Skip to main content
PAINWeek 2024 Main banner
Icon Legend
This session is not in your agenda.
This session is in your agenda. Click to remove it
Back

P-027 - A Qualitative Assessment of Surgeon Perceptions and Experiences with Acute Pain Management

POSTER ABSTRACT
Location:  Exhibit Hall
Abstract Title: A Qualitative Assessment of Surgeon Perceptions and Experiences with Acute Pain Management


Background: Post-operative acute pain is a common patient experience and is reported by up to 80% of patients after surgery.1 While experiencing some degree of pain may be expected as part of the post-operative recovery process, the inadequate management of acute pain may result in significant impacts on patients’ health and wellbeing, including detriments to quality of life and prolonged recovery time.1 A variety of medications are used for the management of acute pain. Based on a recent epidemiological analysis, the most common acute pain medications filled in the pharmacy setting include non-steroidal anti-inflammatory drugs (NSAIDs) and opioids (e.g., hydrocodone, oxycodone), while the most common pain medications administered in the hospital setting were non-opioid analgesics (e.g., acetaminophen) and opioids.2 Multiple factors may contribute to inadequate post-operative pain management, including regulatory restrictions, difficulties balancing pain medication analgesic effectiveness with adverse events (AEs), limited treatment options for high-risk patients, and challenges with patient-physician communication and expectations.3 Prior research has described the patient experience of acute post-operative pain4, however there is little research on the viewpoints and experiences of surgeons. We aim to better understand the physician perspective of managing post-operative acute pain in adult patients from a diverse set of surgical specialties.

Purpose/Objectives: The objectives of this research were to: 1) collect data from United States (US)-based surgeons to better understand the challenges, barriers, and facilitators related to managing post-operative acute pain in adult patients; and 2) from the surgeons’ perspective, identify how inadequate acute pain management is defined and its impacts on adult patients.


Methods: In this cross-sectional study, qualitative research methods were used to collect and analyze surgeon descriptions of acute pain management. Purposive sampling was used to identify and screen 30 physicians who met the following eligibility criteria: specialized in general, orthopedic, or plastic surgery; involved in the management of patients’ acute pain; ≥3 years of experience in a surgical setting following completion of a residency or fellowship program; ≥50% working time in a clinical setting; and average caseload consisting of ≥50% adult patients.

This study was reviewed and approved by an independent institutional review board. Physicians reviewed and provided informed consent prior to the start of the interview.

One-on-one, 60-minute concept elicitation interviews were conducted using an interview guide that addressed study objectives. Interviews were semi-structured, allowing for probing and exploration if clarification was needed or if unexpected themes emerged. Physician interview transcripts were coded and analyzed using NVivo qualitative software. Two trained researchers coded the same initial 20% of transcripts, then compared their coding to assess reliability in a consensus building approach. Thematic analysis was used to identify patterns in participant responses concerning the relevant and important elements of acute pain management.


Results: Thirty surgeons participated in the study, with an equal distribution across general, orthopedic, and plastic surgical specialties (n=10, 33.3% each). Nearly all surgeons were male (n=29, 96.7%), most were white (n=22, 73.3%), and a third practiced in the northeastern US (n=11, 36.7%). Clinicians reported a median (range) of 24.5 (4-45) years of surgical experience and most often reported performing 10 surgeries per week. Surgeons reported conducting surgeries in hospitals (n=27, 90.0%), ambulatory surgical centers (n=16, 53.3%), and accredited office-based surgical centers (n=8, 26.7%).

When asked to describe their level of satisfaction with currently available prescription medications for acute pain management, five (16.7%) surgeons reported being satisfied, 19 (63.3%) reported being somewhat satisfied, and three (n=10.0%) were not satisfied; one orthopedic surgeon reported being “totally displeased”. Approximately half reported being comfortable prescribing opioids, with the other half describing varying levels of comfort. While physicians lauded the analgesic effectiveness of opioids, they described significant challenges with AEs, addiction risk, and complexity with prescribing opioids to at-risk populations. Physicians cited challenges with administrative factors related to prescribing opioids, including quantity limits, checking state monitoring programs, stock shortages or pharmacist hesitancy to fill opioid prescriptions, and US Drug Enforcement Administration oversight; more than half of physicians found these limitations burdensome.

Surgeons described the value of NSAIDs in reducing pain and inflammation and the lack of addiction risk, but cited disadvantages, including AEs like gastric bleeding and renal failure, and milder analgesic effectiveness compared to other pain medications. Acetaminophen and gabapentin were described as providing some pain relief, but clinicians noted impacts on liver functioning and sedation or altered cognition, respectively.

While reflecting on the patient-impacts of post-operative acute pain management, half of surgeons reported perceiving their patients were “somewhat satisfied” with current pain medications, approximately one-third reported their patients were satisfied, and one surgeon felt their patients were unsatisfied. Surgeons reported that patients experienced prolonged post-operative recovery, difficulties with emotional functioning, and impairments to activities of daily living (ADL). Additionally, two-thirds of surgeons reported patients discontinuing pain medication or expressing hesitancy around taking medication due to AEs.

Conclusions/Implications for future research and/or clinical care: Surgeons discussed medication, administrative, and patient-related factors that impact prescribing practices for managing post-operative acute pain. Participants reported being somewhat satisfied with medications currently available to manage acute pain, expressing dissatisfaction with AEs, risk of addiction or abuse, and lack of sufficient analgesic effectiveness for certain treatments. Surgeons also described several burdensome administrative challenges, particularly related to prescribing opioids. Physician perceptions of patient-impacts suggest inadequately managed pain negatively impacts patients’ ADL and recovery, and that there is a need for more efficacious analgesics with improved safety. This qualitative research illustrates the perspectives of general, orthopedic, and plastic surgeons on the facilitators and challenges of effective acute pain management and underscores a need for novel therapeutics with improved safety and effectiveness, reduced administrative burden, and lack of addiction potential. Study results will be used to inform future research to quantify these salient themes identified in this study.


References: 1. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-2298. doi:10.2147/JPR.S144066
2. Lopez A. et al. An Evaluation of the Prevalence of Acute and Chronic Pain Medication Use in the United States: a Real-World Database Analysis. [Poster presented at ASRA Pain Medicine Meeting]; 2023.
3. Gan TJ. et al. Practice Patterns and Treatment Challenges in Acute Postoperative Pain Management: A Survey of Practicing Physicians. Pain Ther. 2018;7(2):205-216. doi:10.1007/s40122-018-0106-9
4. Dasa V. et al. A Qualitative Assessment of Surgeon Perceptions and Experiences with Acute Pain Management. [Poster presented at PAINWeek]; 2024.