LAUSR

BACKGROUND Ongoing postoperative pain assessments are vital to optimizing pain management and attenuating the development of poor health outcomes after surgery. This study aimed to characterize acute multidimensional trajectories of pain impact on physical function, sleep, mood and stress and examine clinical characteristics and demographics associated with trajectory membership. Additionally, this study compared levels of pain intensity and prescription opioid use at two-weeks and one month postoperatively, across acute symptom trajectories. METHODS Participants (N = 285) undergoing total knee arthroplasty, total hip arthroplasty, and spinal fusion procedures were recruited for this multisite prospective observational study. Longitudinal, joint k-means clustering was used to identify trajectories based on pain impact on activity, sleep, mood, and stress. RESULTS Three distinct pain impact trajectories were observed: Low (33.7%), Improving (35.4%), and Persistently High (30.9%). Participants in the Persistently High Impact trajectory reported pain interfering moderately to severely with activity, sleep, mood, and stress. Relative to other trajectories, the Persistently High Impact trajectory was associated with greater postoperative pain at one month postoperatively. Preoperatively, participants in the Persistently High Impact trajectory reported worse Pain Catastrophizing Scale Scores, PROMIS Pain Interference, PROMIS Anxiety, and PROMIS Social Isolation scores than participants presenting with other trajectories. No statistical differences in opioid utilization were observed across trajectories. CONCLUSIONS Variation in acute postoperative pain impact on activity, sleep, mood, and stress exists. Considering the complex nature of patients' postoperative pain experiences, understanding how psychosocial presentations acutely change throughout hospitalization may assist in guiding clinicians' treatment choices and risk assessments.