gms | German Medical Science

Objectives/Interrogation: Pain after surgery is common and not always well controlled. Results of a recent survey of adult surgical patients showed 86% experienced pain after surgery; of these, 75% had moderate/extreme pain during the immediate post-surgical period, with 74% still experiencing these levels of pain after discharge. Post-surgical pain was the most prominent pre-surgical patient concern, and nearly half reported they had high anxiety levels about pain. The importance of patient education regarding pain management is agreed upon, although support in the literature, especially in the outpatient setting, is not strong.

The objective of this prospective, randomized, placebo-controlled experimental study is to investigate the effect of adding a formalized patient education program (videos and recovery diary handout) to the current standard-of-care counseling on patient experience after outpatient orthopedic upper extremity surgery.

Methods: One hundred and three adult patients undergoing elective outpatient, upper extremity surgeries were randomized to view one of two educational programs: 1) a 2-video series regarding post-operative pain management or 2) a video regarding wound care. Randomization was stratified based on the expected postoperative opioid prescription size. Outcome measures included both validated (PROMIS Pain Intensity) and non-validated (pain scale, measures of satisfaction and knowledge) scores.

Results and Conclusions: Eighty-nine patients completed the study, resulting in analysis of 47 patients in the wound care group and 42 patients who received formalized education in pain management. Patients who received the additional wound care education showed an increase in pain intensity as measured by the PROMIS Pain Intensity Short Form 3a administered 3 days after surgery (average of 0.13 points on a 5 point scale) compared to pre-operative levels, whereas patients who had received pain management education showed a decrease in their PROMIS Pain Intensity Score of 0.81 points (p=0.04). Similarly, patients undergoing the pain management education reported significantly lower pain scores (pain rated on a scale from 0-10; average 2.7 vs 3.1, p=0.004) with the most clinically significant benefit on post-operative days one to five.

A formalized pain management education program can significantly decrease the pain experienced by patients after outpatient upper extremity orthopedic surgery. The authors recommend that a comprehensive approach to pain management include a focus on patient education.