Perioperative pain management barriers in cardiac surgery: Should we persevere?

The Effect of Diclofenac on Bleeding, Platelet Function, and Consumption of Opioids Following Cardiac Surgery

“…For a more accurate assessment of postoperative pain, a strict protocol and additional patient education on pain relief would be required. Cogan et al [17] found that additional information in the brochure on pain relief received by patients after cardiac surgery did not reduce pain scores. On the other hand, in a study by Ziehm et al [18] , the patients who were psychologically better prepared and receiving reassurance that they would not have major pain after the operation showed reduced pain scores after open-heart surgery.…”

The need for novel strategies to address postoperative pain associated with cardiac surgery: A commentary and introduction to “SMArTVIEW”

“…Evidence from randomized controlled trials has found that perioperative educational interventions, designed to target pain-related misbeliefs among patients undergoing cardiac surgery, consistently yield small to no effects in terms of improving patient painrelated knowledge, skills, and pain management outcomes. 12,[25][26][27][28][29] In 2004, Watt-Watson et al 25 examined the impact of a preoperative education booklet titled, "Pain Relief After Your Surgery" in order to reduce acute postoperative pain intensity and painrelated interference with recovery (n = 406). Compared to usual care, the intervention group did not experience improved pain management; some significant gains in terms of pain-related interference (P < 0.01) as well as concerns related to analgesics (P < 0.05) were found.…”

“…While in hospital, patients are often unclear of their own role in pain management and lack knowledge, skills, and confidence about how to communicate their pain experience and symptoms to clinicians. 12 For example, in a survey of elderly surgical patients ( N = 125), Brockopp et al 18 found that 53% of patients disagreed with the following statement: “When people are in pain due to surgery, it is better to take pain medication regularly rather than just when they hurt” and 31% agreed that “in the hospital, doctors are the only people who can help patients with their pain.” Whether patients lack knowledge, have preconceived ideas or attitudes, or assume to be passive recipients of pain relief, challenges persist in engaging patients as active self-managers immediately following surgery. 19 , 20 …”

“…3 Barriers to effective pain assessment and management following cardiac and major vascular surgery have been conceptualized on patient, health care provider, and system levels. [12][13][14][15] In 2015, our team released a position statement in the British Journal of Cardiology, arguing the need for a digital health connected care strategy-from hospital to home-that would address leading drivers of readmission following cardiac and major vascular surgery. 16 In 2018, we launched an international, randomized controlled trial (HiREB#3641) of a multicomponent digital health intervention entitled "TecHnology Enabled Self-MAnagemenT-VIsion for remote automated patient monitoring and EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW CoVRed), more commonly referred to as SMArTVIEW.…”

“… 3 Barriers to effective pain assessment and management following cardiac and major vascular surgery have been conceptualized on patient, health care provider, and system levels. 12 – 15 …”