In surgical patients, time to pain resolution, complete recovery from surgery, and opioid cessation were found to be predicted by the worst pain occurring 10 days after surgery, according to a study published in JAMA Network Open.
Investigators sought to determine whether preoperative and immediately postoperative factors were associated with patient outcomes, in an effort to improve targeted referrals and intensive interventions after surgery.
Researchers conducted a subanalysis of the Stanford Accelerated Recovery Trial (Clinicaltrials.gov identifier: NCT01067144), a single-center, randomized, double-blind, placebo-controlled study examining the effects of perioperative administration of gabapentin vs placebo for pain control. The data of 371 patients (mean age, 56.67 years; 39.4% men) from a mixed surgical cohort were analyzed. Participants were administered several assessments both pre- and postoperatively, including a modified Brief Pain Inventory.
The primary outcomes were time to pain resolution at the surgical site, time to opioid cessation, and complete recovery time. For each patient, 3 acute pain trajectories, based on average, current, and worst pain after surgery, were compared. A total of 15 acute pain descriptors were assessed for their value as predictors of the study’s primary outcomes.
A total of 193 patients were classified as having low pain intensity (52.0%; mean age, 55.8 years; 42.7% men), and 178 as having high levels of pain (48.0%; mean age, 57.6 years; 36.2% men). Patients were partitioned into low- and high-pain clusters, respectively. The high-pain cluster in each pain trajectory was found to predict time to pain cessation (hazard ratio [HR], 0.63; 95% CI, 0.50-0.80; P <.001) and time to opioid cessation (HR, 0.52; 95% CI, 0.41-0.67; P <.001), but not time to surgical recovery (HR, 0.89; 95% CI, 0.69-1.14; P =.89).
Patients with increased presurgical pain at the site of surgery (adjusted relative risk [aRR], 1.11; 95% CI, 1.07-1.15; P <.001) or a history of substance abuse treatment (aRR, 1.90; 95% CI, 1.42-2.53; P <.001), as well as women (aRR, 1.36; 95% CI, 1.08-1.70; P =.008), and those who had received a placebo (aRR, 1.27; 95% CI, 1.03-1.56; P =.03), were found to predict high postsurgical acute pain.
The worst reported pain at postoperative day 10 was found to best predict the time to pain resolution (HR, 0.83; 95% CI, 0.78-0.87; P <.001), time to opioid discontinuation (HR, 0.84; 95% CI, 0.80-0.89; P <.001), and time to full recovery (HR, 0.91; 95% CI, 0.86-0.96; P <.001).
Study strengths include frequent assessments and extended follow-up (2 years). Study limitations include lack of standardized protocols for pain management or active opioid tapering/cessation, possible inaccurate categorization to low/high clusters, and an arbitrary 10-day follow-up.
“Ultimately, early identification of high-risk patients would facilitate personalized care with closer follow-up, earlier referral for specialist care, and extension of multimodal pain regimens,” noted the authors.
Hah JM, Cramer E, Hilmoe H, et al. Factors associated with acute pain estimation, postoperative pain resolution, opioid cessation, and recovery. JAMA Netw Open. 2019;2(3):e190168.