Simple tests may help predict patients' pain after surgery

October 24, 2005

WINSTON-SALEM, N.C. - New research at Wake Forest University Baptist Medical Center shows that having patients complete a series of simple tests before surgery may help predict the intensity of their post-surgical pain and how much pain medication they will need.

"Despite advances in pain management, recent surveys revealed that a high percentage of hospitalized patients nationwide continue to experience moderate to severe pain after surgery," said Peter H. Pan, M.D., an obstetrical anesthesiologist and the lead researcher. "Our ultimate goal is to learn how to predict which patients are at risk for excessive pain so we can tailor treatment to them."

Pan presented the study results today at the American Society of Anesthesiology Annual Scientific Meeting in Atlanta.

The research was designed to address a dilemma in pain management - determining the right amount of pain medication for each patient. If patients are undertreated and have severe pain, it can lead to ongoing, chronic pain. On the other hand, over treatment with pain medicine is associated with bothersome side effects.

The Joint Commission on Accreditation of Healthcare Organizations has set a goal for hospitals to develop standards for assessing and treating pain so that patients don't experience pain above a "3" on a 10-point scale. Determining the best dose for each patient can be difficult because of individual differences in pain tolerance, according to Pan.

"Requirements for pain medication and the severity of pain experienced by patients can be influenced by sensitivity to pain, levels of anxiety, age, genetics and expectations about pain," he said. "However, few studies have explored whether physical and psychological responses obtained before surgery can be used together to predict the severity of pain and pain medication required after surgery."

For the study, the researchers looked at whether a variety of simple tests could predict post-surgical pain in 34 women scheduled to have elective cesarean sections. About two weeks before surgery, the women answered questionnaires to measure anxiety, their expectations about pain and the levels of pain they were having during pregnancy. In addition, a small heat element was applied to their arms and backs and the women were asked to rate the intensity and unpleasantness. The heat, which ranged from 95 to 122 degrees, was not applied long enough to cause skin damage and could be stopped by the patient at anytime.

After surgery, the women reported on their pain severity levels and researchers measured their requirements for pain medication. The researchers found that six groups of predictive factors accounted for 90 percent of the total variances in patients' post-surgical pain severity and medication requirements.

The best predictor of the total amount of pain medication required was a validated questionnaire that measured anxiety. The best predictors of overall post-surgical pain were blood pressure readings shortly before surgery and patients' responses to the heat element that was performed before surgery. The model was also useful in identifying patients in the top 20 percent of pain severity and amount of pain medication required after surgery.

"More research is needed to develop a more complete model," said Pan, "but the study shows the potential to identify patients at risk for high pain levels after surgery so we can tailor treatments to improve their quality of care."

Pan's co-investigators were Robert Coghill, Ph.D., Timothy T. Houle, Ph.D., Lynne Harris, B.S.N., and James C. Eisenach, M.D., all from Wake Forest University Baptist Medical Center, and Melvin H. Seid, M.D., W. Michael Lindel, M.D., R. Lamar Parker, M.D., and Scott Washburn, M.D., from Lyndhurst Gynecological Associates in Winston-Salem.
-end-
Media Contacts: Karen Richardson, krchrdsn@wfubmc.edu; or Ann Hopkins, prtemp@wfubmc.edu; at 336-716-4587.

About Wake Forest University Baptist Medical Center
Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. The system comprises 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report.

Wake Forest Baptist Medical Center

Related Pain Articles from Brightsurf:

Pain researchers get a common language to describe pain
Pain researchers around the world have agreed to classify pain in the mouth, jaw and face according to the same system.

It's not just a pain in the head -- facial pain can be a symptom of headaches too
A new study finds that up to 10% of people with headaches also have facial pain.

New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.

The insular cortex processes pain and drives learning from pain
Neuroscientists at EPFL have discovered an area of the brain, the insular cortex, that processes painful experiences and thereby drives learning from aversive events.

Pain, pain go away: new tools improve students' experience of school-based vaccines
Researchers at the University of Toronto and The Hospital for Sick Children (SickKids) have teamed up with educators, public health practitioners and grade seven students in Ontario to develop and implement a new approach to delivering school-based vaccines that improves student experience.

Pain sensitization increases risk of persistent knee pain
Becoming more sensitive to pain, or pain sensitization, is an important risk factor for developing persistent knee pain in osteoarthritis (OA), according to a new study by researchers from the Université de Montréal (UdeM) School of Rehabilitation and Hôpital Maisonneuve Rosemont Research Centre (CRHMR) in collaboration with researchers at Boston University School of Medicine (BUSM).

Becoming more sensitive to pain increases the risk of knee pain not going away
A new study by researchers in Montreal and Boston looks at the role that pain plays in osteoarthritis, a disease that affects over 300 million adults worldwide.

Pain disruption therapy treats source of chronic back pain
People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Sugar pills relieve pain for chronic pain patients
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology.

Peripheral nerve block provides some with long-lasting pain relief for severe facial pain
A new study has shown that use of peripheral nerve blocks in the treatment of Trigeminal Neuralgia (TGN) may produce long-term pain relief.

Read More: Pain News and Pain Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.