A Longitudinal Cohort Study of Pain Intensity and Interference after Ureteroscopy for Nephrolithiasis Without Post-Operative Opioids.
Year of Publication
2020 Oct 10
<p><strong>OBJECTIVE: </strong>To better understand the degree and time to resolution of pain in the post-operative period, we captured patient-reported pain intensity and interference prospectively in patients following ureteroscopy for nephrolithiasis.</p>
<p><strong>MATERIALS AND METHODS: </strong>Adults undergoing ureteroscopy for renal/ureteral stones from 11/2018 to 1/2020 were eligible for inclusion. All received non-opioid postoperative pain control. Patients prospectively completed PROMIS-Pain Intensity and PROMIS-Pain Interference instruments pre-operatively on POD 0 and via email on POD 1, 7, and 14. Scores are reported as T-scores (normalized to US population, mean=50) with changes of 5 (0.5 SD) considered clinically significant.</p>
<p><strong>RESULTS: </strong>126 patients completed enrollment at POD 0 (POD 1=74, POD 7=61, POD 14=47). Compared to US means, intensity and interference were significantly different at all time point comparisons (Wilcoxon rank test; all p<0.001) except intensity at POD 7 (p=0.09) and interference at POD 14 (p=0.12). For both, there was a significant difference at each time comparison (repeated measures ANOVA; all p <0.05). Increasing age was predictive of lower intensity (CI: -0.31- -0.04; p=0.012) and interference (CI: -0.36 - -0.06; p=0.01) at POD 1. The presence of a post-operative stent was predictive of higher intensity (CI: 0.68-10.81; p=0.03) and interference (CI: 0.61-12.96; p=0.03) at POD 7. Increasing age remained a predictor of lower interference at POD 1 on multivariable analysis (CI: -0.46 - -0.01; p=0.03).</p>
<p><strong>CONCLUSIONS: </strong>Pain intensity and interference are elevated immediately, but intensity normalizes by POD 7, while interference remains elevated until POD 14. Age and indwelling ureteral stent influence both intensity and interference.</p>