Originally published by our sister publication Anesthesiology News
SAN DIEGO—Postsurgical pain is highly variable, and developing an appropriate analgesic plan requires acknowledging and planning for differences between patients.
“In anesthesia, we are often focused on the procedure—what degree of surgical injury is involved, and how painful it is going to be,” said Kristin L. Schreiber, MD, PhD, an associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital, in Boston. “However, as a neuroscientist who studies pain in people after surgery, one thing that has been particularly striking is how variable pain is among people who are having essentially identical surgical injury.”
Addressing the different analgesic needs of patients requires some prediction of people’s individual pain and analgesic requirement.
The first step in this process is accurately, sensitively and comprehensively measuring a patient’s level of pain.
“When you measure pain well, you see a wide range of not only pain severity, but also impact of pain on different aspects of people’s lives,” Dr. Schreiber said.
Studying biopsychosocial modulators of pain can provide key insights into why people undergoing the same surgical procedure frequently experience such different levels of post-op pain.
“The biopsychosocial model is an overarching framework which explains how certain groups of factors modulate pain,” she said.
The biological portion of this framework focuses on the differential expression of factors such as pain-relevant inflammatory mediators, enzymatic systems and an individual’s pharmacometabolic processes. Psychological factors include whether a patient is struggling with anxiety, depression, stress or sleep disturbances. Social factors include isolation, cultural influences, gender constructs and whether the patient has strong systems of positive support.
“Depending upon where someone is at on all of those factors, the severity and burdensomeness of postsurgical pain may vary substantially,” Dr. Schreiber said.
Preoperative phenotyping can help determine where an individual stands with regard to these pain modulators in a systematic way. The use of validated questionnaires and bedside pain tests can discern a patient’s pain phenotype, and the information gleaned from these tests can be used to predict individual risk of worse or prolonged pain, opioid use, and the success of particular analgesic and behavioral interventions.
Schreiber is on the advisory boards of AAAPT (Pain Research Guidelines), IARS international subcommittee, IARS scientific review and IMMPACT.
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