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* From Axia Research, Hamilton;
the Toronto Western Hospital, University Health Network, University of Toronto, Toronto; and
Pharmacia Canada Inc, Mississauga, Ontario, Canada.
Address correspondence to: Angela Rocchi, Axia Research, 181 Main Street West, Hamilton, Ontario L8P 4S1, Canada. Phone: 905-522 -2961; Fax: 905-522 5614; E-mail: angela{at}axiaresearch.com
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Abstract |
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Methods: Three hundred and five general population subjects from across Canada who had surgery in the previous three years were retrospectively questioned regarding pain experiences in the surgical facility and at home, pain medication efficacy and pain medication satisfaction.
Results: While in the surgical facility, pain was experienced by 68% of patients who expected overnight admission ("inpatients") and 49% of patients who expected same-day discharge ("outpatients"). Overall, 47% of inpatients and 15% of outpatients reported that their highest experience of pain was severe or extreme; 25% of inpatients and 9% of outpatients reported that their average pain was severe or extreme. In the two weeks post-discharge, 79% and 74% respectively of inpatients and outpatients experienced pain. Severe or extreme pain occurred at home in 25% of inpatients and 28% of outpatients; average pain was severe or extreme for 9% of inpatients and 12% of outpatients.
Complete or a lot of pain relief was experienced by 54% to 72% patients who received pain medication; higher rates of pain medication satisfaction were reported than rates of pain relief from pain medication.
Conclusion: Severe or extreme pain was experienced by many surgical patients. Improvements could be made to patients’ postsurgical pain experience in Canada, both in the surgical facility and subsequent to discharge.
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Introduction |
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Practice patterns do not always evolve, despite adequate guidelines and/or accreditation requirements. In 1995, Warfield et al. conducted a national survey in the US and reported a high incidence and severity of postoperative pain; of the 77% of patients who reported pain, 80% rated postsurgical pain as moderate to extreme.5 A recent US survey reported 82% of patients who experienced pain had moderate to extreme pain.6 Moreover, outpatient surgery patients reported more pain after discharge than before discharge; this is worrisome due to the unsupervised nature of their home recovery. Similar general population surveys of postsurgical pain have not been reported in a Canadian setting.
The objective of this study was to assess the recent postoperative pain and pain medication experiences of Canadians.
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Methodology |
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General population subjects were eligible for the study if they had surgery in the past three years (excluding dental surgery). Subjects participating in three consecutive Omnibus surveys were questioned regarding eligibility and interest. The Omnibus survey is a weekly 1,000 sample general population survey conducted by Canada’s largest public-opinion research firm. Eligible and interested Omnibus subjects were contacted within one week and administered the questionnaire by telephone. The intended sample size was 300, corresponding to sample sizes from previous surveys.5,6
Analyses were conducted on a descriptive basis only.
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Results |
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Patient characteristics
Patient characteristics are reported in Table I
. Compared to the Canadian general population, ages 55–64 were over-represented and those 75 and over were under-represented. Outpatient surgery subjects (those who were expected to go home on the day of surgery) were slightly younger than inpatient subjects (those who were expected to stay overnight), and more likely to have had surgery recently. Overall, 60% of all subjects had their surgery in the past year. One patient could not provide inpatient/outpatient status and was excluded from subgroup analyses.
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). The average experience of pain was severe or extreme for 25% of inpatients and 9% of outpatients.
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). Severe or extreme average pain levels were reported by 9% of inpatients and 12% of outpatients.
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).
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Discussion |
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Despite incomplete pain relief, patients reported satisfaction with pain medication. This has been a common finding in analgesia research.9,10 Pain medication satisfaction is multifactorial. Beyond analgesic efficacy, satisfaction can be affected by patient education and expectations, overall provider care, and relief at the resolution of the primary medical condition.
The primary limitations of this study were the small sample size, retrospective design and potential for recall bias. Future research using prospective data collection could avoid recall bias and also permit more detailed data collection, for example the type and dose of medications administered.
A strength of this study was its broad generalizability, since it was based on the Canadian general population with almost no exclusion criteria. However, subjects over age 75 may have been under-represented.
In conclusion, postoperative pain continues to occur at frequencies and severities to warrant concern. Patients continue to report greater satisfaction with pain medications than pain relief. Improvements could be made to patients’ postsurgical pain experience in Canada.
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Footnotes |
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Revision received September 9, 2002. Accepted for publication May 16, 2002.
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References |
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2 American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Section. Practice guidelines for acute pain management in the perioperative setting. A report by the American Society of Anesthesiologists Task Force on Pain Management, Acute Pain Section. Anesthesiology 1995; 82: 1071–81.[Medline]
3 American Pain Society Quality of Care Committee. Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA 1995; 274: 1874–80.[Abstract]
4 Canadian Pain Society. www.canadianpainsociety.ca/manifesto. September 14th, 2001.
5 Warfield CA, Kahn CH. Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 1995; 83: 1090–4.[Medline]
6 Apfelbaum JL, Gan TJ, Chen C. Patient perception of post-operative pain experience after outpatient surgery: patient survey. Anesthesiology 2000; 93S: A1 (abstract).
7 Beauregard L, Pomp A, Choiniere M. Severity and impact of pain after day-surgery. Can J Anaesth 1998; 45: 304–11.
8 Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg 1997; 85: 808–16.[Abstract]
9 Strassels SA, Chen C, Carr DB. Postoperative analgesia: economics, resource use, and patient satisfaction in an urban teaching hospital. Anesth Analg 2002; 94: 130–7.
10 Miaskowski C, Nichols R, Brody R, et al. Assessment of patient satisfaction using the American Pain Society’s Quality Assurance Standards on acute and cancer-related pain. J Pain Symptom Manage 1994; 9: 5–11.[Medline]
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