Discrimination measures in an ROC analysis of pain reactions

Women suffer more short and long-term pain than men after major thoracotomy

OBJECTIVES

Prolonged activation of pain centers is a proposed cause of chronic pain syndromes. Women are at particular risk for chronic pain as they tend to more readily detect pain and to attenuate it less than men. We set out to determine whether sex affected pain and recovery after major surgery by analyzing data originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy.

METHODS

Patients presenting for lobectomy, segmentectomy, or bilobectomy, but not pneumonectomy or chest wall resection, were enrolled. Pain, physical activity, and the extent that pain interfered with activities after surgery were prospectively assessed with standard questionnaires (Brief Pain Inventory and physical component score of SF-36) on postoperative days 1 to 5, and at postoperative weeks 4, 8, 12, 24, 36, and 48 by a blinded research assistant. Perioperative care was standardized and included patient-controlled thoracic epidural analgesia until thoracostomy tube removal.

RESULTS

Fifty eight men and 62 women were enrolled. Women reported more pain than men throughout the entire study period, and they had a higher rate of nonsteroidal anti-inflammatory drug use, but not opioid use. This increased pain was not explained by incision type, surgeon, tumor type, or tumor stage. Older patients reported less pain after discharge than younger patients. Postoperative physical activity levels were significantly less than those reported preoperatively, but did not differ by sex.

DISCUSSION

Women have a distinctly different pain experience than men after thoracic surgery and probably require novel and/or multimodal analgesic regimens to improve their comfort.

Pain reactions in pregnant women

Reactions to radiant heat stimuli were measured in pregnant women and in a control group of non-pregnant women matched in age. Receiver operating characteristic curve parameters were computed for each of the stages of pregnancy from the 6th month until the postpartum period. When painful stimuli were used, a group by stage of pregnancy interaction was found in the analysis on the response criterion for reporting pain. Pregnant women were found to be significantly more willing to label radiant heat stimuli as painful during the last 2 weeks of pregnancy than during any of the other stages of pregnancy. The control women tested during the same time sequence as the pregnant women showed stable response criteria across the 6 month testing period. There were no group or stage of pregnancy effects evident when the discrimination accuracy measures were analyzed; nor were any effects found with responses to thermal stimuli. The results suggest that the changes in pain reaction associated with pregnancy are based on non-sensory factors that influence the subject's willingness to report pain.