Patient and family education regarding the management of acute pain after injury or surgery plays an important role in the successful pain control and expedition of recovery. Timely and appropriate education also decreases patient anxiety and worries about postoperative pain. One patient survey had shown that more than half of the patients surveyed were concerned about experiencing pain after surgery and that this caused some of them even to postpone surgery.² The emphasis on the patient and family education is not new. In 1992, the Department of Health and Human Services published the Acute Pain Clinical Practice Guideline,³ which stressed the significance of patient and family education for acute pain management. The essential elements of pain education (shown in Fig. 12.1), as stated in these guidelines, include telling the patient the following:

It is good to set up goals for pain management during the hospitalization and after discharge. These goals are centered around the functional requirements during the recovery period after surgery or injury. Examples of the functional requirements are ambulation, physical therapy, and deep breathing. These activities promote recovery and improve outcomes. These goals are best established with coordination between physicians, nursing staff, patient, family member, and other health care providers involved in the patient treatments and recovery.⁴ One dimension of the plan is to establish a tolerable and acceptable pain level during these activities such as physical therapy or dressing changes. Knowledge of the patient pain history is critical to create effective pain management plan for the current hospitalization or home recovery period.

Patient expectations can be a difficult concept to quantify—but setting appropriate expectations plays an important role in patient outcomes, especially overall patient satisfaction with their overall surgical experience and pain control. Furthermore, the nature of patient expectations can sometimes be challenging to define but typically involves the patient’s anticipation of an event—such as an increase in joint function after surgery.⁵ Moreover, a gap in expectations often exist between the physician and the patient. Acknowledgment of this gap upfront, prior to surgery, may minimize the negative consequences of unmet expectations. Several factors such as age, gender, and health status can also influence a patient’s expectation for recovery after surgery.⁶ Health care provider awareness of these factors may also decrease may expedite and smooth the recovery leading to better overall patient satisfaction.

Discrepancies between what patients and their doctors expect from medical treatment are welldocumented in the medical literature. Even on the basic understanding of what constitutes
“quality of life,” doctor and patient perceptions may significantly diverge. If quality of life issues and the potentially divergent perspectives are not acknowledged and integrated into the patient’s assessment, it can result in a lack of understanding about the efficacy of treatment or even lack of compliance.⁷ One study examined the expectation gap among joint replacement patients to understand its nature: 168 patients undergoing either a total hip or total knee replacement filled out a questionnaire regarding their expectations of how surgery would affect pain levels, function, and overall well-being. At the same time, their surgeons filled out an identical questionnaire about their own expectations for their patients. The study revealed a substantial gap between the expectations of these two groups, with 52.5% of the patients having expectations that exceeded that of their surgeon.⁵ One way to minimize this gap is a frank discussion between the surgeon and the patient ahead of the surgery including a thorough risk-benefit analysis of the procedure. During this meeting, the patient and the physician can collaboratively make an informed decision about whether surgery is the best choice for their individual needs. This process is time consuming but can help patients to create realistic expectations and decrease the risk of dissatisfaction after surgery.⁸ Other ways may help to decrease the expectation gap is to use psychological interventions. In one study, patients undergoing cardiac surgery underwent a psychology-based, presurgical intervention to help manage their expectations of surgery. Compared to the control group who did not undergo a presurgical intervention, these patients showed an increased recovery from their disability, an increased ability to return to work, and an increased mental quality of life.⁹