To reduce interviewer bias, patients complete the questionnaire independently with no assistance from family or staff. The International Pain Outcomes Questionnaire uses 11-point Numeric Rating Scale (where 0 = none and 10 = worst imaginable) or binary items (appendix 1). Patients fill out the International Pain Outcomes Questionnaire in their respective language on the first day after surgery. This includes pain intensity and its duration, pain interference with doing activities in bed, or taking a deep breath or coughing, or sleep, side effects (such as nausea and drowsiness), emotions (anxiety and helplessness), satisfaction with pain treatment, and preoperative presence of chronic pain and its intensity (appendix 1). 12 Patients are asked to evaluate different facets of pain. Chronbach’s alpha of the total scale was high (0.86). The factor analysis resulted in a three-factor structure explaining 53.6% of the variance. The construct validity of the International Pain Outcomes Questionnaire is confirmed by the Bartlett test ( P < 0.001). This patient outcome questionnaire is based on the revised American Pain Society Patient Outcome Questionnaire. Materials and MethodsĪ standardized postoperative questionnaire, the International Pain Outcomes Questionnaire, which has been validated in English and has been translated using standardized methods into 29 different languages, 12 is used in PAIN OUT. We hypothesize, based on clinical practice, that older patients have lower postoperative pain scores than younger patients. 13 In current study, the objective is to analyze associations between age and a diverse range of pain-related patient reported outcomes and treatments, studying a large sample of patients undergoing spinal surgery, hip replacement, knee replacement, or laparoscopic cholecystectomy. Using the International Pain Outcome Questionnaire, 12 which assesses these different dimensions of pain, the experience of pain was measured in the unique international PAIN OUT registry. Additionally, the cultural influence on pain expression should be considered. Since the experience of pain is multidimensional and described on several levels-sensory (intensity and character of pain), affective (emotional component), and impact (ability to function) 11-all these items should be assessed to obtain a comprehensive evaluation of this experience. 10 To be able to improve postoperative pain management in this group, it is important to have more information on the experience of postoperative pain in elderly patients. 8, 9 Studies demonstrate that pain in older patients is underrecognized and undertreated due to lack of pain assessment and concern of increased risks of adverse effects. Some studies suggest that elderly patients report pain to be of a lower intensity than younger patients, 6, 7 while other studies do not find differences. In the literature, the incidence and intensity of postoperative pain in the elderly are conflicting.
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