A comparison of predictors and intensity of acute postsurgical pain in patients undergoing total hip and knee arthroplasty

Patrícia R Pinto, Teresa McIntyre, Vera Araújo-Soares, Patrício Costa, Ramón Ferrero, Armando Almeida, Patrícia R Pinto, Teresa McIntyre, Vera Araújo-Soares, Patrício Costa, Ramón Ferrero, Armando Almeida

Abstract

Background: Acute pain is an expected result after surgery. Nevertheless, when not appropriately controlled, acute pain has a very negative impact on individual clinical outcomes, impairing healing and recovery, and has clear consequences on health care system costs. Augmenting knowledge on predictors and potentially modifiable determinants of acute postsurgical pain can facilitate early identification of and intervention in patients at risk. However, only a few studies have examined and compared acute pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study was to compare THA and TKA in acute postsurgical pain intensity and its predictors.

Methods: A consecutive sample of 124 patients with osteoarthritis (64 undergoing THA and 60 TKA) was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1, and acute postsurgical pain experience was examined at T2. Additionally, the same hierarchical regression analysis was performed separately for each arthroplasty type.

Results: TKA patients reported higher levels of acute postsurgical pain compared with THA (t=8.490, p=0.004, d=0.527, 95% confidence interval, 0.196-0.878). In the final THA predictive model, presurgical pain was the only variable approaching significant results (t[57]=1.746, β=0.254, p=0.086). In the final TKA predictive model, optimism was the only predictor of pain (t[51]=-2.518, β=-0.339, p=0.015), with emotional representation (t[51]=1.895, β=0.254, p=0.064) presenting a trend toward significance.

Conclusion: The current study is the first examining THA and TKA differences on acute postsurgical pain intensity and its predictors using a multivariate approach. Results from this study could prove useful for the design of distinct interventions targeting acute postsurgical pain management depending on whether the site of arthroplasty is the hip or the knee. Finally, the current results also support the argument that these two surgeries, at least with regard to acute pain, should be approached separately.

Keywords: acute post-surgical pain; multivariate analyses; presurgical psychological intervention; psychological factors; total hip arthroplasty; total knee arthroplasty.

Conflict of interest statement

Disclosure We declare that none of the authors have any financial or other relationships that might lead to conflict of interest. The authors report no conflicts of interest in this work.

References

    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–785.
    1. Brander VA, Stulberg SD, Adams AD, et al. Predicting total knee replacement pain – a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.
    1. Bachmeier CJ, March LM, Cross MJ, et al. A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage. 2001;9:137–146.
    1. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566–572.
    1. 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.
    1. Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V. Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study. PLoS One. 2013;8(9):e73917.
    1. Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature and impact. J Pain Res. 2013;3(6):691–703.
    1. Bourne RB, Chesworth B, Davis A, et al. Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res. 2010;468(2):542–546.
    1. Vissers MM, Bussmann JB, Verhaar JA, Busschbach JJ, Bierma-Zeinstra S, Reijman M. Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review. Semin Arthritis Rheum. 2012;41:576–588.
    1. Hamel MB, Toth M, Legedza A, Rosen MP. Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee. Arch Intern Med. 2008;168:1430–1440.
    1. Ebrahimpour PB, Do HT, Bornstein LJ, Westrich GH. Relationship between demographic variables and preoperative pain and disability in 5945 total joint arthroplasties at a single institution. J Arthroplasty. 2011;26(6):133–137.
    1. Singh JA, Lewallen DG. Medical and psychological comorbidity predicts poor pain outcomes after total knee arthroplasty. Rheumatology. 2013;52(5):916–923.
    1. Sakellariou VI, Poultsides LA, Ma Y, Bae J, Liu S, Sculco TP. Risk assessment for chronic pain and patient satisfaction after total knee arthroplasty. Orthopedics. 2016;39(1):55–62.
    1. Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth. 2015;114(4):551–561.
    1. Gordon DB, Leon-Casasola OA, Wu CL, Sluka KA, Brennan TJ, Chou R. Research gaps on practice guidelines for acute postoperative pain management in adults: findings from a review of the evidence for an American Pain Society Clinical Practice Guideline. J Pain. 2016;17:158–166.
    1. Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM, Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine . Acute Pain Management: Scientific Evidence. 3rd ed. Melbourne: Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine; 2010.
    1. Schug SA. The global year against acute pain. Anaesth Intens Care. 2011;39:11–14.
    1. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9:122–145.
    1. Charlton JE. Acute and postoperative. In: Charlton E, editor. Core Curriculum for Professional Education in Pain. Seattle: IASP Press; 2005. pp. 125–138.
    1. Apfelbaum JL, Chen C, Mehta SS, et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534–540.
    1. Bonnet F, Marret E. Postoperative pain management and outcome after surgery. Best Pract Res Clin Anaesthesiol. 2007;21:99–107.
    1. Bruce J, Thornton AJ, Scott NW, et al. Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer. Br J Cancer. 2012;107(6):937–946.
    1. Ip HY, Abrishami A, Peng PW, et al. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111:657–677.
    1. Pinto PR, McIntyre T, Almeida A, Araújo-Soares V. The mediating role of pain catastrophizing in the relationship between presurgical anxiety and acute postsurgical pain after hysterectomy. Pain. 2012;153:218–226.
    1. Sobol-Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: a systematic review and meta-analysis. Eur J Pain. 2016;20(10):1573–1586.
    1. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–1245.
    1. Khan RS, Skapinakis P, Ahmed K, et al. The association between preoperative pain catastrophizing and postoperative pain intensity in cardiac surgery patients. Pain Med. 2012;13(6):820–827.
    1. Özalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N. Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand. 2003;47(1):26–29.
    1. Liu SS, Buvanendran A, Rathmell JP, et al. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012;36(11):2261–2267.
    1. Pinto PR, McIntyre T, Ferrero R, Almeida A, Araujo-Soares V. Predictors of acute post-surgical pain and anxiety following primary total hip and knee arthroplasty. J Pain. 2013;14(5):502–515.
    1. Kornilov N, Lindberg MF, Gay C, et al. Factors related to postoperative pain trajectories following total knee arthroplasty: a longitudinal study of patients admitted to a russian orthopaedic clinic. Pain Res Treat. 2016. Jun 15, Epub. Available from: .
    1. Lindberg MF, Miaskowski C, Rustøen T, et al. Preoperative pain, symptoms, and psychological factors related to higher acute pain trajectories during hospitalization for total knee arthroplasty. PLoS One. 2016;11(9):e0161681.
    1. Lindberg MF, Miaskowski C, Rustøen T, et al. The impact of demographic, clinical, symptom and psychological characteristics on the trajectories of acute postoperative pain after total knee arthroplasty. Pain Med. 2016. May 10, Epub. Available from: .
    1. Lunn TH, Gaarn-Larsen L, Kehlet H. Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty. Pain. 2013;154:1858–1885.
    1. Rakel BA, Blodgett NP, Zimmerman MB, et al. Predictors of postoperative movement and resting pain following total knee replacement. Pain. 2012;153(11):2192–2203.
    1. Roth ML, Tripp DA, Harrison MH, Sullivan M, Carson P. Demographic and psychosocial predictors of acute perioperative pain for total knee arthroplasty. Pain Res Manag. 2007;12(3):185–194.
    1. Thomazeau J, Rouquette A, Martinez V, et al. Acute pain factors predictive of post-operative pain and opioid requirement in multi-modal analgesia following knee replacement. Eur J Pain. 2016;20(5):822–832.
    1. Barrington JW, Lovald S, Ong K, et al. Postoperative pain after primary total knee arthroplasty: comparison of local injection analgesic cocktails and the role of demographic and surgical factors. J Arthroplasty. 2016;31(9):288–292.
    1. Kim SH, Yoon KB, Yoon DM, Yoo JH, Ahn KR. Influence of centrally mediated symptoms on postoperative pain in osteoarthritis patients undergoing total knee arthroplasty: a prospective observational evaluation. Pain Pract. 2015;15(6):E46–E53.
    1. Torres-Claramunt R, Hinarejos P, Amestoy J, et al. Depressed patients feel more pain in the short term after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016:1–6.
    1. Erlenwein J, Przemeck M, Degenhart A, et al. The influence of chronic pain on postoperative pain and function after hip surgery: a prospective observational cohort study. J Pain. 2016;17(2):236–247.
    1. Pagé MG, Katz J, Curtis K, et al. Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty. J Anesthesia. 2016;30(4):568–577.
    1. Aarons H, Hall G, Hughes S, Salmon P. Short-term recovery from hip and knee arthroplasty. J Bone Joint Surg [Br] 1996;78:555–558.
    1. Pang WW, Hsu TC, Tung CC, Hung CP, Chang DP, Huang MH. Is total knee replacement more painful than total hip replacement? Acta Anaesthesiol Sin. 2000;38(3):143–148.
    1. Wylde V, Rookerb J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res. 2011;97:139–144.
    1. Cleeland C, Ryan KM. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singapore. 1994;23:129–138.
    1. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.
    1. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The Revised Illness Perception Questionnaire (IPQ-R) Psychol Health. 2002;17:1–16.
    1. Scheier MF, Carver CS, Bridges MW. Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. J Pers Soc Psychol. 1994;67(6):1063–1078.
    1. Theunissen M, Peters ML, Schouten EG, et al. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One. 2014;9(6):e100225.
    1. Riley JL, Robinson ME. CSQ: five factors or fiction? Clin J Pain. 1997;13:156–162.
    1. Arbuckle JL. IBM SPSS Amos 22 User’s Guide. Crawfordville, FL: Amos Development Corporation; 2013.
    1. Jensen MP, Hu X, Potts SL, Gould EM. Single versus composite measures of pain intensity: relative sensitivity for detecting treatment effects. Pain. 2013;154(4):534–538.
    1. Spadoni GF, Stratford PW, Solomon PE, Wishart LR. The evaluation of change in pain intensity: a comparison of the P4 and single-item numeric pain rating scales. J Orthop Sports Phys Ther. 2004;34(4):187–193.
    1. Jensen MP, McFarland CA. Increasing the reliability and validity of pain intensity measurement in chronic pain patients. Pain. 1993;55(2):195–203.
    1. Kline RB. Principles and Practice of Structural Equation Modeling. New York, NY: Guilford; 2005.
    1. Cohen J. Statistical Power Analysis for the Behavioural Sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1998.
    1. Duivenvoorden T, Vissers M, Verhaar J, et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013;21:1824–1840.
    1. Jensen MP. A neuropsychological model of pain: research and clinical implications. J Pain. 2010;11(1):2–12.
    1. Jensen MP. Psychosocial approaches to pain management: an organizational framework. Pain. 2011;152(4):717–725.
    1. Patterson DR, Jensen MP. Hypnosis and clinical pain. Psychol Bull. 2003;129(4):495–521.
    1. Tefikow S, Barth J, Maichrowitz S, Beelmann A, Strauss B, Rosendahl J. Efficacy of hypnosis in adults undergoing surgery or medical procedures: a meta-analysis of randomized controlled trials. Clin Psychol Rev. 2013;33(5):623–636.
    1. Meevissen Y, Peters M, Alberts H. Become more optimistic by imagining a best possible self: effects of a two week intervention. J Behav Ther Exp Psychiatry. 2011;42(3):371–378.
    1. Peters M, Meevissen Y, Hanssen M. Specificity of the best possible self intervention for increasing optimism: comparison with a gratitude intervention. Terapia Psicológica. 2013;31(1):93–100.
    1. Hanssen M, Peters M, Vlaeyen J, Meevissen Y, Vancleef L. Optimism lowers pain: evidence of the causal status and underlying mechanisms. Pain. 2013;154:53–58.
    1. Johnston M, Vogele C. Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med. 1993;15(4):245–256.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する