Sex Differences in the Incidence of Severe Pain Events Following Surgery: A Review of 333,000 Pain Scores

Tighe, Patrick J.; Riley, Joseph L.; Fillingim, Roger B.

doi:10.1111/pme.12498

Cited by 68 publications

(39 citation statements)

References 45 publications

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“…In the whole-model analysis, male patients had a substantially more rapid decrease in postoperative pain compared with female patients, even after controlling for age, comorbidity status, type of surgery, and surgical complexity. These findings extend prior work on sex differences in static pain scores in both experimental and clinical settings [4,16,21,31,35]. However, in age-stratified analyses, the effect of sex on postoperative pain was significant only in those greater than or equal to 65 years of age.…”

Section: Discussionsupporting

confidence: 84%

Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery

Tighe

Le-Wendling

Patel

et al. 2015

Pain

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The objective of this study was to determine the effects of age, sex, and type of surgery on postoperative pain trajectories derived in a clinical setting from pain assessments in the first 24 hours after surgery. This study is a retrospective cohort study using a large electronic medical records (EMR) system to collect and analyze surgical case data. The sample population included adult patients undergoing non-ambulatory, non-obstetric surgery in a single institution over a 1-year period. Analyses of postoperative pain trajectories were performed using a linear mixed effects model. Pain score observations (91,708) from 7,293 patients were included in the statistical analysis. On average, the pain score decreased about 0.042 [95% CI: (−0.044, −0.040)] points on the numerical rating scale (NRS) per hour following surgery for the first 24 postoperative hours. The pain score reported by male patients was about 0.27 [95% CI: (−0.380, −0.168)] NRS points lower than that reported by females. Pain scores significantly decreased over time in all age groups, with a slightly more rapid decrease for younger patients. Pain trajectories differed by anatomic location of surgery, ranging from −0.054 [95% CI: (−0.062, −0.046)] NRS units per hour for integumentary and nervous surgery to −0.104 [95% CI: (−0.110, −0.098)] NRS units per hour for digestive surgery, and a positive trajectory (0.02 [95% CI: (0.016, 0.024)] NRS units per hour) for musculoskeletal surgery. Our data support the important role of time after surgery in considering the influence of biopsychosocial and clinical factors on acute postoperative pain.

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Section: Discussionsupporting

confidence: 84%

Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery

Tighe

Le-Wendling

Patel

et al. 2015

Pain

Self Cite

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“…The SPTS-12 also demonstrated good to excellent internal consistency for both men and women in Studies 2 and 3. However, due to the small number of women in the study, this result should be interpreted tentatively especially in light of the almost ubiquitous findings that women and men differ in terms of their responses to acute experimental,47,59 clinical,60 and chronic pain 61. Reliability within subgroups such as sex should be examined in future studies with larger samples from various settings.…”

Section: Discussionmentioning

confidence: 89%

Sensitivity to Pain Traumatization Scale: development, validation, and preliminary findings

Katz¹,

Fashler²,

Wicks³

et al. 2017

JPR

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BackgroundThis article reports three studies describing the development and validation of the 12-item Sensitivity to Pain Traumatization Scale (SPTS-12). SPT refers to the anxiety-related cognitive, emotional, and behavioral reactions to pain that resemble the features of a traumatic stress reaction.MethodsIn Study 1, a preliminary set of 79 items was administered to 116 participants. The data were analyzed by using combined nonparametric and parametric item response theory resulting in a 12-item scale with a one-factor structure and good preliminary psychometric properties. Studies 2 and 3 assessed the factor structure and psychometric properties of the SPTS-12 in a community sample of 823 participants (268 with chronic pain and 555 pain-free) and a clinical sample of 345 patients (126 with chronic post-surgical pain, 92 with other nonsurgical chronic pain, and 127 with no chronic pain) at least 6 months after undergoing coronary artery bypass graft surgery, respectively.ResultsThe final SPTS-12 derived from Study 1 comprised 12 items that discriminated between individuals with different levels of SPT, with the overall scale showing good to very good reliability and validity. The results from Studies 2 and 3 revealed a one-factor structure for chronic pain and pain-free samples, excellent reliability and concurrent validity, and moderate convergent and discriminant validity.ConclusionThe results of the three studies provide preliminary evidence for the validity and reliability of the SPTS-12.

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“…However, more recently published data investigating procedure-specific risk factors for the development of severe POP strongly support a role of sex—apart from preoperative chronic pain and age—as one major predictor [12]. Another recent large retrospective study confirmed this by showing a higher risk of females to report more severe pain events; however sex differences were somehow small with odds ratios between 1.14 and 1.16 [22]. Here, we demonstrate that sex is as well a predictor for worst POP since surgery similar to those earlier clinical trials showing an effect on POP [7–9, 12, 22].…”

Section: Discussionmentioning

confidence: 99%

Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis

et al. 2017

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ObjectivesCurrent literature is in disagreement regarding female sex as a risk factor for pain after surgery. We hypothesized, that sex differences exist but that they are influenced by certain factors. Here, we investigated the influence of sex for different clinically relevant postoperative pain (POP) outcome parameters and evaluated the role of assumed confounders for sex differences.MethodsFrom 1372 screened patients undergoing orthopedic surgery at the university hospital of Muenster between March 2010 and June 2011, 890 patients were included. The validated International Pain Outcomes questionnaire was used to assess the role of sex for several aspects of POP including pain severity, physical and emotional functional interference as well as the patient’s perceptions of the care they received on the first day after surgery. Assessed confounders were age, preoperative chronic pain, anesthetic technique employed and surgical procedure. All statistical analyses were performed with SPSS Statistics Software 22.ResultsLinear regression analysis demonstrated that sex was a statistically significant risk factor for “worst pain since surgery”. Additionally, significant sex differences in “time spent in severe pain”, “feeling anxious due to pain”, “feeling helpless due to pain” and “opioid consumption since surgery” could be identified. An univariate general linear model showed that “age” and “preoperative pain” were significant confounders for sex differences. Further descriptive subgroup analysis revealed consistent sex differences for several POP outcome variables especially in patients older than 50 years or patients with preoperative chronic pain. However, sex differences disappeared in younger patients and in patients without preoperative pain.DiscussionOur data confirmed that sex differences exist in pain intensity and frequency, pain interference with feelings and opioid consumption during the first 24 hours postoperatively. However, sex differences were significantly influenced by the factors “age” and “preoperative pain”. These findings may in part explain why clinical studies get different results related to sex differences and renders specific awareness in older women and female patients with preoperative chronic pain.

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Sex Differences in the Incidence of Severe Pain Events Following Surgery: A Review of 333,000 Pain Scores

Cited by 68 publications

References 45 publications

Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery

Clinically derived early postoperative pain trajectories differ by age, sex, and type of surgery

Sensitivity to Pain Traumatization Scale: development, validation, and preliminary findings

Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis

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