• T J Gan, D A Lubarsky, E M Flood, T Thanh, J Mauskopf, T Mayne, and C Chen.
• Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA. gan00001@mc.duke.edu
• Br J Anaesth. 2004 May 1; 92 (5): 681-8.

BackgroundOptimal treatment for acute pain is a function of an individual's willingness to make trade-offs between treatment side effects and pain control. The objective was to investigate the degree to which patients are willing to make these trade-offs.MethodsFifty patients undergoing major abdominal surgery were enrolled and completed interviews before and after surgery. Measures included an experience with pain questionnaire and an adaptive conjoint analysis (ACA) interview.ResultsPercentage of pain relief obtained post-surgery was between 70 and 80%. Eight-two per cent reported at least one moderate or severe side effect. ACA results demonstrated that pain efficacy and side effect type/severity have almost equal 'importance' scores. Patients varied in their willingness to trade-off pain efficacy for different or milder side effects.ConclusionsWe conclude that people have different relative preferences for different side effects and are willing to trade-off pain relief for less upsetting and/or less severe side effects but to different degrees. Thus, physicians should consider offering pain medications with fewer side effects than narcotics as a first choice. Our study indicates the need to balance analgesia and side effects in order for patients to achieve optimal pain control.

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