Satisfaction with pain relief after operative treatment of an ankle fracture.

Background: American patients are prescribed more opioid pain medication than Dutch patients after operative treatment of an ankle fracture, but it is possible that pain is undertreated in Dutch patients. This study tests if there is a difference in pain and satisfaction with pain relief between Dutch and American patients after operative treatment of ankle fractures.

Methods: Thirty American and 30 Dutch patients were enrolled in a prospective comparative study prior to operative treatment of ankle fractures. Patients rated pain and satisfaction with pain relief on postoperative day 1 (POD1) and at time of suture removal (SR). Pain and satisfaction scores were compared and multivariable analysis identified their predictors.

Results: At POD1, a third of Dutch patients used no opioids and a sixth took strong opioids. At SR, only 4 of 30 (13%) were taking tramadol and half were taking no medication. All of the American patients used strong opioid pain medication on POD1 and 19 of 30 (63%) were still taking strong opioids at SR. Patients that did not use opioids and Dutch patients had less pain and equivalent satisfaction with pain relief compared to patients that used opioids and American patients respectively. Nationality was the best predictor of pain intensity at POD1. Opioid medication was the best predictor of pain at SR and decreased satisfaction with pain management.

Conclusions: Pain and satisfaction with pain relief are culturally mediated. Patients that use non-opioid pain medication report less pain and greater satisfaction with pain relief than patients managed with opioid pain medication.

Level Of Evidence: Level I, Prognostic Study with more than 80% follow-up.