Location and Patterns of Persistent Pain Following Cardiac Surgery

Katijjahbe MA 1 , Royse C 2 , Granger C 3 , Denehy L 4 , Md Ali NA 5 , Abdul Rahman MR 5 Show all authors , King-Shier K 6 , Royse A 7 , El-Ansary D 8

Affiliations 

  • 1 Department of Physiotherapy, Hospital Canselor Tunku Mukhriz, University, Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia. Electronic address: katijjahbe@yahoo.com
  • 2 Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, USA
  • 3 Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia; Department of Physiotherapy, The Royal Melbourne Hospital, Parkville, Australia
  • 4 Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, Australia
  • 5 Cardiothoracic Surgery, Heart and Lung Centre, UKM Medical Centre, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
  • 6 Faculty of Nursing and Department of Community Health Sciences, University of Calgary, Calgary, Canada
  • 7 Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia
  • 8 Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Clinical Research Institute, Westmead Private Hospital, Westmead, Australia
Heart Lung Circ, 2021 Aug;30(8):1232-1243.
PMID: 33608196 DOI: 10.1016/j.hlc.2020.12.009

Abstract

OBJECTIVES: To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population.

METHODS: A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively.

RESULTS: Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time.

CONCLUSION: Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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