Predictors of Postoperative Pain and Analgesic Consumption: A Qualitative Systematic Review

Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Anesthesiology (Impact Factor: 5.88). 09/2009; 111(3):657-77. DOI: 10.1097/ALN.0b013e3181aae87a
Source: PubMed


Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.

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    • "More than 50% of patients experience chronic and acute pain ranging from moderate to severe intensity during hospitalization (Couceiro, Valença, Luciana Cavalcanti Lima, de Menezes, & Raposo, 2009; Gianni et al., 2010; Sommer Pain Management Nursing, Vol -, No -(--), 2014: pp 1-12 Strohbuecker, Mayer, Evers, & Sabatowski, 2005; Wadensten, Fr€ ojd, Swenne, Gordh, & Gunningberg, 2011). Patient pain is influenced by physiologic, psychological, social, chronobiologic, ethnic, and cultural factors, as well as circadian rhythms (Nielsen & Lautenbacher, 2004; Bond & Simpson, 2006; Engel, 1977; International Association for the Study of Pain, 2001; Strain, Lautenbacher, Galfe, & Holzl, 1989; Vivian, Abrishami, Peng, Wong, & Chung, 2009). Nurses are highly involved in acute pain assessment and management practices (De Silva, 2008; Dihle, Bjolseth, & Helseth, 2006; Manias, Bucknall, & Botti, 2005). "
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    ABSTRACT: Unrelieved pain is a worldwide health care problem that can lead to unnecessary complications and increased health care expenditure. The aim of this study was to examine nurses' knowledge and attitudes toward pain in Saudi Arabia. A descriptive design was employed using the Nurses' Knowledge and Attitudes Survey regarding pain. The study took place in a tertiary teaching hospital in Saudi Arabia. All nurses employed in the hospital were eligible to participate. A total of 775 questionnaires were distributed to nurses working in acute care, intensive care, and nursing education and administration settings. In all, 593 respondents completed the questionnaires, representing a response rate of 76.5%. Data were analyzed using descriptive and inferential statistics. Most participants were from overseas (97.5%), speaking 23 different languages; 36.5% of nurses held a bachelors of science degree in nursing or the equivalent. The mean score of correctly answered items in was 16.9 (95% confidence interval, 16.6-17.31) out of a total possible score of 40. Nurses demonstrated some misconceived attitudes such as not giving the required dose of morphine to a smiling patient despite the patient being in pain. It is of concern that the findings identified problems of inadequate knowledge and inappropriate attitudes regarding pain assessment and management in Saudi Arabia. Considering these problems, the development of pain programs and policies affecting national and international nurses is highly imperative.
    No preview · Article · Dec 2014 · Pain Management Nursing
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    • "Such multiple causes of pain were also found in other settings, for instance, in patients seen by a specialised pain consultation service of a university hospital [18,19]. Pre-existing chronic pain is a risk factor for both increased acute and chronic post-operative pain [20,21]. Whether similar relationships influence pain management in cancer patients or patients at the end of life is an important question with potential therapeutic implications. "
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    • "We must hence carry out a thorough treatment of dynamic postoperative pain, as it is not enough to only treat pain at rest, and to avoid other predicting factors, such as pain more than one month prior to the intervention, aggressive or repeated surgery, associated nerve injury or prior psychopathological factors [10]. Moreover, factors predisposing patients to a greater postoperative pain are young age and the type of surgery, such as orthopaedic surgery (due to the involvement of periosteum, which has a very low pain sensitivity threshold) and thoraco-abdominal surgery (due to the large involvement of the functions of the corresponding organs) [10]. The concept of pre-emptive analgesia is based on the administration, prior to surgical incision, of an analgesic in order to mitigate or prevent central hypersensitivity phenomena, aiming to reduce analgesic consumption in the postoperative period and chronic pain. "
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    ABSTRACT: Just as pain is a symptom with multifarious causes, many approaches can be taken to its management. Once a correct diagnosis has been made, treatment of pain may be chosen from among drug therapy, surgical or other intervention, nerve stimulation, radio waves, physical manipulation, lifestyle changes, psychological and alternative approaches. Thus, medical practitioners involved in assisting patients to manage their pain come from a broad range of fields including clinical psychologists, physiotherapists, occupational therapists, nurses, anesthesiologists, neurologists, physiatrists, psychiatrists and professionals involved in the palliative care of patients. This book seeks to provide a comprehensive overview of the topic of pain management. In so doing, it will act as a resource for students, physicians and other health care professionals, as well as those requiring information in order to better understand their options regarding management of their own pain or that of family members in their care.
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