Introduction

The effective management of perioperative pain is an ongoing focus among orthopedic surgeons. Previous studies have attempted to determine if self-rated pain tolerance correlates with true pain tolerance. However, limited data exists to quantify the subjective self-reported pain tolerance levels in hip arthroscopy patients. Anecdotally, many patients voluntarily report that they “have a high pain tolerance”. Those individuals clearly lack insight into their obvious presence in a doctor’s office for an elective pain-dependent, frequently asymptomatic, entity like Femoroacetabular Impingement Syndrome (FAIS). Though objective measures of pain tolerance should be distributed normally across the population, we hypothesize that most (>75%) patients undergoing hip arthroscopy for FAIS self-report a high pain tolerance. To quantify the self-rated pain tolerance level among hip arthroscopy patients and to determine if differences exist in self-rated pain tolerance between different sexes or age groups.

Methods

A retrospective case series of prospectively-collected data from patients undergoing primary hip arthroscopy by a single surgeon beginning April 1, 2016 through April 9, 2024. Patients were included if they were above age 18, underwent primary hip arthroscopy, and completed questions regarding self-reported pain tolerance on their new patient questionnaire. Patients were excluded if they had previously undergone hip arthroscopy, did not complete the new patient questionnaire, or underwent concomitant sports hernia repair, hamstring repair, or gluteal tendon repair. Demographic information, type of Femoroacetabular Impingement morphology (cam, pincer), self-rated pain tolerance, and prior opioid use were collected. Patients were asked if they had a high pain tolerance (yes/no) in their preoperative intake questionnaire. The percentage of patients which reported themselves having a “high” pain tolerance was calculated. The data was then further stratified by age group, sex, prior opioid use, and allergies. Linear regression analysis was performed to determine if significant differences existed between groups.

Results

Two-hundred and five subjects were included (139 female, 66 male). Most patients (87.8%) self-reported a high pain tolerance. A greater percentage of men (94%) reported high pain tolerance, compared to 85% of women. The greatest percentage of high self-rated pain tolerance among age groups was within the 30-39 years of age group (96%). The age group with the lowest percentage of high self-rated pain tolerance was <20 years, with 75% reporting a high pain tolerance. Additionally, 89% of patients with prior opioid use endorsed a high pain tolerance, and 87.4% of patients with allergies endorsed a high pain tolerance. However, none of the differences between any of the above groups were determined to be statistically significant after regression analysis.

Conclusion

Most (88%) hip arthroscopy patients self-report a high pain tolerance, which is a strong statistical improbability (illusory superiority via both Lake Wobegon and Dunning-Kruger effects). Therefore, self-rated pain assessments may not be entirely reliable as a true indicator of pain tolerance. Objective measures of pain tolerance are needed for future related research.