Distinguishing between pain intensity and pain resolution: Using acute post‐surgical pain trajectories to predict chronic post‐surgical pain

Althaus, Astrid; Becker, Oliver Arránz; Neugebauer, Edmund

doi:10.1002/j.1532-2149.2013.00385.x

Cited by 98 publications

(102 citation statements)

References 32 publications

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“…More specifically, patients in pain trajectory #3 showed the steepest decline in reported postoperative pain and had the highest levels of anxiety prior to surgery. This result is consistent with those of a previous study of acute post-operative latent trajectories [47]. However, anxiety in this latter study no longer contributed significantly to the model once the other predictors were entered, suggesting that the effect of anxiety on acute postoperative pain might be better accounted for by other predictors.…”

Section: Predictors Of Pain Trajectory Membershipsupporting

confidence: 91%

“…As such, our findings are consistent with those reported by Clarke et al [9] who failed to find a significant relationship between acute worst movement-evoked pain after THA and CPSP. However, a significant relationship between acute postoperative pain trajectories and CPSP has been found in other studies of pain trajectories [12,47]. These latter pain trajectory studies differ from our study in terms of sample size (n = 6 [12]) and surgical population studied [47].…”

Section: -Week and 6-month Outcomescontrasting

confidence: 91%

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Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

et al. 2016

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This study showed that during the postoperative period patients differed in terms of pain intensity profiles and that these differences were associated with outcomes for up to 6 weeks following surgery. Pain trajectories were not predictive of persistent postoperative pain status at 6 months. Nonetheless, these results highlight the importance of patient heterogeneity in acute postoperative pain and pain-related outcomes months after THA.

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Section: Predictors Of Pain Trajectory Membershipsupporting

confidence: 91%

Section: -Week and 6-month Outcomescontrasting

confidence: 91%

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

et al. 2016

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“…In the current study the percentage of patients whose pain did not improve was higher than what has been reported in patients with postsurgical pain following elective surgery (Althaus et al, 2014; Chapman et al, 2012). One important distinction between elective and post-trauma surgical procedures is that preemptive analgesia and education related to pain management can be administering prior surgery, but it is not always possible for trauma as injury is inherently unpredictable (Radresa et al, 2014).…”

Section: Discussioncontrasting

confidence: 83%

“…The intercept and slope were modeled as random effects. Based on previous literature examining trajectories in patients with postoperative pain (Althaus, Arránz Becker, & Neugebauer, 2014; Chapman et al, 2011) and pain following discharge from the emergency room (Chapman, Fosnocht, & Donaldson, 2012), a 50% confidence interval was created around each pain trajectory. If the 50% confidence interval included zero, the patient was classified as having a flat pain trajectory and categorized into the no change in pain group.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of Patients with Lower Extremity Trauma with Improved and Not Improved Pain During Hospitalization: A Pilot Study

Griffioen

Johantgen

Rueden

et al. 2016

Pain Management Nursing

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Background Up to 62% of patients report chronic pain at the injury site 6-12 months after blunt trauma, with pain from lower extremity fractures exceeding that from other sites. High pain intensity at time of injury is a risk factor for chronic pain, but it is not clear what patient characteristics influence the pain intensity level during the immediate hospitalization following injury. Aim The purpose of this pilot study was to determine the feasibility of collecting pain scores from medical records, to calculate pain trajectories, and to determine whether it is possible to examine patient characteristics by classifying them into those whose pain improved and those whose pain did not improve. Design This descriptive study retrospectively reviewed medical records of 18 randomly chosen patients admitted to an academic trauma center. Methods Patient characteristics and pain scores were collected form electronic and handwritten medical records. Results The pain trajectories calculated from routinely collected pain scores during the in-patient stay showed that for 44% of the patients the pain improved during the hospitalization, for 39% the pain remained the same and for 17% the pain worsened. Variables age, smoking, weight, abbreviated injury scores, length of hospital stay, mean pain score and opioid equianalgesic dose differed based on pain trajectory. Conclusion While patient characteristics differed based on pain trajectory, any significant effects seen from individual tests should be considered tentative, given the number of analyses conducted on this data set. However, feasibility and significance of conducting a larger study has been established.

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“…1–5 The most common assessment of pain resolution following surgery has focused on static pain scores at fixed postoperative intervals, which provide limited information regarding individual differences in temporal pain profiles, a parameter that could substantively impact the management of pain. Recent studies by Chapman and colleagues have highlighted disparities in acute postoperative pain trajectories following elective surgery 1 and surgery in cardiac 3 and chronic pain 2 patients over several days.…”

mentioning

confidence: 99%

Time to Onset of Sustained Postoperative Pain Relief (SuPPR)

Tighe

King

Zou

et al. 2016

The Clinical Journal of Pain

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Objectives Prior work on postoperative pain trajectories have examined pain score changes over time using daily averages of pain scores. However, little is known about the time required until patients consistently report minimal postoperative pain. Materials and Methods We conducted a retrospective cohort study of surgical case data from 7,293 adult patients to examine the impact of age, gender, and the type of surgery on the time to sustained postoperative pain relief (SuPPR). We defined SuPPR as the time required until a patient reports the first of multiple (2, 3, 4, or 5 sequential measurements; e.g., SuPPR-2, SuPPR-3, etc.), uninterrupted, mild pain scores (≤4/10). Results Overall, SuPPR times ranged from 3 min for SuPPR-2 and 9 min for SuPPR-5 to 160.1 h for SuPPR-2 and 183.1 h for SuPPR-5. For the SuPPR-2 outcome, the median time to event was 10.9 h (interquartile range [IQR], 3–26.1 h) after surgery. For the SuPPR-5 outcomes, the median time to event was 31.5 h (IQR, 17.8–54.2 h) after surgery. The peak median difference between two sequential SuPPR definitions was between SuPPR-3 and SuPPR-2 at 9 h, with subsequent decreases to 6.5 h between SuPPR-4 and SuPPR-3, and 5.2 h between SuPPR-5 and SuPPR-4. There were statistically different differences across SuPPR 2 through 5 definitions by age, gender, and type of surgery. Discussion Although additional analyses are necessary, SuPPR may represent a novel method for evaluating acute pain service performance.

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Distinguishing between pain intensity and pain resolution: Using acute post‐surgical pain trajectories to predict chronic post‐surgical pain

Cited by 98 publications

References 32 publications

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

Characteristics of Patients with Lower Extremity Trauma with Improved and Not Improved Pain During Hospitalization: A Pilot Study

Time to Onset of Sustained Postoperative Pain Relief (SuPPR)

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