General study about patients’ post-surgery pain perspectives

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    • #34410
      Good intentions

      Here is a new and interesting paper about the patient’s role in dealing with post-surgery pain. It shows that more responsibility is being shifted to the patient in reporting pain after surgery. As opposed to “the old days” when a doctor or assistant would query the patient to be sure that they were okay.

      It contains an interesting paragraph about how many patients do not want to be seen as complainers (see past posts about Dr. Felix on this forum).

      An excellent counterpart to this study would be one in which the surgeon’s perspectives on post surgery pain are studied. What do they hope for and expect? What are there perspectives on patients who report post-surgery pain?

      Surgery patients’ perspectives of their role in postoperative pain: A scoping review

      Laura L. Walton, Elsie Duff, Rakesh C. Arora, Diana E. McMillan

      A scoping review was conducted with the objective of reviewing literature that described adult patients’ perspectives or highlighted the adult patient’s role in post-operative pain management, including assessment. Understanding patients’ attitudes toward their roles in pain management through a scoping review of the current literature is critical for informing research and improvements in post-operative pain management.

      Patients’ beliefs influenced not only their desire for additional pain management, but also affected their perceptions of pain assessment. A study that examined the sociocultural influences of patients’ beliefs found that over 30% of patients expressed that “good people should avoid talking about pain” (Tawil et al., 2018, p.5). This was not a unique finding. In another study, over one-quarter of cardiac patients expressed that the primary reason they did not report pain was to avoid being viewed by care providers as ‘complaining’ (McTier et al., 2014). In addition, some patients expressed a desire to be viewed as having a high pain tolerance (Henningsen et al., 2018). Others indicated they were concerned that reporting a high level of pain on the numeric rating scale could lead clinicians to misperceive their intentions and suspect they were either attention- or medication-seeking (Eriksson et al., 2014).”

    • #34411

      Right, and this distorts the picture. The full extent of the issue of post-surgery pain isn’t known because of this and other reasons. It’s pretty clear that the pain problem is worse than what it seems because of limited follow-up and the reluctance of many patients to describe the problem fully.

    • #34416

      I am disappointed that this study of patient pain has little to do with HT issues. Why? The medical report presented is not directed to hernia patients or hernia surgery. A quite different animal. The patients under-reporting pain likely are not in opposition to their type of surgery nor do they perceive their surgeons as non-cooperative or unfeeling about their pain.
      How about reports of pain here at HT? Quite different. My impression is that these HT patients complain that the surgeons involved avoid the patients or downplay their pain. In the hernia literature some surgeons have acknowledged this surgeon avoidance of post-op pain is an issue in the field. Some of these patients experienced failed surgeries, which in turn led to questioning their surgeon’s ability and/or method. Thus these HT patients are in conflict or opposition to their surgeons or hernia surgery. Contrast that with the apparent situation of patients in the pain study presented in this thread: those patients are cooperative as are apparently their surgeons. So we are left with an apples and oranges comparison. Caution should be raised about generalizing non-specific studies of patient pain to the hernia patients we know here at HT.

    • #34420
      Good intentions

      The authors categorized the results. Hernia surgery would most likely be under general surgery or undifferentiated surgery. It’s not clear why you would think that expectations from hernia surgery would be different than expectations from any other surgery. They all start from the same place – patient has medical problem, sees doctor, gets referred to surgeon, expects surgery to heal them and make them whole again. Except, of course, for amputation surgery, which is actually called out in the paper.

      A scoping study is basically a broad review of how widespread a certain area of interest is being studied.

      This didn’t copy over very well but you can see that they created categories and assigned each individual study to a category.

      Table 1. Surgical Focus of Included Literature: Number of Studies

      Orthopedic surgery General surgery Obstetric surgery Cardiac surgery Neuro-surgery Urological surgery Mixed or not defined surgery Spine surgery Reconstructive surgery
      6 6 3 3 1 1 8 2 1

    • #34425

      Your first statement evinces the problem I noted: You say, “The authors categorized the results. Hernia surgery would most likely be under general surgery or undifferentiated surgery.”

      You say, “most likely,” thus it’s your interpretation not that of the authors. It is just as likely that hernia surgery cases were not included. Without explanation HT readers cannot be assured that the medical report applies here.

      HT cases are not just merely “undifferentiated” or “general” surgeries. HT cases are failed surgeries. Again without explanation HT readers cannot be assured that the medical report concerns cases of pain from failed surgeries.

      My assumption–and a reasonable one–is that toleration of pain will differ between cases of successful and unsuccessful surgeries. Your information sidesteps this distinction; thus the medical report appears irrelevant to us.

      If I am wrong, I will be happy to hear why. In that case you should explain how the report applies to HT cases of failed hernia surgeries (i.e., patients are left with debilitating conditions and at least some of them claim their surgeons have ignored them). Thank you.

      • This reply was modified 5 months, 3 weeks ago by pinto.
    • #34484

      Right, and this distorts the picture

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