Association Between Socrates Pain Dimensions and Sleep Quality in Orthopedic Operative Patients: An Observational Study

Abstract

Introduction: Postoperative pain is a frequent complication after orthopedic surgery and is closely linked to sleep disturbances, which can slow recovery and impair quality of life. The SOCRATES framework assesses multiple pain dimensions beyond intensity, providing deeper insights into pain–sleep interactions.

Aim and Objectives: To assess the association between SOCRATES pain dimensions and sleep quality in postoperative orthopedic pati0ents, and to identify which aspects of pain most strongly affect sleep outcomes.

Methodology: A prospective observational study was conducted on 300 orthopedic surgical patients admitted to the Owaisi Group of Hospitals, Hyderabad, over six months. Pain was assessed using the Numerical Rating Scale (NRS) and SOCRATES mnemonic at baseline (0 hr), 48 hrs, and 15 days postoperatively. Sleep quality was evaluated on day 15 using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using Spearman correlation and the Kruskal–Wallis test.

Results and Discussion: The majority were male (63.67%), aged 18–59 years, with falls (75%) and road traffic accidents (42.67%) as primary causes. Lower limb pain predominated. At baseline, severe pain (NRS ≥7) was universal; by day 15, mean pain score reduced to 2.67 ± 0.86. PSQI scores ranged from 3–10, with 95.3% scoring >5, indicating poor sleep quality. Pain and sleep scores showed a strong positive correlation (ρ = 0.859, p < 0.001). The Kruskal–Wallis test confirmed significant differences in sleep quality across pain categories (χ² = 221.057, p < 0.001).

Conclusion: Higher postoperative pain is significantly associated with poorer sleep quality. Despite pain reduction over two weeks, sleep disturbances persisted in most patients, suggesting additional contributing factors. Multimodal pain control, sleep hygiene, and supportive interventions are recommended for better recovery.