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A recent study found that patients’ perioperative pain experience was a better predictor of chronic postsurgical pain than acute pain intensity.
An exploratory study published in the British Journal of Anaesthesia identified perioperative pain experience as a more reliable predictor of chronic postsurgical pain (CPSP) compared with traditional measures of acute pain intensity.
CPSP has emerged as a significant public health concern, affecting up to 25% of patients undergoing surgery and impairing their QOL, recovery, and long-term functionality. While acute pain intensity has long been recognized as a predictor of CPSP, research indicates that psychological factors such as anxiety, depression, and pain catastrophizing can heighten pain perception and increase the risk of chronic pain.
Recent studies suggest that focusing on pain-related functional interference and patient-reported outcomes (PROs) may offer deeper insights into CPSP development, shifting the focus from pain intensity to a more comprehensive understanding of patients’ pain experience.
Axel Maurice-Szamburski, MD, PhD, and coauthors conducted a secondary analysis of a multicenter randomized clinical trial comparing continuous perineural analgesia and single-injection nerve blocks in 294 patients undergoing ambulatory orthopedic surgeries at five centers between June 2017 and January 2020.
Eligible participants were aged less than 80 years with American Society of Anesthesiologists physical status of 1-3 and monitored for 90 days post-surgery. Exclusion criteria included allergies, chronic pain history, strong opioid use, substance misuse, cognitive impairments, and pregnancy. Pain catastrophizing was assessed during preoperative consultation using the Pain Catastrophizing Scale (PCS). The study team recorded any substance use and medications.
On the day of their respective surgeries, participants received either continuous or single-injection nerve blocks, both with ropivacaine and multimodal analgesia. Postoperative pain management included oral paracetamol, ketoprofen, and on-demand tramadol or oxycodone. Quality of Recovery (QOR-40) was evaluated on day 1, and the EVAN-G questionnaire assessed patient experience on day 2. Follow-ups on days 45 and 90 used the SF-36 survey and DN4 tool to screen for chronic postsurgical pain and neuropathic symptoms, respectively.
On day 90, 29% of patients (63 of 294) reported CPSP, with 14% (28) exhibiting neuropathic characteristics. Univariate analysis identified several factors associated with CPSP, including tobacco and cannabis use, preoperative pain, surgery type and duration, regional anesthesia type, and acute pain levels.
Study-specific factors such as pain and physical dependence dimensions of the QOR scale (day 1), the pain dimension of the EVAN-G scale (day 2), and the SF-36’s physical and mental component scores (day 45) were also significantly linked to CPSP. However, multivariate analysis revealed that poor pain experience on day 2, as captured by the EVAN-G pain dimension, was the strongest independent predictor of CPSP at 90 days (P<0.01).
Acute pain levels did not remain significant after adjustment. Tobacco use and preoperative pain also retained their association with CPSP in the final model.
Secondary outcomes showed that higher satisfaction scores in the pain dimension of the EVAN-G scale were associated with lower rates of CPSP and fewer neuropathic symptoms (P<0.01).
Other EVAN-G dimensions, such as attention, privacy, and waiting time, did not correlate with CPSP. Similarly, QOR-40 dimensions like psychological support and emotional state showed no significant impact, but physical dependence and pain dimensions were linked to CPSP development (P < .03).
On day 45, higher Physical Component Scores (PCS) on the SF-36 were significantly associated with patients being pain-free on day 90 (P<0.01), while Mental Component Scores (MCS) showed only moderate differences (P=0.05).
“This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale,” Dr. Maurice-Szamburski and colleagues said. “It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.”
