Desire to receive more pain treatment - a relevant patient-reported outcome measure to assess quality of post-operative pain management? Results from 79,996 patients enrolled in the pain registry QUIPS from 2016 to 2019

Marcus Komann, Philipp Baumbach, Ulrike M Stamer, Claudia Weinmann, Christin Arnold, Esther Pogatzki-Zahn, Winfried Meißner
Journal of Pain 2021 January 19
Acute postoperative pain is frequently evaluated by pain intensity scores. However, interpretation of the results is difficult and thresholds requiring treatment are not well defined. Additional patient-reported outcome measures (PROMs) might be helpful to better understand individual pain experience and quality of pain management after surgery. We used data from the QUIPS pain registry for a cross-sectional study in order to investigate associations between the desire to receive more pain treatment (D2RMPT) with pain intensity ratings and other PROMs. Responses from 79,996 patients were analyzed, of whom 10.7% reported D2RMPT. A generalized estimating equation Poisson model showed that women had a lower risk ratio (RR) to answer this question with "yes" (RR: .92, p<.001). Factors that increased the risk most were "maximal pain intensity ≥ 6/10 on a numerical rating scale" (RR: 2.48, p<.001) and "any pain interference" (RR: 2.48, p<.001). The largest reduction in risk was observed if patients were "allowed to participate in pain treatment decisions" (RR: .41, p<.001) and if they felt that they "received sufficient treatment information" (RR: .58, p<.001). Our results indicate that the (easily assessed) question D2RMPT gives additional information to other PROMs like pain intensity. The small proportion of patients with D2RMPT (even for high pain scores) opens the discussion about clinicians' understanding of over- und under-treatment and questions the exclusive use of pain intensity as quality indicator. Future studies need to investigate whether asking about D2RMPT in clinical routine can improve post-operative pain outcome. Perspective This article presents characteristics of the patient-reported outcome measure "Desire to receive more pain treatment". This measure could be used to apply pain treatment in a more individualized way and lead to improved treatment strategies and quality.

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