Impact of Perioperative Pain Intensity, Pain Qualities, and Opioid Use on Chronic Pain After Surgery

• DOI: 10.1097/aap.0b013e318237516e
• Publication Date: 2012-12-19T16:51:19Z
• Authors: Elizabeth G. VanD...; Wilma M. Hopman; David H. Goldstein; Rosemary A. Wilson; Tanveer E. Towheed; Miu Lam; Margaret B. Harrison; Michelle L. Reitsma; Shawna L. Johnston; James D. Medd; Ian Gilron
• Keywords: Adult; Ontario; Pain, Postoperative; Chi-Square Distribution; Anxiety; Middle Aged; Pelvic Pain; Risk Assessment; Severity of Illness Index; 3. Good health; Analgesics, Opioid; 03 medical and health sciences; Gynecologic Surgical Procedures; 0302 clinical medicine; Risk Factors; Surveys and Questionnaires; Preoperative Period; Humans; Regression Analysis; Female; Prospective Studies; Chronic Pain; Pain Measurement

A better understanding of the pathogenesis of chronic postsurgical pain is needed in order to develop effective prevention and treatment interventions. The objective of this study was to evaluate the incidence and risk factors for chronic postsurgical pain in women undergoing gynecologic surgery.Pain characteristics, opioid consumption, and psychologic factors were captured before and 6 months after surgery. Analyses included univariate statistics, relative risks (RRs) and 95% confidence intervals (95% CIs), and modified Poisson regression for binary data.Pain and pain interference 6 months after surgery was reported by 14% (n = 60/433) and 12% (n = 54/433), respectively. Chronic postsurgical pain was reported by 23% (n = 39/172) with preoperative pelvic pain, 17% (n = 9/54) with preoperative remote pain, and 5.1% (n = 10/197) with no preoperative pain. Preoperative state anxiety (RR = 1.8; 95% CI, 1.1-2.8), preoperative pain (pelvic RR = 3.7; 95% CI, 1.9-7.2; remote RR = 3.0; 95% CI, 1.3-6.9), and moderate/severe in-hospital pain (RR = 3.0; 95% CI, 1.0-9.4) independently predicted chronic postsurgical pain. The same 3 factors predicted pain-interference at 6 months. Participants describing preoperative pelvic pain as "miserable" and "shooting" were 2.8 (range, 1.3-6.4) and 2.1 (range, 1.1-4.0) times more likely to report chronic postsurgical pain, respectively. Women taking preoperative opioids were 2.0 (range, 1.2-3.3) times more likely to report chronic postsurgical pain than those not taking opioids. Women with preoperative pelvic pain who took preoperative opioids were 30% (RR = 1.3; 95% CI, 0.8-1.9) more likely to report chronic postsurgical pain than those with preoperative pelvic pain not taking opioids.Preoperative pain, state anxiety, pain quality descriptors, opioid consumption, and early postoperative pain may be important predictors of chronic postsurgical pain, which require further investigation.