Subacute Pain as a Predictor of Long-Term Pain Following Orthopedic Surgery

Abstract

The aim of this study was to document the level of pain and functionality in the 12 months following orthopedic surgery and identify if high pain levels following discharge were associated with pain persisting at 12 months.An observational prospective cohort study was undertaken, following 87 patients (mean age 62.4 years [18–92]; 47.1% male) who required orthopedic surgery at the Royal Hobart Hospital, Australia. Following an initial survey, patients were telephoned at 10 days, 6 weeks, 3 months, and 12 months after discharge.Postdischarge pain levels were high with 97.4% of patients suffering pain at 10 days, 81.2% at 6 weeks and 79.5% at 3 months. Pain affected the ability to undertake activities of daily living (ADLs) for 32.7% and 20.0% of patients at 10 days and 6 weeks, respectively. Twelve months after discharge, 65.5% of patients reported pain persisting at the surgical site, with 29.9% of all patients suffering moderate–severe incidental pain; and nearly one quarter of patients reported pain affected their sleep or ADLs. Average pain levels rated as moderate–severe at 10 days (P = 0.01) and 6 weeks (P = 0.02) and pain of neuropathic origin at 3 months (30.2% vs 10.3% P = 0.03) and 12 months (30.4% vs 4.9% P = 0.01) were associated with persistent pain at 12 months.Pain in the period following discharge from hospital is significant and undermanaged. Previous studies has shown that that acute pain, particularly in the first 48 hours following surgery is a predictor for long-term pain after surgery. This study adds to the current literature by showing that pain in the subacute period, following discharge from hospital is also associated with the pain persisting at 12 months. These findings have important implications for improving quality of life as well as potentially preventing persistent pain with increased follow-up and more intensive management of post-discharge pain.

Pain intensity and pain self-management strategies following discharge after surgery: An Australian prospective observational study

“…5,20 The few studies conducted in this area, which have reviewed patients following orthopaedic surgery, have shown an association between high pain levels following discharge and the development of PPP. 18,[21][22][23] The high prevalence of moderate-severe pain found in this study could detrimentally affect the patient in both the immediate and longer term.…”

“…Moderate-to-severe acute post-discharge pain following surgery has been associated with an increased risk of persistent post-operative pain. 18 A cut-off of 4 or more on an 11-point NRS has been classified as moderate pain. 19 Consequently, participants who experienced, on average, a pain level of 4 or more on the 11-point NRS were classified as experiencing moderate-severe pain, and analysis was undertaken to ascertain who was most at risk of this and what effect, if any, increased knowledge had on the likelihood of experiencing moderatesevere pain.…”

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards

“…[1][2][3] However, pain management with opioids needs to be balanced with its risks to patients, as well as unnecessary exposure of the community to these agents. [1][2][3] However, pain management with opioids needs to be balanced with its risks to patients, as well as unnecessary exposure of the community to these agents.…”

“…The need to adequately control post-operative pain is a key presurgical concern for patients, and often pain management requires use of strong analgesics such as opioids. [1][2][3] However, pain management with opioids needs to be balanced with its risks to patients, as well as unnecessary exposure of the community to these agents.…”

The Effectiveness of Battlefield Acupuncture in Addition to Standard Physical Therapy Treatment after Shoulder Surgery: A Protocol for a Randomized Clinical Trial

“…This type of orthopedic surgery is associated with excellent short-term results and good long-term maintenance of shoulder function after chronic, unidirectional, and traumatic dislocation [4,[9][10][11]. However, as many as 80% of patients who undergo orthopedic surgery experience acute post-operative pain, which acutely impairs physical function and is a risk factor for the development of persistent pain [12]. Given the number of military personnel undergoing shoulder stabilization surgery, and the debilitating effects of post-operative pain, non-pharmaceutical strategies to decrease postoperative pain are warranted.…”