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. 2017 Jan 1;18(1):124-139.
doi: 10.1093/pm/pnw080.

The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty

Maren Falch Lindberg  1   2 , Christine Miaskowski  3 , Tone Rustøen  2   4 , Leiv Arne Rosseland  4   5 , Steven M Paul  3 , Bruce A Cooper  3 , Anners Lerdal  1   2
Affiliations

The Impact of Demographic, Clinical, Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty

Maren Falch Lindberg et al. Pain Med. .

Abstract

Objective: Total knee arthroplasty is a painful procedure. No studies have evaluated modifiable predictors of acute postoperative pain trajectories during hospitalization.

Methods: Consecutive patients (N = 188) were enrolled in a longitudinal cohort study and completed a demographic questionnaire, as well as the Brief Pain Inventory, Hospital Depression and Anxiety Scale, Lee Fatigue Scale, Fatigue Severity Scale, and Brief Illness Perception Questionnaire on the day before surgery. Clinical data were extracted from medical records.

Setting and patients: Each patient completed a pain diary that assessed pain at rest and with activity, and hours per day in pain every evening from day of surgery until postoperative day 3. Using hierarchical linear modeling, we investigated which demographic, clinical, symptom, and psychological characteristics predicted initial levels as well as the trajectories of acute pain at rest and with activity, and hours per day in pain.

Results: Higher levels of all three acute pain characteristics on the day of surgery resulted in worse trajectories. Higher pain scores with rest and with activity on the day of surgery were associated with more days with femoral block, higher average dose of opioids, and higher emotional response to osteoarthritis. Higher number of comorbidities, higher average dose of opioids, and lower perceived control predicted more hours per day in pain on the day of surgery.

Conclusions: This study identified several potentially modifiable predictors of worsening pain trajectories following total knee arthroplasty. Optimal pain management warrants identification of these high-risk patients and treatment of modifiable risk factors.

Keywords: Acute Postoperative Pain; Hierarchical Linear Modeling; Pain at Rest; Pain with Activity; Total Knee Arthroplasty.

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Figures

Figure 1
Figure 1
Trajectories of pain at rest (A), pain with activity (B), and log of hours per day in pain (C) using an unconditional model.
Figure 2
Figure 2
Trajectories of pain at rest by number of days with a continuous femoral nerve block (A), average dose of intravenous opioid equivalents (B), emotional response to osteoarthritis (C), and average pain at rest on the day of surgery (D) from the day of surgery until postoperative day 3. Higher/lower differences in Figures 2A–C were calculated based on 1 standard deviation above/below the predicted value.
Figure 3
Figure 3
Trajectories of pain with activity by number of days with a continuous femoral nerve block (A), average dose of intravenous opioid equivalents (B), emotional response to osteoarthritis (C), and average pain with activity on the day of surgery (D) from the day of surgery until postoperative day 3. Higher/lower differences in Figures 3A–C were calculated based on 1 standard deviation above/below the predicted value.
Figure 4
Figure 4
Trajectories of hours per day in pain by average dose of intravenous opioid equivalents (A), number of comorbidities (B), perceived control of osteoarthritis (C), and hours per day in pain on the day of surgery (D) from the day of surgery until postoperative day 3. Higher/lower differences in Figures 4A–C were calculated based on 1 standard deviation above/below the predicted value.
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