PAIN RELIEF Set set realistic expectations of post-op pain before the patient's surgery.

Many patients think that their post-surgical pain is going to be worse than it actually is, but researchers now know more about this phenomenon.

First, overestimating post-op pain can cause unnecessary anxiety in patients, which can lead to more problems after surgery.

Second, you're likely to blame.

Researchers presenting at the Anesthesiology 2017 Annual Meeting attribute patients' misconceptions about post-op pain to a lack of pre-operative education from healthcare providers.

Their study evaluated 223 patients who were undergoing orthopedic, neurosurgical or general surgery procedures on what level of post-op pain they expected on a scale of 0 to 10. Then, patients were asked 1 hour following surgery and the first day after surgery what their actual pain levels were. There was quite a disparity in the numbers:

• Patients averaged an anticipated pain rating of 4.66, but had an actual average pain rating of 2.56 immediately following surgery.
• A day later, patients expected a pain rating of 5.45, but had an actual pain rating of 4.3.

"Patients likely overestimate pain due to a lack of understanding of the surgical procedure, fear and anxiety, and also not fully understanding what will be done by the anesthesiologist to mitigate their post-operative pain," says study author Jaime Baratta, MD, the director of regional anesthesia at Thomas Jefferson University Hospital in Philadelphia.

Dr. Baratta says that anxiety in patients before surgery can cause other problems post-op, too. "It's well-documented that increased pre-operative anxiety is associated with increased pain post-operatively as well as slower functional recovery in the post-op period."

The group most susceptible to overestimating their post-op pain? Regional anesthesia patients. Dr. Baratta says that's because nobody properly explained regional techniques to those patients. Plus, if it were explained to them, it's often done so in the immediate pre-operative when patients are focused more on surgery than on their anesthesia.

Dr. Baratta says her study proves that healthcare providers need to do a better job of educating their patients before surgery on what they can expect to feel post-op. "Given how hectic things are on the day of surgery, one of the best ways to prepare patients is with handouts explaining what types of analgesia will be available to them for that particular surgery," she says. "These handouts could be part of the pre-operative workup when surgery is first scheduled."

Brielle Gregory