A PROMISing Study

Abstract

INTRODUCTION: PROMIS is a tool developed by the NIH to provide precise measurement of patient pain. Unlike historical methods that only measure pain intensity and quality, the PROMIS Pain Survey directly assesses the impact of pain on patient behavior and the interference of pain on physical, mental and social activities. This assessment tool generates individual scores that can be compared over time and against population averages generated from a 22,100-person sample. The PROMIS Pain Survey tool was utilized to prospectively measure the effect of open midline hernia repair on hernia-related pain as a patient reported outcomes measure. METHODS: All patients undergoing ventral hernia repair by the senior author (G.A.D.) since August 2010 have completed the PROMIS Pain Survey. To provide a legacy control of pain intensity, the patients were also assessed on the 11-point Comparative Pain Scale. All 57 patients who underwent midline hernia repair between August 2010 and October 2012 with preoperative and postoperative PROMIS data were included in this study. RESULTS: A statistically significant improvement in both the pain intensity (p=0.015) and pain interference (p=0.016) over an average follow up period of 7.1 months was measured. Pain-related behavior did not change significantly (p=0.268) (Table 1). Improvement did not vary with age, BMI, diabetes, smoking, gender, or previous hernia repair. Critical analysis of the data demonstrates that pain interference with physical, mental and social activities continues to decline with increasing time after surgery (Figure 1).Table 1: A comparison of preoperative and most recent postoperative PROMIS and pain intensity scores. Statistical analysis is based upon Wilcoxon signed ranks test.Figure 1: Pain interference and behavior scores over time following open ventral hernia repair. (Dotted red line = threshold for clinically significant change; error bars = SEM).CONCLUSION: The PROMIS Pain Survey provides a precise and multifaceted tool for evaluation of pain. This outcomes tool demonstrates in a novel manner the benefit of abdominal wall reconstruction with significant improvements in both pain intensity and pain interference following open midline hernia repair. The scores have improved with length of time since surgery. Although behavior did not change significantly, the trend is towards improvement. Given more time, as interference improves, behavior may follow. While not possible in a single surgeon study, PROMIS may be the ideal tool to compare patient reported outcomes across various types of abdominal wall reconstruction.