Postoperative Pain Trajectories and Pain Chronification—an Empirical Typology of Pain Patients

Abstract

In this study, we demonstrated that there is substantial variation in postsurgical pain trajectories, not only with regard to postsurgical initial pain intensity, but also with regard to individual rates of pain resolution. Successful pain resolution appeared to be a better predictor of absence of increased pain intensities six months after surgery than initial pain immediately after surgery. Hence, attention should be given to appropriate pain treatment in order to minimize the risk of CPSP.

Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

“…Fourth, some patients might have very different postoperative pain trajectories and heterogeneity in the slopes, which awaits further investigation to explain unusual pain resolution after surgery. Finally, compared with previous studies, the pain scores of this study were relatively low, which may be explained by discrepancies in type of surgery, pain measurement (worst or average pain) and management, and race differences in pain sensitivity 9–18. Although we identified several factors statistically significantly associated with postoperative pain level and decrement rate, the effect size of some influential factors may be too small to have clinical significance.…”

“…Besides, analyses for temporal domain of pain revealed a meaningful link between psychosocial modulators of postoperative pain and pain chronification 14. A variety of analytical methods have been used to assess the pain trajectory in previous studies, including latent curve model,9 13 14 25 Bayesian change-point model,25 and cluster analysis for trajectory classification 10 12 16–18. Compared with change-point model and cluster analysis, latent curve model is useful in distinguishing between pain intensity and pain resolution and identifying potential influential factors for these two important parameters of pain.…”

“…Besides, since pain may fluctuate in intensity and character over time, pain trajectory analysis is a better evaluation tool than individual pain measurements in reflecting the complex interplay between treatment and symptom 9 10. Studies have reported the association between postoperative pain trajectories and important clinical outcomes, including chronic postsurgical pain after knee arthroplasty,11 breast cancer surgery,12 and other types of surgery,13 14 functional disabilities in arthritis patients,15 risk of postoperative readmission,16 and oncological outcomes of colorectal cancer 17. A recent post-hoc analysis of randomised trial showed the high pain cluster of pain trajectory significantly predicted prolonged postoperative pain and delayed opioid cessation, further highlighting the clinical implications of time course analysis of acute pain 18…”

Local and regional anaesthesia in dogs and cats: Overview of concepts and drugs (Part 1)

“…months to years to end of life) pain. The intensity and duration of pain in recovery is an important indicator of the likelihood of chronic pain development in humans (Althaus et al, 2018;Boerboom et al, 2018;de Brito, Omanis, Ashmawi, & Torres, 2012;Jin et al, 2016;Rashiq & Dick, 2014;Voscopoulos & Lema, 2010). The fact that human patients with local anaesthetic drugs included in the analgesic protocols were less likely to develop both postoperative and chronic pain is a very compelling reason to utilize local/regional blockade (Boerboom et al, 2018;de Brito et al, 2012;Rashiq & Dick, 2014).…”

Development of More Precise Measurement to Predict Pain 1 Month Postoperatively Based on Use of Acute Postoperative Pain Score in Patients With Distal Radial Fracture

“…Additionally, the slope, intercept, and pain intensity at 30 days of each cluster were analyzed by ANOVA and a post‐hoc test using Bonferroni correction with the statistical analysis software SPSS version 26.0 (SPSS, Chicago, IL, U.S.A.). Finally, we calculated the ratio of patients for each cluster who rated their pain intensity at 30 days post‐surgery as a VAS score > 20 9,27,28 …”