A Comprehensive Evidence Summary for Pain Assessment and Management After Hemorrhoidal Surgery to Inform Clinical Practice Guidelines

Shengwei Zou,1,2,* Xiaoyu Li,3,* Ya Bo Yang,1 Yuxuan Zeng,1 Yang Yang,2 Qin Gan,3 Jiliang Su,4 Caiju Lu5 1School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 2Department of Respiratory Emergency and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 3Department of Traditional Chinese Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 4Jiangxi Provincial Key Laboratory of Hematological Diseases, Department of Hematology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China; 5Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Caiju Lu, Department of Nursing, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China, Email ndyfy01330@ncu.edu.cnObjective: To evaluate and summarize the best available evidence on pain assessment and management after hemorrhoidal surgery, thereby providing an evidence-based foundation for the future development of clinical practice guidelines.Methods: Literature was systematically retrieved using the “ 6S” evidence model, a hierarchical framework designed to prioritize the highest quality synthesized evidence. Searches were conducted across key databases (PubMed, Embase, Cochrane Library) from inception to February 1, 2025. Two independent reviewers performed screening, data extraction, and quality appraisal, with discrepancies resolved by consensus or a third reviewer.Results: A total of 22 studies were included, comprising 1 clinical decision, 3 guidelines, 7 expert consensuses, 3 evidence summaries, and 8 systematic reviews. These yielded 29 key evidence statements across seven domains: principles of pain management, pain assessment, pharmacological and non-pharmacological interventions, Traditional Chinese Medicine (TCM), wound cleansing and dressing selection, and health education.Conclusion: This study consolidates 29 evidence-based recommendations from seven clinical domains essential for post-hemorrhoidectomy pain management. These findings directly inform clinical practice guidelines through the establishment of standardized frameworks for validated pain assessment tools, core pain management principles, multimodal analgesia protocols integrating both pharmacological and non-pharmacological interventions, TCM therapeutic approaches, evidence-based wound cleansing and dressing selection standards, and structured health education programs, thereby enabling evidence-driven clinical standardization to improve outcomes.Keywords: hemorrhoidal surgery, postoperative pain, pain assessment, pain management, evidence summary