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
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Katherine H. O. Deane, Richard Gray, Paula Balls, Clare Darrah, Louise Swift, Alan B. Clark, Garry R. Barton, Sophie Morris, Sue Butters, Angela Bullough, Helen Flaherty, Barbara Talbot, Mark Sanders, Simon T. Donell

Published in: BMC Health Services Research | Issue 1/2018

Login to get access

Abstract

Background

Self-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)).

Methods

A 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.

Results

ITT 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.

Conclusion

Self-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 Registration

ISRCTN10868989. Registered 22 March 2012, retrospectively registered.
Appendix
Available only for authorised users
Literature
1.
2.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534–40.CrossRefPubMed
3.
Fischer HBJ, Simanski CJP, Sharp C, Bonnet F, Camu F, Neugebauer EA, Rawal N, Joshi GP, Schug SA, Kehle H. A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia. 2008;63:1105–23.CrossRefPubMed
4.
Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg (Br). 2007;89B:316–22.CrossRef
5.
Dahlen L, Zimmerman L, Barron C. Pain perception and its relation to functional status post total knee arthroplasty: a pilot study. Orthop Nurs. 2006;25:264–70.CrossRefPubMed
6.
7.
Agency for Health Care Policy and Research. Acute pain management: operative or medical procedures and trauma rep. No. 92–0032; 1992.
8.
Hudcova J, McNicol ED, Quah CS, Lau J, Carr DB. Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Db Syst Rev. 2006;4:CD003348.
9.
Cepeda MS, Carr DB, Miranda N, Diaz A, Silva C, Morales O. Comparison of morphine, ketorolac, and their combination for postoperative pain: results from a large, randomized, double blind trial. Anesthesiology. 2005;103:122–32.CrossRef
10.
Dauri M, Faria S, Gatti A, Celidonio L, Carpenedo R, Sabato AF. Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences. Curr Drug Targets. 2009;10:716–33.CrossRefPubMed
11.
Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal anti-inflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005;102:1249–60.CrossRefPubMed
12.
13.
Medicines Management Group. Policy for self-Administration of Medicines (SAM). Norwich: Norfolk and Norwich University Hospital Foundation Trust; 2013.
14.
Barker L. Trust guideline for the enhanced recovery Programme for Total hip and Total knee replacement. Norwich. Guideline registration CA4091v1: Norfolk and Norwich University Hospital Foundation Trust; 2010.
15.
Smith TO, McCabe C, Lister S, Christie SP, Cross J. Rehabilitation implications during the development of the Norwich enhanced recovery Programme (NERP) for patients following total knee and total hip arthroplasty. Orthop Traumatology: Surg Res. 2012;98:499–505.
16.
Kastanias P, Denny K, Robinson S, Sabo K, Snaith K. What do adult surgical patients really want to know about pain and pain management? Pain Manag Nurs. 2009;10:22–31.CrossRefPubMed
17.
Pellino TA, Gordon DB, Engelke ZK, Busse KL, Collins MA, Silver CE, Norcross NJ. Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthop Nurs. 2005;24:182–90.CrossRefPubMed
18.
Gibson HB. Psychology, pain and anaesthesia. London: Chapman & Hall; 1994.
19.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg (Br). 2007;89B:893–900.CrossRef
20.
Bjellanda I, Dahlb AA, Tangen Haug T, Necelmann D. The validity of the hospital anxiety and depression scale: an updated literature review. J Psychosom Res. 2002;52:69–77.CrossRef
21.
Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;4:1–24.CrossRef
22.
Slappende R, Weber EWG, Bugter MLT, Dirksen R. The intensity of preoperative pain is directly correlated with the amount of morphine needed for postoperative analgesia. Anesth Analg. 1999;88:146–8.
23.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
24.
Lundeberg T, Lund I, Dahlin L, Borg E, Gustafsson C, Sandin L, et al. Reliability and responsiveness of three different pain assessments. J Rehabil Med. 2001;33:279–83.CrossRefPubMed
25.
Horne R, Hankins M, Jenkins R. The satisfaction with information about medicines scale (SIMS): a new measurement tool for audit and research. Qual Health Care. 2001;10:135–40.CrossRefPubMedPubMedCentral
26.
27.
EuroQoL Group. EuroQoL - a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRef
28.
Dawson J, Fitzpatrick R, Murray D, Carr A. Questionnaire on the perception of patients about total knee replacement. J Bone Joint Surg (Br). 1998;80B:63–9.
29.
Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, Brewin C, Wing J, editors. Measuring mental health needs. London: Gaskell; 1992.
30.
31.
Wolfe F, Michaud K. Assessment of pain in rheumatoid arthritis: minimal clinically significant difference, predictors, and the effect of anti-tumor necrosis factor therapy. J Rheumatol. 2007;34(8):1674–83.PubMed
32.
Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elb Surg. 2009;18:927–32.CrossRef
33.
Pocock SJ, Assmann SE, Enos LE, Kasten LE. Statistics in medicine 21:2918-2930 subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002;21(19):2917–30.CrossRefPubMed
34.
Owens WD, Felts JA, Spitznagel EL. ASA physical status classifications: a study of consistency of ratings. Anethesiol. 1978;49:239–43.CrossRef
35.
36.
Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharm World Sci. 2006;28:140–51.CrossRefPubMed
37.
Kastanias P, Gowans S, Robinson S. Patient-controlled oral analgesia for posoperative pain management following total knee replacement. Pain Res Manag. 2010;15:11–6.CrossRefPubMedPubMedCentral
38.
Striebel HW, Romer M, Kopf A, Schwagmeier R. Patient controlled oral analgesia with morphine. Can J Anaesth. 1996;43:749–53.CrossRefPubMed
39.
Striebel HW, Scheitza W, Philippi W, Behrens U, Toussaint S. Quantifying oral analgesic consumption using a novel method and comparison with patient controlled intravenous analgesic consumption. Anesth Analg. 1998;86:1051–3.CrossRefPubMed
40.
Parker S, Fadayevelan R, Lee S. Acute Hospital Care for Frail Older People. Age Ageing. 2006;35:551–2.CrossRefPubMed
41.
Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998;53:1209–18.CrossRefPubMed
42.
Wells N, Pasero C, McCaffery M,Hughes RG. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Chapter 17 Improving the Quality of Care Through Pain Assessment and Management. In Ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008.
43.
Magee H, Parsons S, Askham J. Measuring dignity in Care for Older People. The Picker Institute Europe, Oxford: A research report for Help the Aged; 2008.
44.
45.
Sawhney M, Maeda E. Nursing knowledge and beliefs regarding patient-controlled oral analgesia (PCOA). Pain Manag Nurs. 2013;14:318–26.CrossRefPubMed
46.
Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids. A critical review and proposals for long-term dosing. J Pain Symptom Manag. 2001;22:672–87.CrossRef
47.
Care Quality Commission. Standards of care, outcome 9: Management of Medicines; 2010.
48.
49.
50.
Metadata
Title
Patient-directed self-management of pain (PaDSMaP) compared to treatment as usual following total knee replacement; a randomised controlled trial
Authors
Katherine H. O. Deane
Richard Gray
Paula Balls
Clare Darrah
Louise Swift
Alan B. Clark
Garry R. Barton
Sophie Morris
Sue Butters
Angela Bullough
Helen Flaherty
Barbara Talbot
Mark Sanders
Simon T. Donell
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3146-2

Other articles of this Issue 1/2018

BMC Health Services Research 1/2018 Go to the issue

Research article

Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal

Research article

Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review

Research article

Differences in the determinants of health insurance enrolment among working-age adults in two regions in Ghana

Research article

Cross-sectoral integration in youth-focused health and social services in Canada: a social network analysis

Research article

Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database

Correction

Correction to: The private healthcare market and the sustainability of an innovative community nurses programme based on social entrepreneurship - CoNSENSo project