A Longitudinal Cohort Study of Pain Intensity and Interference after Ureteroscopy for Nephrolithiasis Without Post-Operative Opioids.

TitleA Longitudinal Cohort Study of Pain Intensity and Interference after Ureteroscopy for Nephrolithiasis Without Post-Operative Opioids.
Publication TypeJournal Article
Year of Publication2020
AuthorsTalwar R, Dobbs RW, Stambiako H, Lin G, Tasian GE, Ziemba JB
JournalUrology
Date Published2020 Oct 10
ISSN1527-9995
Abstract

OBJECTIVE: 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.

MATERIALS AND METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

DOI10.1016/j.urology.2020.09.042
Alternate JournalUrology
PubMed ID33049231