Minority of patients face long-term pain after surgery

BMJ Group News

A minority of patients face long-term pain and disability after an operation - in some cases worse than the pain or discomfort of the condition that prompted them to have surgery - according to researchers. Bad pain immediately after the operation and poor physical health before the operation were associated with an increased chance of long-term pain.

What do we know already?

Thousands of people have surgery every year and for many the operation will be a success. However, for some people surgery can lead to long-term pain and leave them more disabled than before the operation. Mental health and general vitality can also be affected.

Studies have found that a variety of factors may contribute to a poor long-term outcome from surgery, including physical factors like the duration of the operation and psychological factors like fear of surgery. But few studies have been able to measure the change in physical and mental health before and after an operation.

The new study measured people’s general physical and mental health, their quality of life, pain and mental attitudes, at the time they were due to attend for the operation. They were questioned again within four days after surgery, and then again 6 and 12 months later. The operations people had included hysterectomy, breast implantation, and hip and knee replacements.

What does the new study say?

On average, people’s well-being and pain scores were better or the same 6 months after surgery compared with before surgery. But for a minority of people they were worse.

The study found 17 percent of people had worse pain at 6 and 12 months after the operation, and almost a quarter (24 percent) said they had less general vitality after their operation.

The researchers identified a number of factors that were linked to having long-term pain:

• Being in poor health before the operation
• Having bad pain immediately after the operation
• Having a longer operation time.

Poorer mental health and lower vitality after the operation was linked to:

• Poor health before surgery
• Being very frightened about the operation
• Having a less optimistic outlook on life.

How reliable are the findings?

The study started with a large number of people, but more than half dropped out during the course of the study. That could be because they needed another operation or because they decided to stop taking part, or just didn’t send back the questionnaires.

This might have affected the results because the people who stayed in the study might have had different experiences to those who dropped out. For example, people who were less healthy and experienced more problems after surgery might have been less willing to spend time filling in questionnaires. If this happened, the study might underestimate the numbers who went on to have long-term problems.