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Updated: Mar 22, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care
Karen L Connolly1, Kishwer S Nehal1, Stephen W Dusza1
1Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Background:
Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS.
Objective:
We sought to determine if patients experience pain during their MMS visit.
Methods:
In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0-10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day.
Results:
Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1-8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose.
Limitations:
Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesthesia volume and oral pain medications.
Conclusion:
Some patients experience pain during MMS. However, the majority of patients report a low level of pain. Additional preventative measures could be considered in patients at higher risk.
Insights
Some patients experience pain during Mohs micrographic surgery (MMS), with 32.8% reporting pain. Pain levels were generally low, but higher risk patients may benefit from additional preventative measures.
Area of Science:
- Dermatology
- Surgical Oncology
- Pain Management
Background:
- Intraoperative pain during Mohs micrographic surgery (MMS) is not well-characterized.
- Many patients report postoperative pain following MMS procedures.
Purpose of the Study:
- To investigate the occurrence and characteristics of intraoperative pain during MMS.
- To assess patient-reported pain levels throughout the MMS visit.
Main Methods:
- Phase I: Patients reported pain at discharge using a verbal numerical rating scale (0-10).
- Phase II: Pain levels were assessed before each Mohs layer and at discharge.
- Utilized verbal numerical rating scale for pain assessment.
Main Results:
- 32.8% of patients (n=98) reported pain during their MMS day, with a mean score of 3.7/10.
- Pain was more frequent in patients with longer office times, 3+ Mohs layers, or flap/graft repairs.
- Periorbital area and nose were the most common sites for reported pain.
Conclusions:
- A significant minority of patients experience pain during MMS, though most report low levels.
- Factors like procedure duration and complexity correlate with increased pain reporting.
- Further research into pain management strategies for high-risk MMS patients is warranted.
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