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Clinical Orthopaedics and Related Research®

Published in:

01-05-2014 | Symposium: Perioperative Pain Management in Orthopaedic Surgery

Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study

Authors: Patricia M. Lavand’homme, MD, PhD, Irina Grosu, MD, Marie-Noëlle France, RN, Emmanuel Thienpont, MD, MBA

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2014

Abstract

Background

Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain.

Questions/purposes

In this prospective observational study, we examined the relationship between postoperative pain trajectories and persistent pain, specifically neuropathic pain, at 3 months after knee arthroplasty.

Methods

Over a 1-year period, all patients undergoing elective unilateral knee arthroplasty for osteoarthritis by one surgeon were invited to participate in the study, provided they had not had prior knee surgery and their American Society of Anesthesiologists grade was 3 or lower; 128 patients fulfilled these criteria. Patients filled in a diary questioning postoperative pain at rest and during mobilization and maximal pain from Day 1 until Day 8 after surgery. At 3 months, the patients were questioned concerning the presence of persistent pain and its nature and intensity using the Douleur Neuropathique 4 [Neuropathic Pain 4] and Brief Pain Inventory questionnaires. At 3 months, 112 of the 128 patients (87%) were successfully contacted.

Results

At 3 months, 47 of the 112 (42%) patients were totally pain free and 65 (58%) reported persistent pain at the surgical site. Among the latter, 12 patients (11%) presented with a neuropathic component and more severe persistent pain. Pain trajectories highlighted higher acute pain scores for maximal pain (from Day 1 until Day 8) and for pain at mobilization (from Day 3 until Day 8) in patients with neuropathic persistent pain (p < 0.05 at all time points compared with the no persistent pain group).

Conclusions

Postoperative pain trajectories constructed from patient’s pain diary suggest that a subgroup of patients who will present with higher pain at 3 months after knee arthroplasty might be identified early in the postoperative period and might benefit from preventative treatment.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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Title: Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study
Authors: Patricia M. Lavand’homme, MD, PhD
Irina Grosu, MD
Marie-Noëlle France, RN
Emmanuel Thienpont, MD, MBA
Publication date: 01-05-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 5/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3389-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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