Background:Postoperative pain after cardiac surgery is a significant problem, but studies often report pain value as an average of the study cohort, obscuring clinically meaningful differences in pain trajectories. We sought to characterize heterogeneity in postoperative pain experiences.Methods:We enrolled patients undergoing a cardiac surgery at a tertiary care center between January 2019 and February 2020. Participants received an electronically-delivered questionnaire every 3 days for 30 days to assess incision site pain level. We evaluated the variability in pain trajectories over 30 days by the cohort-level mean with confidence band and latent classes identified by group-based trajectory model. Group-based trajectory model estimated the probability of belonging to a specific trajectory of pain.Results:Of 92 patients enrolled, 75 provided ≥3 questionnaire responses. The cohort-level mean showed a gradual and consistent decline in the mean pain level, but the confidence bands covered most of the pain score range. The individual-level trajectories varied substantially across patients. Group-based trajectory model identified 4 pain trajectories: persistently low (n=9, 12%), moderate declining (initially mid-level, followed by decline; n=26, 35%), high declining (initially high-level, followed by decline; n=33, 44%), and persistently high pain (n=7, 9%). Persistently high pain and high declining groups did not seem to be clearly distinguishable until approximately postoperative day 10. Patients in persistently low pain trajectory class had a numerically lower median age than the other 3 classes and were below the lower confidence band of the cohort-level approach. Patients in the persistently high pain trajectory class had a longer median length of hospital stay than the other 3 classes and were often higher than the upper confidence band of the cohort-level approach.Conclusions:We identified 4 trajectories of postoperative pain that were not evident from a cohort-level mean, which has been a common way of reporting pain level. This study provides key information about the patient experience and indicates the need to understand variation among sites and surgeons and to investigate determinants of different experience and interventions to mitigate persistently high pain.

中文翻译：

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心脏手术后疼痛的轨迹：测量、报告和个体化治疗的意义

背景：心脏手术后的术后疼痛是一个重大问题，但研究通常将疼痛值报告为研究队列的平均值，从而掩盖了疼痛轨迹的临床意义差异。我们试图描述术后疼痛经历的异质性。方法：我们招募了 2019 年 1 月至 2020 年 2 月期间在三级护理中心接受心脏手术的患者。参与者每 3 天收到一份电子问卷，持续 30 天，以评估切口部位疼痛水平. 我们通过基于组的轨迹模型确定的置信带和潜在类别，通过队列水平平均值评估了 30 天内疼痛轨迹的变异性。基于组的轨迹模型估计了属于特定疼痛轨迹的概率。结果：在入组的 92 名患者中，75 提供了≥3 个问卷答复。队列水平平均值显示平均疼痛水平逐渐且持续下降，但置信区间覆盖了大部分疼痛评分范围。个体水平的轨迹因患者而异。基于组的轨迹模型确定了 4 种疼痛轨迹：持续低（n=9, 12%）、中度下降（最初为中等水平，随后下降；n=26, 35%）、高度下降（最初为高水平，随后下降；n=33, 44%）和持续高痛（n=7, 9%）。直到大约术后第 10 天，持续高疼痛组和高下降组似乎无法明确区分。持续低疼痛轨迹组的患者中位年龄在数字上低于其他 3 个组，并且低于队列水平的较低置信区间方法。持续高疼痛轨迹类别的患者中位住院时间比其他 3 个类别更长，并且通常高于队列水平方法的置信区间上限。结论：我们确定了 4 个不明显的术后疼痛轨迹来自队列水平的平均值，这是报告疼痛水平的常用方法。这项研究提供了有关患者体验的关键信息，并表明需要了解不同部位和外科医生之间的差异，并调查不同体验和干预措施的决定因素，以减轻持续的高疼痛。我们确定了 4 个术后疼痛轨迹，这些轨迹在队列水平平均值中并不明显，这是报告疼痛水平的常用方法。这项研究提供了有关患者体验的关键信息，并表明需要了解不同部位和外科医生之间的差异，并调查不同体验和干预措施的决定因素，以减轻持续的高疼痛。我们确定了 4 个术后疼痛轨迹，这些轨迹在队列水平平均值中并不明显，这是报告疼痛水平的常用方法。这项研究提供了有关患者体验的关键信息，并表明需要了解不同部位和外科医生之间的差异，并调查不同体验和干预措施的决定因素，以减轻持续的高疼痛。