Unifying Concepts

Preoperative Prediction of Severe Postoperative Pain

Quantitative testing of a patient’s basal pain perception before surgery has the potential to be of clinical value if it can accurately predict the magnitude of pain and requirement of analgesics after surgery.
A simple way to detect these patients at the preoperative visit is to fulfill the Kalkman score, a validated risk scale based on patient’s history and the type of surgery.

Preoperative Prediction of Severe Postoperative Pain

  • Sex: female, 1 point; male, 0 point
  • Age: younger than 30 years, 2 points; 31 to 65 years; 1 points; older than 65 years, 0 point
  • Pain before surgery at the site: none, 0 point; moderate, 2 points; severe, 3 points
  • Regular use of opioids, 1 point
  • Regular use of anxiolytic antidepressants, 1 point (otherwise)
  • Open surgery, 1 point (otherwise)
  • Type of surgery: thoracic, 3 points; abdominal, 2 points; orthopaedic, 1 point; other, 0 point
  • Long-lasting procedures (>120 minutes), 1 point (otherwise)
  • Obesity (BMI>30), 1 point (otherwise)
  • High levels of anxiety in the preoperative visit, 1 point (otherwise)

The risk-intense postoperative pain is important when the score is 4 out of 15.



  1. Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain. 2003 Oct;105(3):415-23. [Medline]
  2. Janssen KJ, Kalkman CJ, Grobbee DE, Bonsel GJ, Moons KG, Vergouwe Y. The risk of severe postoperative pain: modification and validation of a clinical prediction rule. Anesth Analg. 2008 Oct;107(4):1330-9. [Medline]


Created Jul 6, 2018.

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