Pain as the Subjective Fifth Vital Sign Among Patients Undergoing Knee or Hip Arthroplasty
The purpose of this study was, among patients undergoing knee or hip arthroplasty, to examine patients expectations for and experiences of postoperative pain, their perceptions of the quality of their pain management, and to identify potential barriers to effective pain management. This was a prospective cohort study of 68 patients undergoing knee or hip arthroplasty at Yale-New Haven Hospital. Patients were interviewed within 48 hours after surgery using a modified version of the American Pain Society Satisfaction Survey and were asked the amount of pain they expected to have postoperatively (EP) and the actual pain that they experienced in the previous 24 hours (AP) using the Numerical Rating Scale (NRS). Patients were asked a series of questions regarding their attitudes toward pain management (PM). Their rating of the quality of PM was measured in two ways: a) how satisfied they are with their physicians management of their pain, and b) how well their goals for PM have been achieved. Patients were 59% female and 82% white. Most patients experienced moderate to severe pain following surgery, with a mean worst pain of 8.2 [plus-minus] 2.7 on the 11-point NRS. Patients expected to experience significantly more pain following surgery (mean 7.3 [plus-minus] 2.4) than they actually experienced (mean 5.1 [plus-minus] 2.5) (EP-AP=2.3, p<.001, signed rank test). Forty percent of patients in the study believed that pain is a necessary part of the healing process, 36% were concerned about addiction, and 22% believed that health care providers are annoyed by discussions about pain. Patients whose goals for PM were met reported a greater difference between the pain they expected and the pain they actually experienced following surgery (EP-AP=2.8) than those whose goals were not met (EP-AP=0.9, p=.02). Fifty percent of patients who reported a pain score >5 felt that their goal for PM was very well or well met, and 70% of patients who reported a pain score >5 were very satisfied or satisfied with their PM. Patients who were concerned about building tolerance to their pain medication were significantly more likely to report that their goals for PM were met despite high pain scores, (47%) than were patients without this concern (16%, p=.02). Patients who were concerned about building tolerance were also more likely to report high satisfaction despite high pain scores) (53%) than patients without this concern (22%, p=.03), and they were also more likely to be significantly concerned about addiction (48% vs. 19%, p=.02). A substantial number of patients are satisfied with their PM and feel that their goal for PM is met despite experiencing moderate to severe pain following surgery. We identified several possible reasons for this discrepancy, including patient concerns about tolerance and addiction. Patients give high ratings of quality of PM if their pain is severe, as long as the pain is not as severe as they expected. This suggests that patients give high ratings of quality, in part, for the wrong reasons. The study also demonstrated that substantial numbers of patients endorse beliefs that may be barriers to effective pain management.
School Location:USA - Connecticut
Source Type:Master's Thesis
Keywords:knee replacement hip arthroplasty postoperative pain management
Date of Publication:11/15/2006