Predictors of Poor Pain Control Following Surgery

Investigators conducted a meta-analysis to identify predictors of poor postoperative pain control with a goal of developing personalized care pathways to improve outcomes.

Nine predictors of poor postoperative pain control were identified in patients who underwent inpatient surgery, according to results from a meta-analysis published in BMJ Open.

The investigators analyzed 33 studies that included 53,362 adult patients. Significant preoperative predictors associated with poor postoperative pain control included younger age (odds ratio [OR], 1.18), female sex (OR, 1.29), smoking (OR, 1.33), history of depressive symptoms (OR, 1.71), history of anxiety symptoms (OR, 1.22), difficulty sleeping (OR, 2.32), higher body mass index (OR, 1.02), presence of preoperative pain (OR, 1.21), and use of preoperative analgesia (OR, 1.54).

Pain catastrophizing, American Society of Anesthesiologists status, chronic pain, marital status, socioeconomic status, education, surgical history, preoperative pressure pain tolerance, and orthopedic surgery were not linked to increased odds of poor pain control postoperatively.

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The authors noted a lack of information in specialties including spine surgery, plastic surgery, and otolaryngology as well as a lack of standard criteria to classify acute postoperative pain outcomes.

“Early identification of predictors in patients at risk of poor postoperative pain control may allow for more individualised interventions, better pain management and decrease reliance on pain medications (particularly opioids),” the authors concluded. “Increased awareness of these predictors can also aid in the development of personalised discipline-specific clinical care pathways (eg, multimodal analgesic strategies and enhanced recovery after surgery programmes) to reduce the length of stay and perioperative medical complications by improving postoperative pain outcomes.”

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Yang MMH, Hartley RL, Leung AA, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9:e025091.

This article originally appeared on Clinical Advisor