Depression, age linked to post-prostatectomy pain

NEW YORK (Reuters Health) - Younger age, symptoms of depression, and severe pain during the immediate post-operative period are significant predictors of severe pain during recovery from radical prostatectomy, study findings indicate.

These results imply that "pain once manifested is not easily converted despite a generous analgesic treatment," Swedish investigators explain in the current issue of BMC Nursing. "This may be more evident in ... younger and depressive patients, who might benefit from a more aggressive therapy instituted in the very early postoperative period."

Dr. Kerstin Wickstrom Ene, at Sahlgrenska University in Gothenburg, and associates examined factors potentially associated with post-operative pain intensity using the visual analog scale (0-100 mm).

The men were an average of 63 years old, and ranged between 43 and 73 years old. A visual analog score of greater than 30 mm was interpreted as inadequate analgesia and severe pain was defined as a visual analog score greater than 70 mm.

All of the men underwent radical prostatectomy, removal of the prostate and the surrounding tissue.

Routine treatments for postoperative pain included continuous epidural analgesia (injection of analgesia into the epidural space of the spine causing loss of feeling in the abdomen and pelvic area) intrathecal analgesia (injection of analgesia directly into the spinal canal); or systemic opioid analgesia.

Patients were asked about pain at 4 hours after surgery and about the "worst pain" experienced during the last 24 hours at intervals of 24, 48, and 72 hours.

Among the 155 patients, 1 out off 4 experienced severe pain. The only demographic factor associated with severe pain was younger age.

Sixteen patients had symptoms of depression determined the day prior to surgery. Depression correlated with postoperative pain and predicted a pain level higher than 70 on the visual analog score. Anxiety level did not affect the pain experience.

Overall, intrathecal analgesia was most effective. Epidural analgesia was associated with higher pain levels on day 2, whereas patients treated with systemic drugs required more opiates.

Further analysis indicated that "the probability that the pain score would exceed 30 mm and 70 mm was predicted only by previous

visual analog value," Ene and colleagues report. They recommend that "patients who wake up after surgery with insufficient pain relief should be treated immediately to avoid further pain."

SOURCE: BMC, Nursing December 9, 2008.