Patient-directed self-management of pain (PaDSMaP) compared to treatment as usual following total knee replacement; a randomised controlled trial

Abstract

BackgroundSelf-administration of medicines by patients whilst in hospital is being increasingly promoted despite little evidence to show the risks and benefits. Pain control after total knee replacement (TKR) is known to be poor.The aim of the study was to determine if patients operated on with a TKR who self-medicate their oral analgesics in the immediate post-operative period have better pain control than those who receive their pain control by nurse-led drug rounds (Treatment as Usual (TAU)).MethodsA prospective, parallel design, open-label, randomised controlled trial comparing pain control in patient-directed self-management of pain (PaDSMaP) with nurse control of oral analgesia (TAU) after a TKR. Between July 2011 and March 2013, 144 self-medicating adults were recruited at a secondary care teaching hospital in the UK. TAU patients (n = 71) were given medications by a nurse after their TKR. PaDSMaP patients (n = 73) took oral medications for analgesia and co-morbidities after two 20 min training sessions reinforced with four booklets. Primary outcome was pain (100 mm visual analogue scale (VAS)) at 3 days following TKR surgery or at discharge (whichever came soonest). Seven patients did not undergo surgery for reasons unrelated to the study and were excluded from the intention-to-treat (ITT) analysis.ResultsITT analysis did not detect any significant differences between the two groups’ pain scores. A per protocol (but underpowered) analysis of the 60% of patients able to self-medicate found reduced pain compared to the TAU group at day 3/discharge, (VAS -9.9 mm, 95% CI -18.7, − 1.1). One patient in the self-medicating group over-medicated but suffered no harm.ConclusionSelf-medicating patients did not have better (lower) pain scores compared to the nurse-managed patients following TKR. This cohort of patients were elderly with multiple co-morbidities and may not be the ideal target group for self-medication.Trial RegistrationISRCTN10868989. Registered 22 March 2012, retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3146-2) contains supplementary material, which is available to authorized users.

Observation and Analysis of the Postoperative Analgesic Effect of Subanaesthetic Dose of Ketamine in Kashin–Beck Disease Patients after Total Knee Arthroplasty

“…By comparing the postoperative VAS scores and trend changes of patients in the resting state and in the exercise state, the results showed that the median postoperative VAS score in group F was 2 (1) at 8 h, 12 h, and 24 h after the operation in the exercise state. ,2), 3(2,3) and 4(2,4) and the median VAS scores of group S 2(2,2), 3(2,3) and 4(3,5) compared with group C VAS e median scores of 3(2,3), 4(4,5) and 5 (3,6) were significantly reduced (p < 0.05). Table 5 shows the comparison of the VAS scores of the three groups of patients in the postoperative exercise state.…”

“…e purpose of Deane's study is to determine whether patients undergoing TKR surgery who self-administer oral analgesics immediately after surgery have better pain control (treatment as usual) than patients who receive pain control through a nurse-led medication round (TAU). A prospective, parallel design, open-label, and randomized controlled trial compared patient-guided pain self-management after TKR and nurse-controlled oral analgesia (TAU) for pain control [3]. Although the research perspective is forward-looking, there are still many unachievable parts of the technology.…”

How nurses support self-management of hospitalized patients through verbal communication: a qualitative study

“…It can be the start for enhancing skills needed for effective self-management, such as problem solving, decision making, self-monitoring and symptom management, and for developing a behavior change action plan [3,8]. In addition, patients can be prepared prior to hospitalization to perform selfmanagement before, during and after hospitalization [32][33][34].…”