Article

Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients

Acute Pain 08/2005; 7(2):75-83. DOI: 10.1016/j.acpain.2005.05.001

ABSTRACT A total number of 1071 patients was investigated using a modified questionnaire of the American Pain Society to evaluate the pain profile and satisfaction/dissatisfaction on the second post-operative day after different types of surgery (abdominal, traumatic, orthopaedic, urologic, gynaecologic, ENT). Patients were either treated with non-standardized pain management (no measurement of pain intensities, no regular administration of analgesics) (non-APS; n = 575) under responsibility of surgical specialties or with standardized pain management (regular assessment of pain and dose adaptation with i.v. PCA or epidurals) (APS; n = 496) by an anaesthesiology-based acute pain service.
Patients with a non-standardized pain management gave answers expressing higher pain intensities and breakthrough pain compared with APS-patients as a sign of their analgesic undertreatment (p ≤ 0.05). The differences between the non-APS and APS groups were also significant after major surgery (abdominal, urologic, traumatic, orthopaedic), showing the benefit of using i.v. PCA or epidurals. Furthermore, it could be demonstrated that patients in the APS treatment group were satisfied with their pain management to a significantly higher degree than patients in the non-APS group. 27.3% of non-APS versus 1.1% of APS-patients (p ≤ 0.05) were dissatisfied with their pain management. The majority of these patients did not want to experience the same management again.
The stepwise multivariate regression to estimate influencing variables on dissatisfaction (e.g. pain intensity, breakthrough pain, pain service, age, type of surgery) had yielded the surprising result that the most important factor for dissatisfaction was the patient's feeling that a complaint about pain had been taken seriously.
Our data has shown the necessity to improve pain management after surgery under the responsibility of surgical specialties, in order to avoid undertreatment and to increase patient's satisfaction. As a consequence of this prospective study, an interdisciplinary standardized pain management was introduced at the University Hospital. A repetition of this audit is planned.

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    • "Some researchers related that to patients' previous experiences and their expectations for peak and trough pattern of pain, and concluded that the pattern of pain relief, not the pain severity, may be the critical determinant of satisfaction (George & Robinson, 2010). Conversely, factors that were found to increase patients' dissatisfaction with pain management include patients' feeling that their complaints of pain had not been taken seriously by HCPs (Roth et al., 2005) and longer waiting time for medication (Carlson et al., 2003). Patients' perceptions and beliefs regarding pain have also been found to contribute to pain management satisfaction. "
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