title: Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study.
abstract: BACKGROUND
  Little is known about how well postoperative pain is managed in living liver donors, despite pain severity being the strongest predictor of persistent pain with long-lasting disability.
  
  
  METHODS
  We conducted a prospective multicenter study of 172 living liver donors. Self-reported outcomes for pain severity, activity interference, affective (emotional) reactions, adverse effects to treatment, and perceptions of care were collected using the American Pain Society Patient Outcomes Questionnaire-Revised. Mixed-effects linear regression was used to identify demographic and psychosocial predictors of subscale scores.
  
  
  RESULTS
  Donors were young (36.8 ± 10.6) and healthy. Of 12 expert society analgesic recommendations for postoperative pain management, 49% received care conforming to 3 guidelines, and only 9% to 4 or 5. More than half reported adverse effects to analgesic treatment for moderate to severe pain that interfered with functional activity; however, emotional distress to pain was unexpectedly minimal. Female donors had higher affective (β = 0.88, P = 0.005) and adverse effects scores (β = 1.33, P < 0.001). Donors with 2 or more medical concerns before surgery averaged 1 unit higher pain severity, functional interference, adverse effects, and affective reaction subscale scores (β range 1.06-1.55, all P < 0.05). Receiving information about pain treatment options increased perception of care subscale scores (β = 1.24, P = 0.001), whereas depressive symptoms before donation were associated with lower scores (β = -1.58, P = 0.01).
  
  
  CONCLUSIONS
  Donors have a distinct profile of pain reporting that is highly influenced by psychological characteristics. Interventions to improve pain control should consider modifying donor behavioral characteristics in addition to optimizing pain care protocols.
authors: 1 Department of Anesthesiology, University of Colorado, Boulder, CO. 2 Department of Biostatistics, University of Michigan, Ann Arbor, MI. 3 Arbor Research Collaborative for Health, Ann Arbor, MI. 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. 5 Department of Psychology, University of Pittsburgh, Pittsburgh, PA. 6 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 7 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA. 8 Department of Anesthesiology, University of Washington, Seattle, WA. 9 Department of Psychology, University of British Columbia, Vancouver, BC, Canada. 10 Department of Surgery, University of Michigan, Ann Arbor, MI. 11 Department of Surgery, University of Pittsburgh, Pittsburgh, PA. 12 Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine, Chicago IL. 13 Department of Transplantation, Lahey Clinic, Burlington, MA. 14 Northwestern University Transplant Outcomes Research Collaborative, Northwestern University Feinberg School of Medicine, Chicago, IL. 15 Department of Surgery, University of California at San Francisco, San Francisco, CA. 16 Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. 17 Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA. 18 Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY. 19 Department of Surgery, University of Pennsylvania, Philadelphia, PA.
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mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult