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. 2022 Jun 7;23(1):548.
doi: 10.1186/s12891-022-05492-6.

Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

Rafael Pinedo-Villanueva  1 , Spyros Kolovos  2 , Christopher Maronga  2 , Antonella Delmestri  2 , Nick Howells  3 , Andrew Judge  2   4   5 , Rachael Gooberman-Hill  4   5 , Vikki Wylde  4   5
Affiliations

Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

Rafael Pinedo-Villanueva et al. BMC Musculoskelet Disord. .

Abstract

Background: Approximately 20% of patients experience chronic pain after total knee replacement (TKR). The impact of chronic pain after TKR on primary care services in the UK is currently unknown. The aim of this study was to compare primary care consultations and pain medicine prescriptions between patients with and without chronic pain after TKR.

Methods: Data from 5,055 patients who received TKR between 2009 and 2016 with anonymised linked data from the Clinical Practice Research Datalink Gold (CPRD) and English Hospital Episode Statistics (HES) Patient Reported Outcome Measures (PROMs) programme were analysed. The exposure time was from 10 years pre-operative to eight years post-operative. Patients with a score ≤ 14 on the Oxford Knee Score pain component scale at 6 months post-operative were classified as having chronic pain after TKR. Primary care consultations and prescribed pain medicines were quantified, and costs calculated based on national cost data.

Results: 721 patients (14%) had chronic pain after TKR. The prevalence and costs of primary care consultations and pain medicine prescriptions per year were consistently higher for patients with chronic pain after TKR compared with those without chronic pain after TKR; these differences were observed both before and after surgery. There was a substantial and sustained increase in the cost of opioid prescriptions after surgery for patients with chronic pain after TKR, peaking at seven years post-operative.

Conclusions: Increased primary care consultations and pain medicine prescriptions associated with chronic pain after TKR represent a considerable financial cost to primary care services. Evaluation of interventions to reduce the risk of developing this pain condition and improve the early management of pain after TKR are needed to improve outcomes for patients and reduce costs to healthcare services.

Keywords: Chronic pain; England; Opioid; Primary care; Total knee replacement.

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Conflict of interest statement

AJ reports grants from NIHR during the conduct of the study; personal fees from Freshfields Bruckhaus Derringer, personal fees from Anthera Pharmaceuticals Ltd, outside the submitted work; RGH reports grants from NIHR during the conduct of the study; RPV reports research funding from UK-NIHR, Kyowa Kirin Services, International Osteoporosis Foundation, and lecture fees and/or consulting honoraria from Amgen, UCB, Kyowa Kirin Services, and Mereo Biopharma, all outside of the scope of this study; VW reports grants from NIHR during the conduct of the study. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Mean number of consultations by healthcare professional for patients with and without chronic pain
Fig. 2
Fig. 2
Mean cost of consultations and prescriptions by year for patients with and without chronic pain
Fig. 3
Fig. 3
Mean cost of pain medicine prescriptions by year and medication type for patients with and without chronic pain
See this image and copyright information in PMC

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