Prediction of postoperative pain after radical prostatectomy

<p>Abstract</p> <p>Background</p> <p>There is a belief that the amount of pain perceived is merely directly proportional to the extent of injury. The intensity of postoperative pain is however influenced by multiple factors aside from the extent of trauma. The purpose of the study was to evaluate the relationship between preoperative factors that have been shown to predict postoperative pain and the self-reports of pain intensity in a population of 155 men undergoing radical prostatectomy (RP), and also to investigate if previous pain score could predict the subsequent pain score.</p> <p>Methods</p> <p>The correlation between potential pain predictors and the postoperative pain experiences during three postoperative days was tested (Pitmans' test). By use of a logistic regression analysis the probability that a Visual Analogue Scale (VAS) score at one occasion would exceed 30 mm or 70 mm was studied, depending on previous VAS score, age, depression and pain treatment method.</p> <p>Results</p> <p>Age was found to be a predictor of VAS > 30 mm, with younger patients at higher risk for pain, and preoperative depression predicted VAS > 70 mm. The probability that VAS would exceed 30 mm and 70 mm was predicted only by previous VAS value. Day two however, patients with epidural analgesia were at higher risk for experiencing pain than patients with intrathecal or systemic opioid analgesia.</p> <p>Conclusion</p> <p>The results show that it would be meaningful to identify RP patients at high risk for severe postoperative pain; i.e. younger and/or depressive patients who might benefit from a more aggressive therapy instituted in the very early postoperative period.</p

Pain, psychological distress and health-related quality of life at baseline and 3 months after radical prostatectomy

BACKGROUND: Inadequate management of postoperative pain is common, and postoperative pain is a risk factor for prolonged pain. In addition to medical and technical factors, psychological factors may also influence the experience of postoperative pain. METHODS: Pain was measured postoperatively at 24, 48, and 72 hr in hospital and after 3 months at home in 140 patients undergoing radical prostatectomy (RP). Patients answered questionnaires about anxiety and depression (HAD scale) and health-related quality of life (SF-36) at baseline and 3 months after surgery. RESULTS: In the first 3 postoperative days, mild pain was reported by 45 patients (32%), moderate pain by 64 (45%), and severe pain by 31 (22%) on one or more days. High postoperative pain scores were correlated with length of hospital stay and with high pain scores at home. Forty patients (29%) reported moderate (n = 35) or severe (n = 5) pain after discharge from hospital. Patients who experienced anxiety and depression preoperatively had higher postoperative pain scores and remained anxious and depressed 3 months after surgery. The scores for the physical domains in the SF-36 were decreased, while the mental health scores were increased at 3 months. Anxiety and depression were negatively correlated with all domains of the SF-36. CONCLUSION: There is a need for nurses to be aware of the psychological status of RP patients and its impact upon patients' experience of postoperative pain and recovery. The ability to identify patients with psychological distress and to target interventions is an important goal for future research

Postoperative pain management - predictors, barriers and outcome

Despite the availability of clinical practice guidelines, effective analgesics and new technologies for drug administration, the management of postoperative pain continues to remain problematic and unsatisfactory. Nurses play an important role in the pain management. They assess and document pain, decide whether to administer analgesics, and they monitor the effect of medication which is prescribed and administered in a variety of ways. Continuous epidural analgesia (EDA) is a safe and effective method that is frequently used after radical prostatectomy (RP), although recent studies also have found intrathecal analgesia (ITA) with opioids and local anaesthetics to compare favourably with an EDA technique. Postoperative pain can be influenced by different factors e.g. perceived control, anxiety and depression and previous pain experience, aside from the pain treatment method. This thesis consists of five studies; the first and the second studies evaluate EDA and ITA as methods for pain treatment after RP; the third study describes pain, psychological distress and health-related quality of life (HRQOL) at baseline and three month after RP; the fourth study focuses on the ward nurses role in pain management and in the fifth study the relationship between known postoperative pain predictors and postoperative pain experience was evaluated. Pain management after RP was not optimal with two thirds of the patients experiencing moderate/severe pain. Reluctance to use pain assessment tools and lack of documentation seemed to be hindrances for the development of a high quality postoperative pain management. Approximately one third of the patients´ and nurses´ pain reports were incongruent with nurses generally overestimating mild pain and underestimating severe pain. Documented pain scores rather than patients´ pain reports determined whether or not patients were to receive opioids. Almost one third of the EDA patients experienced severe pain during one or more of three postoperative days. ITA, given before surgery, seemed to be a commendable method for pain relief. Patients who scored high on the preoperative anxiety and depression scales reported higher postoperative pain scores as well. Patients with the highest pain scores in hospital also experienced the most pain during the three months after discharge from hospital. Anxiety and depression at three months correlated negatively with all components of HRQOL. Physical functioning had decreased, and mental health had increased at three months when compared to baseline. Age predicted a VAS >30mm, with younger patients at higher risk for postoperative pain. Preoperative symptoms of depression predicted a VAS >70mm. The only factor that predicted the next coming VAS score was the previous VAS score. Patients have the right to be recognized as experts on their own pain experience and to have their pain report reflected accurately in the type of pain relief that they receive. They also have the right to expect that relief of their pain is considered to be a reasonable goal of the treatment