Digital Self-Reporting of Pain Improves Postoperative Pain Management

Abstract

Background: Many patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of software (Mserv) for real time patient feedback on pain to improve postoperative pain control and reduce opioid prescription at discharge. Methods: We recruited 234 patients to a prospective cohort study into sequential groups in a non-randomised manner, 1 day post major thoracic or urological surgery. Group 1 underwent standard care (SC, n=102), group 2 had a multifunctional device that fed back to nursing staff alone (DN), n=66) and group 3 had a device that fed back to both nursing staff and the acute pain team (DNPT, n=66). Pain scores were recorded at 24 and 48 hours and patient reported time in severe pain, medications and satisfaction were recorded on discharge. Findings: Odds of having poor or borderline pain control (≥2/4 on pain scale) was calculated between standard care (SC) and device groups (DN & DNPT). DNPT patients were significantly less likely to have borderline or poor pain control at 24 hours (OR 0.33, 95% CI 0.16 to 0.70). Patient-reported time in severe pain at 48 hours was improved in both device groups (DN OR 0.61 95% CI 0.44 to 0.83, DNPT OR 0.54 95% CI 0.39 to 0.75). DNPT patients were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation: Using a device to report pain scores rather than standard care reduced the incidence of poor or borderline pain control in the post-operative period and reduced opioid prescription on discharge from hospital. Funding Statement: This work was supported by the Technology Strategy Board (TP102112) with the support of UCL Business. Declaration of Interests: UCL Business (on behalf of UCLH) are in collaboration with HealthTech IT LLP and Mvine Ltd for the future development of this software (MServ). Ethics Approval Statement: The study received ethics approval from the local Research & Ethics Committee (IRAS reference: 184823).