The Impact of Early PostOperative Pain on Health-Related Quality of Life

Objectives: To examine how the severity of postoperative pain affects patient's health-related quality of life (HRQoL) at 1week following surgery and to compare two generic validated HRQoL instruments. Methods: Patients undergoing general or orthopaedic surgery at the Royal London Hospital were randomly sampled. The following patient outcome data were collected EQ-5D (EuroQoL) pre-operatively and the Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) at 24hours postoperation; and EQ-5D, Short-Form-12 (SF-12) and APS-POQ-R at 7days postoperation. The degree of association between pain and HRQoL was assessed using Pearson's correlation coefficient and multivariate generalized linear regression models. Results: Of the 228 patients included, 166 patients provided data at 7days. Sixteen percent reported severe pain 50% of the day at 7days. The severity of pain on both the APS-POQ-R pain severity and interference and affective impairment domains at 7days was highly correlated with a decrease in HRQoL as assessed by the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), and EQ-5D scores (r=-0.34 to -0.61, P<0.0001). Multivariate regression analyses showed that irrespective of confounding factors (eg, age, gender, and pre-operative HRQoL) patients with severe postoperative pain experience important reductions in both physical and mental well-being domains of their HRQoL. Conclusions: A proportion of patients continue to experience severe pain at 7days postoperatively, even after minor surgery. HRQoL is strongly associated with the level of pain and provides additional data on the impact of postsurgery pain on patient's function and well-being. Additional studies are needed to elucidate the interaction between pain severity and HRQoL during the peri-operative period.