Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Anesthesia
Published in: Journal of Anesthesia 4/2016

01-08-2016 | Original Article

Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

Authors: M. Gabrielle Pagé, Joel Katz, Kathryn Curtis, Noga Lutzky-Cohen, E. Manolo Romero Escobar, Hance A. Clarke

Published in: Journal of Anesthesia | Issue 4/2016

Login to get access

Abstract

Purpose

The aim of this study was to explore acute movement-evoked postoperative pain intensity trajectories over the first 5 days after total hip arthroplasty (THA) and to examine how these pain trajectories are associated with pain-related outcomes 6 weeks and 6 months later.

Methods

A total of 150 adult patients [72 women (48.0 %); mean age 60.0 ± 9.2 (standard deviation) years] completed pain questionnaires preoperatively, several times daily postoperatively until hospital discharge, and 6 weeks and 6 months after surgery.

Results

Results showed that the best model had four different acute postoperative pain trajectories and a significant quadratic term. The trajectories varied in terms of initial pain intensity levels and rates of decline/increase in pain over the first 4 postoperative days. Significant predictors of pain trajectory membership were preoperative pain disability and anxiety as well as cumulative morphine consumption 24 h following surgery. Pain trajectories were significantly associated with levels of pain intensity and anxiety at 6 weeks but not at 6 months postoperatively.

Conclusion

This study showed that during the postoperative period patients differed in terms of pain intensity profiles and that these differences were associated with outcomes for up to 6 weeks following surgery. Pain trajectories were not predictive of persistent postoperative pain status at 6 months. Nonetheless, these results highlight the importance of patient heterogeneity in acute postoperative pain and pain-related outcomes months after THA.
Literature
1.
2.
Nwachukwu BU, McCormick F, Provencher MT, Roche M, Rubash HE. A comprehensive analysis of medicare trends in utilization and hospital economics for total knee and hip arthroplasty from 2005 to 2011. J Arthroplasty. 2015;30(1):15–8.CrossRefPubMed
3.
Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2(1):e000435.CrossRefPubMedPubMedCentral
4.
Werner MU, Kongsgaard UEI. Defining persistent post-surgical pain: is an update required? Br J Anaesth. 2014;113(1):1–4.CrossRefPubMed
5.
Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Exp Rev Neurother. 2009;9(5):723–44.CrossRef
6.
Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.CrossRefPubMed
7.
Perkins FM, Kehlet H. Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology. 2000;93(4):1123–33.CrossRefPubMed
8.
Katz J. One man’s risk factor is another man’s outcome: difference in risk factor profiles for chronic postsurgical pain maintenance vs transition. Pain. 2012;153(3):505–6.CrossRefPubMed
9.
Clarke H, Kay J, Mitsakakis N, Katz J. Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later. J Anesth. 2010;24(4):537–43.CrossRefPubMed
10.
Chapman CR, Donaldson GW, Davis JJ, Bradshaw DH. Improving individual measurement of postoperative pain: the pain trajectory. J Pain. 2011;12(2):257–62.CrossRefPubMedPubMedCentral
11.
Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol. 2011;24(5):545–50.CrossRefPubMed
12.
Bonnet A, Lavand’homme P, France M-N, Reding R, De Kock M. Identification du risque de douleur chronic après hépatectomie pour don de foie par les trajectoires de douleur. Ann Fr Anesth Réanim. 2012;31:945–9.CrossRefPubMed
13.
Bellamy N, Buchanan WW. A preliminary evaluation of the dimensionality and clinical importance of pain and disability in osteoarthritis of the hip and knee. Clin Rheumatol. 1986;5(2):231–41.CrossRefPubMed
14.
15.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.PubMed
16.
Roos EM, Klassbo M, Lohmander LS. WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities. Scand J Rheumatol. 1999;28(4):210–5.CrossRefPubMed
17.
Dunbar MJ, Robertsson O, Ryd L, Lidgren L. Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from The Swedish Knee Arthroplasty Registry. J Bone Joint Surg Br. 2001;83(3):339–44.CrossRefPubMed
18.
McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001;45(5):453–61.CrossRefPubMed
19.
Wright JG, Young NL. A comparison of different indices of responsiveness. J Clin Epidemiol. 1997;50(3):239–46.CrossRefPubMed
20.
Brazier JE, Harper R, Munro J, Walters SJ, Snaith ML. Generic and condition-specific outcome measures for people with osteoarthritis of the knee. Rheumatology (Oxford). 1999;38(9):870–7.CrossRef
21.
Roos EM, Roos HP, Lohmander LS. WOMAC Osteoarthritis Index—additional dimensions for use in subjects with post-traumatic osteoarthritis of the knee. Western Ontario and MacMaster Universities. Osteoarthr Cartil. 1999;7(2):216–21.CrossRefPubMed
22.
Bombardier C, Melfi CA, Paul J, Green R, Hawker G, Wright J, et al. Comparison of a generic and a disease-specific measure of pain and physical function after knee replacement surgery. Med Care. 1995;33[4 Suppl]:AS131–44.PubMed
23.
Bullens PH, van Loon CJ, de Waal Malefijt MC, Laan RF, Veth RP. Patient satisfaction after total knee arthroplasty: a comparison between subjective and objective outcome assessments. J Arthroplasty. 2001;16(6):740–7.CrossRefPubMed
24.
Robertsson O, Dunbar MJ. Patient satisfaction compared with general health and disease-specific questionnaires in knee arthroplasty patients. J Arthroplasty. 2001;16(4):476–82.CrossRefPubMed
25.
Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984;59(3):974.CrossRefPubMed
26.
Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: psychometric and validity data. Arch Phys Med Rehabil. 1987;68(7):438–41.PubMed
27.
Chibnall JT, Tait RC. The Pain Disability Index: factor structure and normative data. Arch Phys Med Rehabil. 1994;75(10):1082–6.CrossRefPubMed
28.
Tait RC, Chibnall JT. Factor structure of the pain disability index in workers compensation claimants with low back injuries. Arch Phys Med Rehabil. 2005;86(6):1141–6.CrossRefPubMed
29.
Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1–2):9–19.CrossRefPubMed
30.
Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.CrossRefPubMed
31.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
32.
Clarke H, Pagé MG, McCartney C, Huang A, Stratford P, Andrion J, et al. Pregabalin reduces postoperative opioid consumption and pain for 1 week after hospital discharge, but does not affect function at 6 weeks or 3 months after total hip arthroplasty. Br J Anaesth. 2015;115(6):903–11.CrossRefPubMed
33.
Asparouhov T, Muthen B. Multilevel mixture models. In: Hancock GR, Samuelsen KM, editors. Advances in latent variable mixture models. Charlotte: Information Age Publishing Inc; 2008. p. 27–51.
34.
Muthen B, Asparouhov T. Growth mixture modeling: analysis with non-Gaussian random effects. In: Fitzmaurice G, Davidian M, Verbeke G, Molenberghs G, editors. Longitudinal data analysis. Boca Raton:Chapman & Hall/CRC Press; 2009. p. 143–165.
35.
Muthen B, Shedden K. Finite mixture modeling with mixture outcomes using the EM algorithm. Biometrics. 1999;55:463–9.CrossRefPubMed
36.
37.
Team RC. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013.
38.
Akaike H. Information measures and model selection. Bull Int Stat Inst. 1983;44:277–91.
39.
de Leeuw J. Introduction to Akaike (1973) information theory and an extension of the maximum likelihood principle. In: Kotz S, Johnson NL, editors. Breakthrough in statistics, vol. 1. London: Springer; 1992. p. 599–609.
40.
Lord FM, Novick MR. Statistical theories of mental test scores. Reading: Addison-Wesley; 1968.
41.
Ram N, Grimm KJ. Growth mixture modeling: a method for identifying differences in longitudinal change among unobserved groups. Int J Behav Dev. 2009;33(6):565–76.CrossRefPubMedPubMedCentral
42.
43.
Hertzog C, Lindenberger U, Ghisletta P, Oertzen T. On the power of multivariate latent growth curve models to detect correlated change. Psychol Methods. 2006;11(3):244–52.CrossRefPubMed
44.
45.
Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012;36(11):2261–7.CrossRefPubMedPubMedCentral
46.
Pinto PR, McIntyre T, Ferrero R, Almeida A, Araujo-Soares V. Predictors of acute postsurgical pain and anxiety following primary total hip and knee arthroplasty. J Pain. 2013;14(5):502–15.CrossRefPubMed
47.
Althaus A, Arranz Becker O, Neugebauer E. Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain. Eur J Pain. 2014;18(4):513–21.CrossRefPubMed
48.
Page MG, Katz J, Romero Escobar EM, Lutzky-Cohen N, Curtis K, Fuss S, et al. Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty. Pain. 2015;156(3):460–8.CrossRefPubMed
49.
Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, et al. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg. 2008;51(6):428–36.PubMedPubMedCentral
50.
Clarke H, Poon M, Weinrib A, Katznelson R, Wentlandt K, Katz J. Preventive analgesia and novel strategies for the prevention of chronic post-surgical pain. Drugs. 2015;75(4):339–51.CrossRefPubMed
51.
Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain. 2013;154(1):95–102.CrossRefPubMed
Metadata
Title
Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty
Authors
M. Gabrielle Pagé
Joel Katz
Kathryn Curtis
Noga Lutzky-Cohen
E. Manolo Romero Escobar
Hance A. Clarke
Publication date
01-08-2016
Publisher
Springer Japan
Published in
Journal of Anesthesia / Issue 4/2016
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-016-2183-4

Other articles of this Issue 4/2016

Journal of Anesthesia 4/2016 Go to the issue

Letter to the Editor

In reply: Comparing face-to-face intubation with different devices

Letter to the Editor

Rethinking general anesthesia for cesarean section

Editorial

Pharmacokinetics and systemic toxicity of local anesthetics in children

Original Article

Ciproxifan, an H3 receptor antagonist, improves short-term recognition memory impaired by isoflurane anesthesia

Clinical Report

Use of a home positive airway pressure device during intraoperative monitored anesthesia care for outpatient surgery

Original Article

Socioeconomic value of intervention for chronic pain