Objective: This exploratory investigation compared patterns of postoperative pain over 6 days in normal patients recovering from surgery with those of patients using opioid medications for chronic pain. It tested the following hypotheses: 1) Chronic pain patients have a different pattern of postoperative pain than normals; 2) Women have a different pattern of postoperative pain resolution than men.
Patients: Normal (N = 96) and chronic pain (N = 42) patients undergoing surgery served as subjects.
Design: The study employed a linear mixed effects model to compare repeated measures of pain in the two patient groups.
Outcome Measures: Patients rated pain daily following surgery over 6 days. Each patient's pain pattern is a linear trend having an intercept (initial pain level) and a slope (rate of pain change over days).
• The chronic pain patients initially reported a higher mean pain level, and they differed from normal patients in their average postoperative pain patterns (P < 0.001), as did men and women (P = 0.039).
• Whereas normals decreased in pain report over the 6 days of recovery at an average rate of -0.35 units per day, chronic pain patients changed at an average rate of only -0.06 units per day (P < 0.001).
• Women began at day 0 with greater average pain than men (6.15 vs 5.16, P = 0.029) but resolved their pain more rapidly (-0.291 points per day vs -0.118 points per day, P = 0.017).
Conclusions: Surgical patients who have chronic pain and use opioid medications for that pain have more postoperative pain than normals and resolve that pain more slowly.
Source: Pain Medicine, Apr 2009;10(3) pp 481-487. Chapman CF, Donaldson G, Davis J, Ericson D, Billharz J. Pain Research Center, Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah, USA. [E-mail: email@example.com]