Improved Evaluation of Postoperative Pain After Photorefractive Keratectomy
Purpose
To provide a multidimensional (sensory, affective and evaluative) analysis of postoperative photorefractive keratectomy (PRK) pain. To evaluate beyond pain intensity, including its qualitative profile.
Methods
This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. Following surgery, a bandage contact lens was placed over the eye and remained until complete corneal reepithelialization. Patients were treated with topical nepafenac 0.1%, moxifloxacin 0.5% 4 times daily for up to 5 days and celecoxibe 200mg tablets daily for up to 4 days. All participants responded to the Visual Analogue Scale (VAS), Brief Pain Inventory (BPI) and McGill pain questionnaires at one, 24, 48, 72 and 96 hours after surgery.
Results
Cronbach’s alpha test showed high internal consistency for each of the McGill - Present Pain Index (PPI), McGill - Pain Rating Index (PRI), BPI - Pain Severity and BPI - Pain Interference methods. Patients reported significantly higher postoperative pain values at the first measurement ( one hour ) on the VAS (4,93 +- 2,38), McGill-PRI total (26,95 +-10,58), BPI - Pain Severity ( 14,53 +-7,36 ) and BPI-Pain Interference (22,30 +- 15,13 ) scores. All scales showed statistically significant direct correlation within each other in all evaluation periods.
Conclusion
This study validates the utility of multidimensional questionnaires to expand the assessment of PRK postoperative pain, including intensity and other qualitative aspects. A better understanding of the mechanisms and clinical pattern of pain after PRK may help to improve its medical control and to allow its more widespread indication.