Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

Pinedo-Villanueva, Rafael; Kolovos, Spyros; Maronga, Christopher; Delmestri, Antonella; Howells, Nick; Judge, Andrew; Gooberman-Hill, Rachael; Wylde, Vikki

doi:10.1186/s12891-022-05492-6

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…Chronic postsurgical pain is typically defined as pain that develops after a surgical procedure and persists at least three months [5,6]. Chronic postsurgical pain is associated with lower patient satisfaction and higher societal and health care expenses due to resource-intensive revision surgery and long-term recovery [4,[7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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Main objective Systematically review and synthesize preoperative and intraoperative factors associated with pain after total knee arthroplasty (TKA) in patients with osteoarthritis. Methods Based on a peer-reviewed protocol, we searched Medline, Embase, CINAHL, Cochrane Library, and PEDro for prospective observational studies (January 2000 to February 2023) investigating factors associated with pain after TKA. The primary outcome was pain twelve months after TKA. Pain at three and six months were secondary outcomes. Multivariate random-effects meta-analyses were used to estimate mean correlation (95% CIs) between factors and pain. Sensitivity analysis was performed for each risk of bias domain and certainty of evidence was assessed. Results Of 13,640 studies, 29 reports of 10,360 patients and 61 factors were analysed. The mean correlation between preoperative factors and more severe pain at twelve months was estimated to be 0.36 (95% CI, 0.24, 0.47; P < .000; moderate-certainty evidence) for more catastrophizing, 0.15 (95% CI; 0.08, 0.23; P < .001; moderate-certainty evidence) for more symptomatic joints, 0.13 (95% CI, 0.06, 0.19; P < .001; very low-certainty evidence) for more preoperative pain. Mean correlation between more severe radiographic osteoarthritis and less pain was -0.15 (95% CI; -0.23, -0.08; P < .001; low-certainty evidence). In sensitivity analysis, the estimated correlation coefficient for pain catastrophizing factor increased to 0.38 (95% CI 0.04, 0.64). At six and three months, more severe preoperative pain was associated with more pain. Better preoperative mental health was associated with less pain at six months. Conclusion and relevance More pain catastrophizing, more symptomatic joints and more pain preoperatively were correlated with more pain, while more severe osteoarthritis was correlated with less pain one year after TKA. More preoperative pain was correlated with more pain, and better mental health with less pain at six and three months. These findings should be further tested in predictive models to gain knowledge which may improve TKA outcomes.

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Section: Introductionmentioning

confidence: 99%

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

et al. 2023

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“…Finally, it is possible for patients to experience ongoing or chronic pain related to the operated joint after orthopaedic surgery; for example, approximately up to 10% to 20% of patients’ experience is not satisfied after total knee arthroplasty (TKA) 49,50 . A portion of these patients may seek treatment of chronic pain after surgery through their primary care provider; this need for care emphasizes the importance of fluent communication among health care teams 49 . Persistent postoperative pain may lead to an increase in the consumption of opioid medications and long-term opioid dependence, which is not an uncommon postsurgical complication 51 .…”

Section: Team Approach: Role-specific Interventionmentioning

confidence: 99%

“…care providers, which may facilitate the integration of interdisciplinary care. Finally, it is possible for patients to experience ongoing or chronic pain related to the operated joint after orthopaedic surgery; for example, approximately up to 10% to 20% of patients' experience is not satisfied after total knee arthroplasty (TKA) 49,50 . A portion of these patients may seek treatment of chronic pain after surgery through their primary care provider; this need for care emphasizes the importance of fluent communication among health care teams 49 .…”

Section: Effect Of Opioids On Orthopaedic Patientsmentioning

confidence: 99%

Team Approach: Use of Opioids in Orthopaedic Practice

et al. 2023

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The opioid epidemic represents a serious health burden on patients across the United States. » This epidemic is particularly pertinent to the field of orthopaedics because it is one of the fields providing the highest volume of opioid prescriptions.» The use of opioids before orthopaedic surgery has been associated with decreased patient-reported outcomes, increased surgery-related complications, and chronic opioid use.» Several patient-level factors, such as preoperative opioid consumption and musculoskeletal and mental health conditions, contribute to the prolonged use of opioids after surgery, and various screening tools for identifying high-risk drug use patterns are available.» The identification of these high-risk patients should be followed by strategies aimed at mitigating opioid misuse, including patient education, opioid use optimization, and a collaborative approach between health care providers.

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“…The incidence of CPSP following TKA varies based on the cohort and sampling techniques applied, with most studies identifying a range of 15-25%, [3,4], though estimates have suggested as many as one in three persons experience ongoing pain following this type of surgery. Persistent pain negatively impacts several aspects of the patient experience, leading to higher healthcare costs and worse patient satisfaction [5], as well as functional disability and decreases in quality of life [6,7]. Chronic pain accounts for over $600 billion dollars annually, more than double that of heart disease and diabetes [1].…”

Section: Introductionmentioning

confidence: 99%

Advances in the management of persistent pain after total knee arthroplasty

Dembek,

Bicket

2023

Current Opinion in Anaesthesiology

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Purpose of reviewTotal knee arthroplasty (TKA) is one of the most commonly performed surgical procedures, with additional growth anticipated as the US population ages. Because the prevalence of chronic postsurgical pain ranges from 15 to 25%, identifying persons at risk for persistent pain following surgery allows for preoperative optimization of risk factors as well as early identification and intervention in the postsurgical period. Recent findingsClinical understanding of available management techniques is critical to management, which should focus on improving patient mobility and satisfaction while reducing patient disability and healthcare costs. Current evidence supports a multimodal management strategy. This includes pharmacologic and nonpharmacologic interventions, procedural techniques, and identification and optimization of psychosocial and behavioral contributors to chronic pain. Procedural techniques known to confer analgesia include radiofrequency and watercooled neurotomy techniques. More recently, case reports have been published describing analgesic benefit with central or peripheral neuromodulation as a novel, though more invasive analgesic therapy.

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Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

Cited by 6 publications

References 22 publications

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Factors correlated with pain after total knee arthroplasty: A systematic review and meta-analysis

Team Approach: Use of Opioids in Orthopaedic Practice

Advances in the management of persistent pain after total knee arthroplasty

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