At least five categories of acute postoperative pain trajectories have been identified, and, crucially, these trajectories are defined predominantly by patient factors rather than type of surgery and intraoperative medications, according to new research by the Temporal Postoperative Pain Signatures (TEMPOS) Group.
The study, published online in January in Anesthesiology and featured on the cover of the March print edition, included 360 patients from a mixed surgical cohort at UF Health, including elective, major orthopedic, urologic, colorectal, pancreatic/biliary, thoracic, or spine surgery. Patients’ pain was measured across postoperative days 1 through 7. Five distinct acute postoperative pain intensity trajectories were identified, and they were predominantly determined by patient-specific factors including age, sex, and psychologic features.
Researchers have already known that pain after surgery varies widely among patients and that determining groups of patients who share pain trajectories can help predict and improve recovery. The new work makes a key contribution to the pain medicine literature by showing the relative impact of patient sociodemographic and behavioral factors rather than procedural factors in assigning patients to a postoperative pain trajectory group.
Improved models and understanding of postoperative pain trajectories can play a key role in personalizing postoperative analgesia as well as lead to preventative therapies for persistent postsurgical pain. Increased acute postoperative pain intensity is associated with the development of persistent postsurgical pain. With an estimated 10% to 56% of surgical patients developing persistent postsurgical pain depending on the surgery type, such research is increasingly vital.
The study, titled “Patient and Procedural Determinants of Postoperative Pain Trajectories” was written by Terrie Vasilopoulos, PhD; Richa Wardhan, MD; Parisa Rashidi, PhD; Roger B. Fillingim, PhD; Margaret R. Wallace, PhD; Paul L. Crispen, MD; Hari K. Parvataneni, MD; Hernan A. Prieto, MD; Tiago N. Machuca, MD, PhD; Steven J. Hughes, MD; Gregory J.A. Murad, MD; and Patrick J. Tighe, MD, MS.
Dr. Tighe and Dr. Vasilopoulos participated in a podcast episode discussing the article. Anesthesiology also promoted the study with an Editorial on the topic.
“One of the most important improvements of this study over previous studies describing postoperative pain trajectory is the inclusion of more careful phenotypic measurement of patient traits to allow a more meaningful indexing of patients falling into a given trajectory,” the Editorial said.
The TEMPOS research was supported by the National Institutes of Health as well as the Donn M. Dennis, MD, Professorship in Anesthetic Innovation (Dr. Tighe).