University of Florida

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By Carlos Medina

Gainesville, Florida — A new study raises questions about how to manage pain after surgery, especially for older adults.

Researchers found that patients 65 and older reported significantly lower pain levels than younger patients after undergoing major surgery. At first glance, that might sound like good news. But the reality is more complicated.

This difference in pain reporting doesn’t necessarily mean older patients are more comfortable. It may mean they’re less likely to feel or communicate pain, which could delay treatment and lead to more serious complications and even death.

Lisiane Pruinelli, Ph.D., M.S.N., R.N., an associate professor and interim department chair at the University of Florida College of Nursing, led the study, which analyzed the postoperative records of thousands of patients from a major Midwest hospital system who underwent major surgery.

Using machine learning — a type of artificial intelligence — the researchers were able to scour electronic health records and capture the self-reported pain levels of patients by age group in the hours and days after surgery. The study was recently published in the Journal of the American Association of Nurse Anesthesiologists.

“We’ve long known that pain is subjective and complex,” Pruinelli said. “But what we’re finding now is that age plays a much bigger role in how pain is perceived, reported and ultimately treated.”

And those perceptions can lead to serious consequences. According to the study, older adults are more likely to suffer complications like delirium, breathing issues and prolonged sedation after surgery. Even after adjusting for pre-existing health conditions, previous studies have found that older patients were up to nearly seven times more likely to die from surgical complications than younger patients.

“We can’t assume that less reporting means less pain,” she explained. “Older adults might be less likely to verbalize their discomfort, may have different pain thresholds or could even have cognitive impairments that make it harder to express what they’re feeling. That puts them at risk for being under-treated.”

The researchers point out that many clinical trials are based on data from younger, healthier people, leaving pain management for older adults somewhat murkier.

Clinicians may also rely too much on pain as an indication of recovery. Pruinelli points out that body tissue reacts similarly to surgery regardless of age, including inflammation and other physiological responses. If these responses are not addressed appropriately, it could cause complications and even lead to chronic pain.

“One of the key concerns is that under-reporting of pain may result in clinicians not offering sufficient or timely pain relief,” Pruinelli said. “That delay can trigger a cascade of other health issues, especially in older patients who are more fragile postoperatively.”

To address this, the study suggests hospitals adopt age-specific pain management plans, using different types of medications, tailored doses and alternative therapies, such as nerve blocks or physical therapy. It also calls for new training to help clinicians, including nurse anesthetists, better recognize pain in older patients, who may not express it in typical ways.

With nearly 40% of surgeries worldwide performed on patients over 65, the study encourages physicians and health systems to rethink how they care for patients in the operating room and beyond.

“People have different trajectories of pain,” Pruinelli said. “We need to personalize pain treatment based on these trajectories and on how individuals respond to different therapies. That includes using objective indicators, predictive analytics and decision-support tools to complement what patients are telling us — or not telling us.”

Pruinelli’s work is part of a broader initiative at the UF College of Nursing to use technology and data to solve real-world health challenges.

“Nurses are on the front lines of patient care, but we are also generating the science that informs how that care should be delivered,” Pruinelli said. “This research is about making sure no patient, especially our most vulnerable, is overlooked or underserved.”