Mild Moderate and Severe Pain in Patients Recovering from Major Abdominal Surgery

摘要

Pain interferes with various activities such as coughing, deep breathing and ambulation designed to promote recovery and prevent complications after surgery. Determining appropriate cutpoints for mild, moderate and severe pain is important since specific interventions may be based upon this classification. The purpose of this research was to determine optimal cutpoints for postoperative patients based upon their worst and average pain during hospitalization and after discharge to home, and whether the optimal cutpoints distinguished patients with mild, moderate or severe pain with respect to patient outcomes. This secondary analysis consisted of 192 postoperative patients aged 60 years and over. Multivariate analyses of variance (MANOVAs) were used to stratify the sample into mild, moderate and severe pain groups using eight cutpoint models for worst and average pain in the last 24 hours. One-way analyses of variance were conducted to determine whether patients experiencing mild, moderate or severe pain were different in outcomes. Optimal cutpoints were similar to those previously reported with the boundary between mild and moderate pain ranging between 3 and 4, and the boundary between moderate and severe pain ranging between 5 and 7. Worst pain cutpoints were most useful in distinguishing patients with regard to fatigue, depression, pain's interference with function, and morphine equivalent administered in the previous 24 hours. A substantial proportion of patients experienced moderate to severe pain. The results suggest a narrow boundary between mild and severe pain that interferes with function. The findings indicate that clinicians should seek to aggressively manage postoperative pain ratings greater than 3.