Identifying At-Risk Subgroups for Acute Postsurgical Pain: A Classification Tree Analysis

Pain Med. 2018 Nov 1;19(11):2283-2295. doi: 10.1093/pm/pnx339.

Abstract

Objective: Acute postsurgical pain is common and has potentially negative long-term consequences for patients. In this study, we evaluated effects of presurgery sociodemographics, pain experiences, psychological influences, and surgery-related variables on acute postsurgical pain using logistic regression vs classification tree analysis (CTA).

Design: The study design was prospective.

Setting: This study was carried out at Chongqing No. 9 hospital, Chongqing, China.

Subjects: Patients (175 women, 84 men) completed a self-report battery 24 hours before surgery (T1) and pain intensity ratings 48-72 hours after surgery (T2).

Results: An initial logistic regression analysis identified pain self-efficacy as the only presurgery predictor of postoperative pain intensity. Subsequently, a classification tree analysis (CTA) indicated that lower vs higher acute postoperative pain intensity levels were predicted not only by pain self-efficacy but also by its interaction with disease onset, pain catastrophizing, and body mass index. CTA results were replicated within a revised logistic regression model.

Conclusions: Together, these findings underscored the potential utility of CTA as a means of identifying patient subgroups with higher and lower risk for severe acute postoperative pain based on interacting characteristics.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acute Pain / diagnosis
  • Acute Pain / drug therapy*
  • Adult
  • Aged
  • Anxiety / diagnosis*
  • Anxiety / drug therapy
  • Catastrophization / diagnosis
  • Catastrophization / drug therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Risk
  • Self Report
  • Surveys and Questionnaires