Under-Treating Pain

"These numbers are not negligible considering the huge amount of CABG (coronary artery bypass grafting) that is occurring in the U.S., in Canada and all over the world. It's among the most frequent type of surgery."
"Given the impact such pain may have on daily functioning and quality of life, patients should be informed about this possibility."
"Patients wait until they're in a lot of pain before asking for something, or they don't ask for it because a 'good' patient doesn't complain."
"For the health expert, the priority is the success of the surgery. The pain is something that will 'go away anyway' -- it's not a priority."
"But if the acute pain in the first few days after surgery was better managed, we would decrease the prevalence of persistent pain."
"[Patients should not have to ask for them, or wait for nurses to offer], because we know that's the worst method to administer painkillers. We have to give them on a regular basis to make sure we maintain an appropriate level of analgesia."
Dr. Manon Choiniere, Professor, University of Montreal

"We are under-treating pain in Canada. We're doing more and more surgeries on more and more people. We're extending life longer than ever before because of these treatments. But they can be nerve-damaging, and so we have a rising incidence of chronic pain, and we need to do something about it."
Dr. Mary Lynch, professor of anaesthesia, psychiatry and pharmacology, Dalhousie University, Halifax

A study to measure post-operative pain after cardiac surgery has seen Canadian researchers reporting that one in ten patients is left with intolerable pain a full two years after surgery has taken place. Dr. Manon Choiniere was lead author in the study, a researcher with the Centre hospitalier de l'Universite de Montreal research centre.

The researchers reported the results of their study concluding that the more intense pain that patients report the first week following surgery the more likely it will prove to be that they would report pain on an ongoing, daily basis, a full two years afterward. "Pain can predict later pain", the authors reported. Their study involved over a thousand cardiac surgery patients, 18 and older, from Montreal, Quebec City, Toronto and Halifax.

These were patients scheduled for surgeries relating to coronary artery bypass grafting, valve replacement or both, between February 2005 to September 2009. Anxiety and depression expressed pre-surgery was assessed, as was pre-existing pain if any, such as angina. After which they assessed how may people still suffered pain beyond what is considered the normal time for tissue healing; three months.

Patients rated the intensity of their pain on a scale of zero (none) to ten (most excessive pain level), at 24, 48 and 72 hours, and seven days post-surgery. And then once again during the months after surgery. They were then asked to report any pain that wasn't related to pain they experienced before surgery, and lasted for at least three months.

A full forty percent of patients reported experiencing persistent post-operative pain three months afterward, of any intensity. Over time the proportion decreased progressively, to 22 percent at six months, and then about ten percent at 24 months. Pain was rated as "moderate" to "severe" in four percent of patients at the 24-month post-surgery assessment. Some people described their pain as a burning electric shock or a tingling sensation at the scar site.

        A surgeon (C) and an assistant surgeon (R) operate on a patient during an open-heart surgery in a cardiac surgery unit at the hospital in Angers, western France, on October 24, 2013  Photograph by: JEAN-SEBASTIEN EVRARD/AFP/Getty Images , Postmedia News

Women appeared likelier than their male counterparts to report intense, persistent post-surgical pain, as were younger patients aged 21 to 55. Two of the risk factors considered for lingering pain were patient anxiety pre-surgery and the severity of pain felt immediately after surgery. Doctors are aware of professional guidelines along with campaigns relating to the importance of providing people with pain relief after surgery.

Yet two-thirds of the heart patients reported moderate to severe pain during the first few days after surgery. Health professionals, it would seem, and patients themselves consider painkillers along the line of addiction risk primarily, and pain alleviation a distant second thought.