A comparison of the clinical and experimental characteristics of four acute surgical pain models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery

Pain. 2014 Mar;155(3):441-456. doi: 10.1016/j.pain.2013.09.002. Epub 2013 Sep 6.


When a clinical trial of an analgesic produces a negative finding, it is important to consider the influence (if any) of experimental error on the validity of that result. Although efforts to identify and minimize experimental error in chronic pain investigations have begun in earnest, less work has been performed on the optimization of acute pain methodology. Of the acute surgical pain methodology articles that have been published over the last decade, almost all focus on either the dental or bunion model. Analgesics are typically evaluated in a variety of surgical models that eventually include hospital-based models (eg, joint replacement and soft tissue surgery). Every surgical procedure has unique clinical characteristics that must be considered to optimize study design and conduct. Much of the methodological knowledge garnered from bunion and dental studies is applicable to other surgical models, but some extrapolations are hazardous. The purposes of this review were (1) to qualitatively describe the clinical and experimental characteristics of the 4 classic surgical models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery; and (2) to quantitatively compare the models by analyzing 3 factors: effect size, enrollment rate, and demographics. We found that the dental extraction and bunionectomy models had higher assay sensitivity than the joint replacement and soft tissue surgery models. It is probable that this finding is secondary to the superior experimental conditions under which the dental and bunion models are executed (utilization of few centers that have the ability to reduce surgical, anesthetic, and postoperative confounders).

Keywords: Acute pain; Analgesic methodology; Bunionectomy; Laparoscopic herniorrhaphy.; Third molar dental impaction; Total knee arthroplasty/Total hip arthroplasty.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Acute Pain / diagnosis
  • Acute Pain / therapy*
  • Analgesics / therapeutic use
  • Arthroplasty, Replacement / adverse effects*
  • Controlled Clinical Trials as Topic / methods
  • Hallux Valgus / diagnosis
  • Hallux Valgus / surgery*
  • Humans
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / therapy*
  • Randomized Controlled Trials as Topic / methods
  • Subcutaneous Tissue / pathology
  • Subcutaneous Tissue / surgery*
  • Tooth Extraction / adverse effects*


  • Analgesics