Postoperative pain following elastic band ligation for mixed hemorrhoids exhibits heterogeneous trajectories, with younger age, higher preoperative anxiety and depression levels, lower levels of social support, and a greater number of ligations increasing the risk of patients falling into an unfavorable relief trajectory.
Key Findings
Results
GMM analysis identified two distinct pain progression trajectories after elastic band ligation of internal hemorrhoids in mixed hemorrhoid patients.
The two trajectories were classified as a 'rapid relief group' and a 'poor relief group'.
The rapid relief group comprised 82 cases (47.4% of patients).
The poor relief group comprised 91 cases (52.6% of patients).
The study included 173 patients with grade III or IV mixed hemorrhoids treated between April 2022 and April 2025.
Pain was measured using VAS scores on postoperative days 1, 3, 7, and 14.
Results
VAS pain scores differed significantly between the two trajectory groups at each postoperative time point and within each group over time.
Statistically significant differences in VAS scores were observed at each postoperative time point (p < 0.001).
Intra-group time changes were also statistically significant between the two groups (p < 0.001).
Pain was assessed on postoperative days 1, 3, 7, and 14.
Results
Age was identified as an independent factor influencing the pain trajectory, with younger age associated with poorer pain relief.
Odds ratio for age: OR = 0.90 (95% CI: 0.85–0.96, p = 0.002).
The negative OR direction indicates that lower age increases the risk of falling into the poor relief trajectory.
This finding was identified via multivariate logistic regression analysis.
Results
Higher preoperative anxiety (SAS score) was an independent factor associated with a poorer pain relief trajectory.
OR for SAS score = 1.05 (95% CI: 1.01–1.10, p = 0.018).
Preoperative anxiety was measured using the Self-Rating Anxiety Scale (SAS).
This was identified as significant in multivariate logistic regression analysis.
Results
Higher preoperative depression (SDS score) was an independent factor associated with a poorer pain relief trajectory.
OR for SDS score = 1.05 (95% CI: 1.01–1.09, p = 0.009).
Preoperative depression was measured using the Self-Rating Depression Scale (SDS).
This was identified as significant in multivariate logistic regression analysis.
Results
Lower levels of social support were independently associated with a poorer postoperative pain trajectory.
OR for SSRS total score = 0.72 (95% CI: 0.65–0.81, p < 0.001).
Social support was measured using the Social Support Rating Scale (SSRS).
The negative OR direction indicates that lower social support increases risk of poor pain relief.
This was identified as significant in multivariate logistic regression analysis.
Results
A greater number of ligations was an independent factor associated with a poorer postoperative pain trajectory.
OR for number of ligations = 4.96 (95% CI: 1.25–19.77, p = 0.023).
This was the factor with the largest odds ratio among the independent predictors.
This was identified as significant in multivariate logistic regression analysis.
Results
The combination of all five independent factors demonstrated high discriminative power for predicting the poor pain relief trajectory.
Area under the ROC curve (AUC) for the combined model: 0.94 (95% CI: 0.91–0.97).
The optimal cutoff value was 0.635.
Sensitivity at the optimal cutoff was 0.82 and specificity was 0.96.
The five factors combined were: age, SAS score, SDS score, SSRS total score, and number of ligations.
What This Means
This research suggests that not all patients experience the same pattern of pain after having a common outpatient procedure — elastic band ligation — used to treat internal hemorrhoids in people with mixed hemorrhoids. When researchers analyzed pain scores collected from 173 patients over the two weeks following surgery, they found that patients fell into one of two groups: those whose pain improved quickly (about 47% of patients) and those whose pain took longer to subside or remained relatively high (about 53% of patients). This means that pain after this procedure is not a uniform experience, and some patients are at notably higher risk of a difficult recovery.
The study identified five key factors that independently predicted which group a patient would fall into. Patients who were younger, had higher levels of anxiety or depression before surgery, had less social support from family or friends, or had more ligation sites during the procedure were more likely to experience the 'poor relief' pain trajectory. When these five factors were combined into a predictive model, it was highly accurate — with an area under the curve of 0.94 — suggesting these variables together can reliably identify at-risk patients before or immediately after surgery.
This research suggests that postoperative pain management after hemorrhoid banding should not be one-size-fits-all. Psychological factors like anxiety, depression, and social support appear to play a meaningful role in how patients recover from pain, alongside clinical factors like the number of ligations performed. Identifying high-risk patients in advance could allow healthcare providers to offer more tailored support — such as additional psychological counseling, enhanced pain management plans, or stronger social support resources — to those most likely to struggle with postoperative pain.
Pei J, Xue G, Jin C, Wang X. (2026). Dynamic Changes and Influencing Factors of Acute Pain After Elastic Band Ligation of Internal Hemorrhoids in Patients With Mixed Hemorrhoids.. Annali italiani di chirurgia. https://doi.org/10.62713/aic.4649