Direct Patient Feedback

Postoperative pain is common, can be severe, has a negative impact on outcomes after surgery and brings along major economic costs for society. A substantial part of patients may develop persistent post-surgical pain. Severity and duration of pain after surgery appear to have a role in this process but the transition from acute postoperative pain to chronic pain is only partially understood. Effective treatment of postoperative pain is hampered by several barriers, including the way measurement of pain and registration of pain-scores are carried out by nurses in clinical practice.
Modern technology offers new opportunities for pain measurement and direct patient feedback on postoperative pain, during and also after clinical admission. We developed a smartphone application that allows clinical patients to report pain scores and other pain related outcomes on postoperative pain with their own telephone device. Patient reported pain scores > 3 on a Numeric Rating Scale (NRS) 0-10 are immediately passed on to the nurse who receives a message of the reported pain score. This can lead to earlier detection of pain and a more timely treatment resulting in improved patient reported outcomes on postoperative pain.

A direct patient feedback system can lead to earlier detection of pain and a more timely treatment resulting in improved patient reported outcomes on postoperative pain.

During clinical admission four types of patient reported data will be collected:
- On the day of hospital admission, participants will be questioned for the existence of a persistent painful condition for 3 months or more before coming into hospital for surgery. If yes, they will be asked to report pain severity by NRS (0-10) and location of this persistent pain.
- Starting the first day following surgery participants will receive the APS-POQ-R every day at 8 a.m..
- Starting after discharge from post anesthetic care unit participants will receive an SMS text message every full two hours between 10 a.m. and 10 p.m.. In this SMS participants are encouraged to deliver a self-reported NRS pain score by clicking a link attached to the SMS.
- Between the afore mentioned 2 hour time intervals and between 10 p.m. and 8.a.m. participants can report a pain-score on their own initiative with a maximum of one report per hour.

Process of data collection after discharge
After hospital discharge participants will receive the BPI-sf every two weeks for a period of three months.

Applying a system in which patients undergoing surgery can report pain scores and other pain-related outcomes with their own smartphone, both during hospitalization and for three months after discharge. During clinical admission patient reported pain scores > 3 (NRS 0-10) in the intervention group are immediately passed on to the nurse who will receive a notification on a smartphone. In the control group this is not the case. After discharge, patients will report pain scores every two weeks for three months.