Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2016 | Research article

Prevalence of pain 6 months after surgery: a prospective observational study

Authors: Rita Laufenberg-Feldmann, Bernd Kappis, Susanne Mauff, Irene Schmidtmann, Marion Ferner

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

Abstract

Background

Pain after surgery is a major issue for patient discomfort and often associated with delayed recovery. The aim of the present study was to evaluate the prevalence of pain and requirement for analgesics up to 6 months after elective surgery, independent if new pain symptoms occurred after surgery or if preoperative pain persisted in the postoperative period.

Methods

A prospective observational single center cohort study was conducted between January 2012 and August 2013. Eligible patients were scheduled to undergo elective surgical interventions including joint (hip, knee arthroplasty), back (nucleotomy, spondylodesis), or urological surgery (cystectomy, prostatectomy, nephrectomy). Pain was assessed on an 11-point numerical rating scale (NRS) before, on postoperative day 2 and 6 months after surgery. Clinical information was collected with structured questionnaires and by telephone interview.

Results

Six hundred and forty-four patients gave informed consent, including 54.4 % men (mean age 62.2, SD 14.3). Higher preoperative pain scores were found in patients undergoing joint (mean 7.6; 95 % confidence interval [CI]: 7.2–8.0) and back surgery (mean 7.1, CI: 6.8–7.5) than in patients prior to urological surgery (mean 2.3; CI: 1.8–2.8). After 6 months, about 50 % of patients after joint or back surgery indicated pain levels ≥3/10, compared to 15.9 % of patients after urological surgery (p < .001). 35.3 % of the patients after joint surgery and 41.3 % after back surgery still use pain medication 6 months postoperatively, in contrast to 7.3 % of patients after urological surgery. 13.6 % of patients who underwent back surgery indicated the regular intake of opioids.

Conclusions

Our results reveal that a significant percentage of patients undergoing procedures in joint or back surgery still need pain medication up to 6 months postoperatively due to ongoing pain symptoms. Improved monitoring of pain management is warranted, especially after discharge from hospital, to improve long-term results.

Trial registration

Clinicaltrials.gov (Identifier: NCT01488617); date of registration December 6th 2011.
Appendix
Available only for authorised users
Literature
1.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40.CrossRefPubMed
2.
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30(1):149–60.CrossRefPubMed
3.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.CrossRefPubMed
4.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630–41.CrossRefPubMed
5.
S3-Leitlinie Behandlung akuter perioperativer und posttraumatischer Schmerzen. Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (DIVS). Deutscher Ärzte-Verlag, Köln. AWMF-Register Nr. 041/001; 2007/05/21 [cited 2016/02/21]; Available from: http://​www.​awmf.​org/​.
6.
Erlenwein J, Stamer U, Koschwitz R, Koppert W, Quintel M, Meissner W, et al. Inpatient acute pain management in German hospitals: results from the national survey "Akutschmerzzensus 2012". Schmerz. 2014;28(2):147–56. Akutschmerztherapie in der stationaren Versorgung an deutschen Krankenhausern : Ergebnisse des Akutschmerzzensus 2012.CrossRefPubMed
7.
American Society of Anesthesiologists Task Force on Acute Pain M. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248–73.CrossRef
8.
Kehlet H, Holte K. Effect of postoperative analgesia on surgical outcome. Br J Anaesth. 2001;87(1):62–72.CrossRefPubMed
9.
Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002;53(4):897–902.CrossRefPubMed
10.
Hall GM, Salmon P. Physiological and psychological influences on postoperative fatigue. Anesth Analg. 2002;95(5):1446–50. table of contents.CrossRefPubMed
11.
Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–45.CrossRefPubMed
12.
Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain. 2003;105(3):415–23. Epub 2003/10/07. eng.CrossRefPubMed
13.
Sommer M, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Geurts JW, et al. Predictors of acute postoperative pain after elective surgery. Clin J Pain. 2010;26(2):87–94.CrossRefPubMed
14.
Peters ML, Sommer M, van Kleef M, Marcus MA. Predictors of physical and emotional recovery 6 and 12 months after surgery. Br J Surg. 2010;97(10):1518–27.CrossRefPubMed
15.
Langford DJ, Schmidt B, Levine JD, Abrams G, Elboim C, Esserman L, et al. Preoperative breast pain predicts persistent breast pain and disability following breast cancer surgery. J Pain Symptom Manage. 2015;49(6):981–94.CrossRefPubMed
16.
Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245(3):487–94. Pubmed Central PMCID: 1877005.CrossRefPubMedPubMedCentral
17.
Masselin-Dubois A, Attal N, Fletcher D, Jayr C, Albi A, Fermanian J, et al. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain. 2013;14(8):854–64.CrossRefPubMed
18.
Archer KR, Seebach CL, Mathis SL, Riley 3rd LH, Wegener ST. Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions. Spine J. 2014;14(5):759–67.CrossRefPubMed
19.
Kinjo S, Sands LP, Lim E, Paul S, Leung JM. Prediction of postoperative pain using path analysis in older patients. J Anesth. 2012;26(1):1–8. Pubmed Central PMCID: 3720127.CrossRefPubMed
20.
Sommer M, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Geurts JW, et al. The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol. 2008;25(4):267–74.CrossRefPubMed
21.
Gerbershagen HJ, Dagtekin O, Rothe T, Heidenreich A, Gerbershagen K, Sabatowski R, et al. Risk factors for acute and chronic postoperative pain in patients with benign and malignant renal disease after nephrectomy. Eur J Pain. 2009;13(8):853–60.CrossRefPubMed
22.
Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153(7):1390–6.CrossRefPubMed
23.
Schnabel A, Pogatzki-Zahn E. Predictors of chronic pain following surgery. What do we know? Schmerz. 2010;24(5):517–31. Pradiktoren fur chronische Schmerzen nach Operationen. Was wissen wir wirklich?
24.
Macrae WD, HTO. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, editors. Chronic postsurgical pain. 1999th ed. Seattle: IASP Press; 1999. p. 125–42.
25.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, et al. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.CrossRefPubMed
26.
Gerbershagen HJ, Ozgur E, Dagtekin O, Straub K, Hahn M, Heidenreich A, et al. Preoperative pain as a risk factor for chronic post-surgical pain - six month follow-up after radical prostatectomy. Eur J Pain. 2009;13(10):1054–61.CrossRefPubMed
27.
Gerbershagen HJ, Ozgur E, Straub K, Dagtekin O, Gerbershagen K, Petzke F, et al. Prevalence, severity, and chronicity of pain and general health-related quality of life in patients with localized prostate cancer. Eur J Pain. 2008;12(3):339–50.CrossRefPubMed
28.
Sandblom G, Carlsson P, Sigsjo P, Varenhorst E. Pain and health-related quality of life in a geographically defined population of men with prostate cancer. Br J Cancer. 2001;85(4):497–503. Pubmed Central PMCID: 2364104.CrossRefPubMedPubMedCentral
29.
Hauser W, Bock F, Engeser P, Tolle T, Willweber-Strumpfe A, Petzke F. Long-term opioid use in non-cancer pain. Dtsch Arztebl Int. 2014;111(43):732–40. Pubmed Central PMCID: 4238316.PubMedPubMedCentral
30.
Armaghani SJ, Lee DS, Bible JE, Archer KR, Shau DN, Kay H, et al. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine. 2014;39(25):E1524–30.CrossRefPubMed
31.
Aasvang EK, Lunn TH, Hansen TB, Kristensen PW, Solgaard S, Kehlet H. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty. Acta Anaesthesiol Scand. 2016;60(4):529–36.CrossRefPubMed
32.
Veal FC, Bereznicki LR, Thompson AJ, Peterson GM, Orlikowski C. Subacute pain as a predictor of long-term pain following orthopedic surgery: an Australian prospective 12 month observational cohort study. Medicine (Baltimore). 2015;94(36), e1498. Pubmed Central PMCID: PMC4616644.CrossRef
Metadata
Title
Prevalence of pain 6 months after surgery: a prospective observational study
Authors
Rita Laufenberg-Feldmann
Bernd Kappis
Susanne Mauff
Irene Schmidtmann
Marion Ferner
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-016-0261-7

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Research article

Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study

Research article

Smartphone use habits of anesthesia providers during anesthetized patient care: a survey from Turkey

Case report

Three-dimensional printing as an aid to airway evaluation after tracheotomy in a patient with laryngeal carcinoma

Research article

Prevalence, associated factors and treatment of post spinal shivering in a Sub-Saharan tertiary hospital: a prospective observational study

Study protocol

Association between changes in cerebral grey matter volume and postoperative cognitive dysfunction in elderly patients: study protocol for a prospective observational cohort study

Research article

Comparison of continuous femoral nerve block (CFNB/SA) and continuous femoral nerve block with mini-dose spinal morphine (CFNB/SAMO) for postoperative analgesia after total knee arthroplasty (TKA): a randomized controlled study