Journal of Anesthesia

, Volume 26, Issue 1, pp 1–8

Prediction of postoperative pain using path analysis in older patients

  • Sakura Kinjo
  • Laura P. Sands
  • Eunjung Lim
  • Sudeshna Paul
  • Jacqueline M. Leung
Original Article

Abstract

Purpose

Effective postoperative pain management is important for older surgical patients because pain affects perioperative outcomes. A prospective cohort study was conducted to describe the direct and indirect effects of patient risk factors and pain treatment in explaining levels of postoperative pain in older surgical patients.

Methods

We studied patients who were 65 years of age or older and were scheduled for major noncardiac surgery with a postoperative hospital stay of at least 2 days. The numeric rating scale (0 = no pain, 10 = worst possible pain) was used to measure pain levels before surgery and once daily for 2 days after surgery. Path analysis was performed to examine the association between predictive variables and postoperative pain levels.

Results

Three hundred fifty patients were studied. We found that preoperative pain level, use of preoperative opioids, female gender, higher ASA physical status, and postoperative pain control methods were the strongest predictors of postoperative pain as measured on the first day after surgery. Younger age, greater preoperative symptoms of depression, and lower cognitive function also contributed to higher postoperative pain levels. Pain levels on the second day after surgery were strongly predicted by preoperative pain level, use of preoperative opioids, surgical risk, and pain and opioid dose on postoperative day 1. However, younger age, female gender, higher ASA physical status, greater preoperative symptoms of depression, lower cognitive function, and postoperative pain control methods indirectly contributed to pain levels on the second day after surgery.

Conclusion

Although preoperative pain and use of preoperative opioids have the strongest effects on postoperative pain, clinicians should be aware that other factors such as age, gender, surgical risk, preoperative cognitive impairment, and depression also contribute to reported postoperative pain. Based on significant statistical correlations, these study results can contribute to more effective postoperative care for those patients having the risk factors studied here. Preoperative treatment/intervention based in part on factors such as preoperative pain, use of preoperative opioids, and depression may improve postoperative pain management.

Keywords

Aged 80 and over Aging Pain Postoperative 

References

  1. 1.
    Berry PH, Dahl JL. The new JCAHO pain standards: implications for pain management nurses. Pain Manag Nurs. 2000;1:3–12.CrossRefPubMedGoogle Scholar
  2. 2.
    Liu SS, Wu CL. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007;104:689–702.CrossRefPubMedGoogle Scholar
  3. 3.
    Puntillo K, Weiss SJ. Pain: its mediators and associated morbidity in critically ill cardiovascular surgical patients. Nurs Res. 1994;43:31–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality, morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493.Google Scholar
  5. 5.
    Vaurio LE, Sands LP, Wang Y, Mullen EA, Leung JM. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102:1267–73.CrossRefPubMedGoogle Scholar
  6. 6.
    Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH. Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain. 2006;7:626–34.Google Scholar
  7. 7.
    Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, Marcus MA, Vlaeyen JW, van Kleef M. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245:487–94.Google Scholar
  8. 8.
    Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2002;94:1052–64.Google Scholar
  9. 9.
    Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, Bandeira D, Ferreira MB. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand. 2002;46:1265–71.Google Scholar
  10. 10.
    Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain. 2003;105:415–23.CrossRefPubMedGoogle Scholar
  11. 11.
    De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain. 2008;24:399–405.CrossRefPubMedGoogle Scholar
  12. 12.
    Gagliese L, Gauthier LR, Macpherson AK, Jovellanos M, Chan VW. Correlates of postoperative pain and intravenous patient-controlled analgesia use in younger and older surgical patients. Pain Med. 2008;9:299–314.CrossRefPubMedGoogle Scholar
  13. 13.
    Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med. 2003;10:390–2.CrossRefPubMedGoogle Scholar
  14. 14.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49.Google Scholar
  15. 15.
    Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999;14:858–65.CrossRefPubMedGoogle Scholar
  16. 16.
    Ferrucci L, Del Lungo I, Guralnik JM, Bandinelli S, Benvenuti E, Salani B, Lamponi M, Ubezio C, Benvenuti F, Baroni A. Is the telephone interview for cognitive status a valid alternative in persons who cannot be evaluated by the Mini Mental State Examination? Aging (Milano). 1998;10:332–8.Google Scholar
  17. 17.
    Marcantonio ER, Goldman L, Mangione CM, Ludwig LE, Muraca B, Haslauer CM, Donaldson MC, Whittemore AD, Sugarbaker DJ, Poss R, Haas S, Cook EF, Orav EJ, Lee TH. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271:134–9.Google Scholar
  18. 18.
    Stage FK, Carter HC, Nora A. Path analysis: an introduction and analysis of a decade of research. J Educ Res. 2004;98(1):5–12.CrossRefGoogle Scholar
  19. 19.
    Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain. 1998;75:177–85.CrossRefPubMedGoogle Scholar
  20. 20.
    Gramke HF, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Sommer M, Marcus MA. Predictive factors of postoperative pain after day-case surgery. Clin J Pain. 2009;25:455–60.Google Scholar
  21. 21.
    Wilder-Smith OH, Tassonyi E, Arendt-Nielsen L. Preoperative back pain is associated with diverse manifestations of central neuroplasticity. Pain. 2002;97:189–94.CrossRefPubMedGoogle Scholar
  22. 22.
    Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808–16.CrossRefPubMedGoogle Scholar
  23. 23.
    Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009;110(5):1061–1067.Google Scholar
  24. 24.
    Cole LJ, Farrell MJ, Gibson SJ, Egan GF. Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging 2010;31(3):494–503 (e-pub 2008).Google Scholar
  25. 25.
    Ochsner KN, Ludlow DH, Knierim K, Hanelin J, Ramachandran T, Glover GC, Mackey SC. Neural correlates of individual differences in pain-related fear and anxiety. Pain. 2006;120:69–77.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Sakura Kinjo
    • 1
  • Laura P. Sands
    • 2
  • Eunjung Lim
    • 3
  • Sudeshna Paul
    • 4
  • Jacqueline M. Leung
    • 1
  1. 1.Department of Anesthesia and Perioperative CareUniversity of CaliforniaSan FranciscoUSA
  2. 2.School of NursingPurdue UniversityWest LafayetteUSA
  3. 3.Department of StatisticsPurdue UniversityWest LafayetteUSA
  4. 4.Department of Health Care PolicyHarvard Medical SchoolBostonUSA

Personalised recommendations