November, 1999

A Look at the Impact of Pain on Health-Related Quality of Life in Post-Operative Patients

SF-36 versus SF-12 scores in persons at home 1 month after surgery

Strassels SA, Carr DB, Cynn DJ, McDonagh MM, Gouveia WA, Rogers WH, Departments of Anesthesia, Pharmacy, Nursing and The Health Institute, New England Medical Center, Boston, MA, 02111, USA

PainLink members from New England Medical Center, Boston, MA, completed a study on pain and the quality of life in patients at home 1 month after orthopedic or urologic surgery. This study, supported by the Mayday Fund, and the Arthur Vining Davis and Saltonstall Foundations, offers an interesting methodological approach to examining the impact of pain on quality of life.

"Very little is known about the effect of postoperative pain on health-related quality of life (HRQL) and functioning for persons who go home after surgery. As average post-operative hospital stays continue to decline, our concern is that patients may be going home with poorly controlled pain," says Scott Strassels.

A total of 26 participants completed the SF-36, a subset of which is the SF-12 1 month after total hip (n = 5) or knee replacement (n = 7) or radical prostatectomy (n = 14) surgery. The SF-36 covers 8 generic health concepts. The SF-12 provides norm-based scores for a physical and mental component summary scale (PCS, MCS). Values for both instruments range from 0-100. Patients' scores for each instrument were compared to US norms.

"The results reveal an interesting disconnect between satisfaction with pain management and reports of pain interfering with daily activities, sleep, and normal sexual activity," says Scott. "The mean pain severity was 2.6 on a 0 - 10 point analog scale during the 2 week period before completing the survey, yet more than half of the participants complained of pain that limited the ability to carry out normal daily activities and of pain that interfered with sleep." (Table 1 details the questions and responses.)

Patients reported significantly decreased health status on the SF-36 scales for physical functioning, bodily pain, social functioning, and role/emotional functioning. Patients also reported significantly decreased health status on the physical component summary. (Table 2 offers a comparison of the study group and US norms on the SF-36 and SF-12 Scales)

The authors conclude that (1) pain adversely affects health-related quality of life and functioning 1 month after surgery, (2) the SF-12 appears to provide valid estimates of HRQL in people one month after orthopedic or urologic surgery, (3) the SF-12 may be preferable to the SF-36 when a shorter HRQL instrument is needed, and (4) suboptimally treated pain may lead to a "psychosocial windup," in which functioning is diminished despite relatively low pain scores.

*p = < 0.05

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Last Updated: April 18, 2000