Pain intensity not only predictor for hysterectomy

Aug 22 2012

By Piriya Mahendra, medwireNews Reporter

Presurgical and surgical factors, and postsurgical pain intensity, should be taken into account when providing rescue analgesia to women after hysterectomy, researchers say.

Armando Almeida (University of Minho, Braga, Portugal) and colleagues found that after controlling for postsurgical acute pain intensity, logistic regression results revealed several presurgical and surgical factors associated with postsurgical rescue analgesia.

These were having other previous pain states, being anesthetized with only general or locoregional anesthesia, and presurgical fear of immediate consequences of surgery, at respective odds ratios of 4.5, 5.3, and 1.3.

Presurgical pain anxiety, pain catastrophizing, and presurgical pain coping statements were not significantly associated with rescue analgesia.

Further analysis revealed that the worst level of postsurgical pain intensity (on a numerical rating scale of 1-10) and postsurgical anxiety (on the anxiety subscale of the Hospital Anxiety and Depression Scale) were significantly associated with rescue analgesia 48 hours after surgery.

After controlling for the worse level of postsurgical pain, postsurgical anxiety remained a significant predictor for rescue analgesia delivery, at an odds ratio of 1.2.

"Results indicate that [rescue analgesia] provision may be influenced by clinical (ie, postsurgical pain intensity) and patient-related psychological factors (ie, presurgical fear and postsurgical anxiety)," remark the authors in the European Journal of Pain.

"Psychological factors carry slightly lower weight as predictors but are significant factors in [rescue analgesia] administration," they say. "Presurgical fear and postsurgical anxiety may act jointly to impact clinical decision-making regarding [rescue analgesia]."

Almeida and team explain that raising clinicians' awareness of the potential influence of presurgical and surgical factors could support a more accurate assessment of patients who require extra analgesia.

"Furthermore health care professionals need to acknowledge that efforts to improve the quality of pain management must move beyond assessment and communication of pain," the authors conclude.

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