoperative pain treatments and unmet needs.
        Best Pract Res-Clin. 2019; 33: 269-286
        • Moore RA
        • Straube S
        • Aldington D.
        Pain measures and cut-offs - no worse than mild pain as a simple, universal outcome.
        Anaesthesia. 2013; 68: 400-412
        • Rothaug J
        • Weiss T
        • Meissner W.
        How simple can it get? Measuring pain with NRS items or binary items.
        Clin J Pain. 2013; 29: 224-232
        • Schnabel A
        • Yahiaoui-Doktor M
        • Meissner W
        • Zahn PK
        • Pogatzki-Zahn EM.
        Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients.
        Pain Rep. 2020; 5: e831
        • Schug SA
        • Palmer GM
        • Scott DA
        • Halliwell R
        • Trinca J.
        Acute pain management: scientific evidence, fourth edition, 2015.
        Med J Australia. 2016; 204 (315-U356)
        • Schwenkglenks M
        • Gerbershagen HJ
        • Taylor RS
        • Pogatzki-Zahn E
        • Komann M
        • Rothaug J
        • Volk T
        • Yahiaoui-Doktor M
        • Zaslansky R
        • Brill S
        • Ullrich K
        • Gordon DB
        • Meissner W.
        Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry.
        Pain. 2014; 155: 1401-1411
        • Sommer M
        • de Rijke JM
        • van Kleef M
        • Kessels AGH
        • Peters ML
        • Geurts JW
        • Patijn J
        • Gramke HF
        • Marcus MAE.
        Predictors of acute postoperative pain after elective surgery.
        Clin J Pain. 2010; 26: 87-94
        • Tighe PJ
        • Le-Wendling LT
        • Patel A
        • Zou BM
        • Fillingim RB.
        Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery.
        Pain. 2015; 156: 609-617
        • van Dijk JF
        • van Wijck AJ
        • Kappen TH
        • Schuurmans MJ.
        Postoperative pain assessment should not be solely based on numeric ratings! Commentary on van Dijk et al. (2011) Response.
        Int J Nurs Stud. 2012; 49: 632-633
        • van Dijk JFM
        • Kappen TH
        • Schuurmans MJ
        • van Wijck AJM.
        The relation between patients' NRS pain scores and their desire for additional opioids after surgery.
        Pain Pract. 2015; 15: 604-609
        • Whitburn LY
        • Jones LE
        • Davey MA
        • McDonald S.
        The nature of labour pain: An updated review of the literature.
        Women Birth. 2019; 32: 28-38
        • Yan J
        • Fine J.
        Estimating equations for association structures.
        Stat Med. 2004; 23: 859-874
        • Yao ZF
        • Hsieh SL.
        Neurocognitive mechanism of human resilience: A conceptual framework and empirical review.
        Int J Env Res Pub He. 2019; 16: 5123
        • Yelland LN
        • Salter AB
        • Ryan P.
        Performance of the modified poisson regression approach for estimating relative risks from clustered prospective data.
        Am J Epidemiol. 2011; 174: 984-992
        • Zou GY
        • Donner A.
        Extension of the modified Poisson regression model to prospective studies with correlated binary data.
        Stat Methods Med Res. 2013; 22: 661-670