Nickisha Patel
Introduction
Unrealistic pain expectations are a recognised contributor to delayed discharge, unplanned admission, and reduced satisfaction in day-case surgery. In trauma and orthopaedic procedures, often performed to relieve chronic pain, patients may hold high expectations of postoperative pain relief. Despite this, responsibility for pain education within perioperative pathways is frequently diffuse. This study explored clinician confidence, perceived ownership, and barriers to pain education in T&O care.
Methods
A cross-sectional convenience sample survey was conducted among 28 T&O perioperative clinicians at a single surgical centre (17 consultants, 6 registrars, 5 senior fellows). A purpose-built questionnaire assessed self-reported confidence in predicting and managing postoperative pain, perceived responsibility for patient education, and barriers to structured pain counselling. Closed responses summarised descriptively; free-text responses underwent structured narrative synthesis.
Results
Most clinicians reported high confidence in predicting (23/28, 82%) and managing (25/28, 89%) postoperative pain. However, only 11/28 (39%) identified pain education as a defined component of their own consultation or consent process. Commonly cited barriers included time constraints (21/28, 75%), assumptions that education occurred elsewhere in the pathway (18/28, 64%), and lack of standardised resources (16/28, 57%). Lack of clinical knowledge was rarely cited as a barrier (3/28, 11%).
Conclusions
Despite high clinical confidence, preoperative pain education in T&O surgery is inconsistently delivered, with diffuse team ownership and system-level barriers. These findings are relevant to day-case perioperative pathways, where unmet pain expectations contribute to delayed discharge. Clarifying responsibility and embedding structured pain expectation discussions within consent are practical quality improvement targets.
Authors
Shruti Sundar, John Va Faye, Rashida Seimu, Nickisha Patel, Vatsala Padmanabhan, Rajasekhar Gowni, Royal Orthopaedic Hospital, Birmingham, United Kingdom