Factors Affecting Persistent Postoperative Pain in Patients with Hip Fractures

Abstract

Osteoporotic fractures are common among older people, and hip fractures (HF) can be devastating. Surgery is indicated for most cases of HF, and chronic persistent postoperative pain is likely to occur. This study investigated the multifaceted factors related to persistent pain occurring during the acute phase and subacute phase of recovery after HF surgery. We conducted a prospective 8-week study of older HF patients after surgery. We evaluated pain intensity, depression symptoms, the fear of falling, pain catastrophizing, cognition and attention, the ability to perform activities of daily living, and the physical performance at 2 weeks (acute phase) and at 4 weeks (subacute phase) after surgery. Patients were divided into the light group (Verbal Rating Scale (VRS) score ≤1) and severe group (VRS score ≥2) according to pain intensity at 8 weeks (recovery phase) after surgery. Factors affecting persistent postoperative pain during recovery were examined using logistic regression analysis. Seventy-two patients were analyzed: 50 in the light group and 22 in the severe group. In the severe group, pain with movement and Pain Catastrophizing Scale scores were higher than those of the light group at 2 weeks and at 4 weeks after surgery. The regression analysis showed that pain with movement at 2 weeks and at 4 weeks after surgery and pain catastrophizing at 4 weeks after surgery were related to persistent postoperative pain. HF patients may have persistent pain if they continue to experience pain and catastrophize their pain during the acute phase and subacute phase after surgery.

New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do?

“…In Cristancho et al [ 59 ], researchers found that a group experiencing a persistently high level of depressive symptoms had poorer functional recovery and higher rates of pain in the year following hip fracture. However, there are new experimental data[ 60 ] showing that the relationship between pain and the geriatric depression scale (GDS) after hip fracture is not statistically significant. The effect of depression on postoperative pain needs to be further determined.…”

Acute Pain Predictors of Remote Postoperative Pain Resolution After Hand Surgery

“…Acute pain severity is associated with an increased risk of persistent pain prevalence at varied time points after surgery. Among 72 elderly patients who underwent surgery for hip fractures, pain with movement assessed 2 and 4 weeks after surgery was significantly associated with persistent pain at 8 weeks after surgery [ 19 ]. Similarly, severe acute postoperative pain after Cesarean section has been associated with the development of CPSP [ 20 ].…”

Use of Intravenous Paracetamol Preoperatively Favors Lower Risk of Delirium and Functional Recovery in Elderly Patients with Hip Fracture: A Propensity Score-Matched Analysis

“…Thus, to ensure transparency, the authors have included both variables as we have done in our previously published studies [ 25 , 26 ]. The 15-item GDS and FIM were used to determine the depression symptoms and the generic ability to perform ADL, respectively [ 27 , 28 ]. Breakpoints of 8 g/dL, 10 g/dL, and 12 g/dL were used to classify the Hb level at admission.…”