OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines

ObjectiveThere is limited information about the extent to which the association between preoperative and chronic postoperative pain is mediated via pain‐on‐movement or pain‐at‐rest. We explored these associations in patients undergoing total hip replacement (THR) and total knee replacement (TKR).MethodsA total of 322 and 316 patients receiving THR and TKR, respectively, were recruited into a single‐center UK cohort (Arthroplasty Pain Experience) study. Preoperative, acute postoperative, and 12‐month pain severity was measured using self‐reported pain instruments. The association between preoperative/acute pain and chronic postoperative pain was investigated using structural equation modeling (SEM).ResultsPatients with high levels of preoperative pain were more likely to report chronic pain after THR (β = 0.195, P = 0.02) and TKR (β = 0.749, P < 0.0001). Acute postoperative pain‐on‐movement was not associated with chronic pain after TKR or THR after adjusting for preoperative pain; however, acute pain‐at‐rest was associated with chronic pain after THR (β = 0.20, P < 0.0002) but not TKR after adjusting for preoperative pain. Analysis of pain‐at‐rest and pain‐on‐movement highlighted differences between THR and TKR patients. Chronic pain‐at‐rest after THR was weakly associated with pain‐at‐rest during the preoperative (β = 0.11, P = 0.068) and acute postoperative period (β = 0.21, P < 0.0001). In contrast, chronic pain‐on‐movement after TKR was strongly associated with the severity of pain‐on‐movement during the preoperative period (β = 0.51, P = 0.001).ConclusionSEM illustrated the different patterns of association between measures of pain over time in patients undergoing THR and TKR for osteoarthritis. These findings highlight the importance of future work that explores the mechanisms underlying pain‐on‐movement and pain‐at‐rest.

Section: Discussionmentioning

confidence: 99%

Rest Pain and Movement‐Evoked Pain as Unique Constructs in Hip and Knee Replacements

Sayers

Wylde

Lenguerrand

et al. 2016

“…Due to the different safety profiles of these treatments, most clinical practice guidelines recommend a stepped care approach to OA, with paracetamol being used as initial pharmacological therapy after trial of non-pharmacological interventions (5,(8)(9)(10). In patients whose symptoms are not controlled by paracetamol at the maximum recommended dose, then the guidelines suggest that an NSAID may be a suitable alternative to pharmacotherapy depending on the individual patient's risk profile (5,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…In patients whose symptoms are not controlled by paracetamol at the maximum recommended dose, then the guidelines suggest that an NSAID may be a suitable alternative to pharmacotherapy depending on the individual patient's risk profile (5,(8)(9)(10). The limited data that exist concerning adherence to these clinical practice guideline recommendations suggest that there is an under-utilization of paracetamol and an inappropriately high usage of NSAIDs (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“It looks after me”: How older patients make decisions about analgesics for osteoarthritis

Milder¹,

Lipworth²,

Williams³

et al. 2011

Objective: To explore the key motivators behind selection of analgesics (non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and complementary medications (CMs)) by patients with osteoarthritis (OA).Methods: A qualitative study, in which in-depth semi-structured interviews were conducted with 15 OA patients, recruited from four general practices in Sydney, Australia. Patients were aged 65 or above, and were currently taking, or had recently taken, an NSAID for osteoarthritis.Results: Three key themes emerged from the data: reliance, routine and pill load. Reliance: Patients were strongly reliant upon NSAIDs because they consistently satisfied their needs. By contrast, they were much less reliant upon paracetamol because of uncertainty or scepticism about its effectiveness. They were not reliant upon CMs but were willing to take them indefinitely because they were perceived as being without risk. Routine and pill load: Many patients took an NSAID, as well as CMs as part of a 'daily routine'. By contrast, patients had difficulty developing a routine around using paracetamol at the recommended maximum dose because of the implicit frequency of dosing required and an aversion to the associated 'pill load'. Conclusion:The results highlight the importance of exploring the perceptions and preferences of patients with regard to analgesics for OA. Clinician advice regarding analgesia for OA should take account of the possible reliance of the patient upon an NSAID, their medicine routines, and their potential concern about the pill load associated, in particular, with paracetamol.

“…We have found similar results for this opportunistic consultation, with 2 of our 3 core tasks inquiring about the type and amount of pain the patient has and checking if the patient was taking regular analgesia. This suggests that despite the recommendation of core nonpharmacologic treatments by international guidelines (3)(4)(5), HCPs, patients, and caregivers remain firmly focused on pain and its management through medication as a priority for OA consultations in primary care. This may suggest that a biomedical approach may still be favored over a biosocial approach for the clinical management of OA, despite guidelines stressing that a holistic and biopsychosocial approach is required (5,26).…”

Section: Finney Et Almentioning

confidence: 99%

“…Despite this and the publication of international treatment recommendations (3)(4)(5), evidence suggests that in the UK, there is a gap between the care recommended and that which people receive (6,7).…”

Section: Introductionmentioning

confidence: 99%

Defining the Content of an Opportunistic Osteoarthritis Consultation With Primary Health Care Professionals: A Delphi Consensus Study

Finney

Porcheret

Grime

et al. 2013

Objective. To define the core content for an opportunistic consultation between a health care professional (HCP) and a patient with osteoarthritis (OA) in primary care.Methods. An ideas generation round and a 2-round Delphi postal consensus study allowed participants to rank the importance of tasks for an opportunistic consultation. The study was conducted with a lay group (n ‫؍‬ 18) and 3 groups of HCPs (n ‫؍‬ 30 for general practitioners, n ‫؍‬ 19 for practice nurses, and n ‫؍‬ 37 for allied health professionals). Results. The ideas generation round formulated 35 consultation tasks. There was a 50% response rate to the 2-round postal exercise (n ‫؍‬ 52). Consensus was reached on 12 tasks for an opportunistic OA consultation using a >80% level of agreement across all groups. Three of these consultation tasks were defined at 100%. The 3 tasks were questions asked by the HCP about how things are going with the condition, the type and amount of pain the patient has, and whether the patient is taking regular analgesia. Conclusion. In a Delphi study to define the content of an opportunistic primary care OA consultation, 12 consultation tasks provided the content of a comprehensive consultation. Three of these tasks with 100% agreement could be adopted in any multidisciplinary consultation for OA in primary care. Inquiring about the condition, the type and amount of pain the patient has, and whether analgesia is being taken forms a core set of questions that are considered important by both lay and health professional groups in an opportunistic consultation.