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Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

BACKGROUND: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the subacute period (defined here as the period from hospital discharge to 3 months postoperatively) is a predictor of pers...

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Autores principales: Liu, Shania, Genel, Furkan, Harris, Ian A, Patanwala, Asad E, Adie, Sam, Stevens, Jennifer, Hassett, Geraldine, Luckie, Kate, Penm, Jonathan, Naylor, Justine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9434276/
https://www.ncbi.nlm.nih.gov/pubmed/35325201
http://dx.doi.org/10.1093/pm/pnac052
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author Liu, Shania
Genel, Furkan
Harris, Ian A
Patanwala, Asad E
Adie, Sam
Stevens, Jennifer
Hassett, Geraldine
Luckie, Kate
Penm, Jonathan
Naylor, Justine
author_facet Liu, Shania
Genel, Furkan
Harris, Ian A
Patanwala, Asad E
Adie, Sam
Stevens, Jennifer
Hassett, Geraldine
Luckie, Kate
Penm, Jonathan
Naylor, Justine
author_sort Liu, Shania
collection PubMed
description BACKGROUND: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the subacute period (defined here as the period from hospital discharge to 3 months postoperatively) is a predictor of persistent pain 12 months postoperatively. This review aimed to examine the available postdischarge pharmacological interventions, including educational and prescribing strategies, and their effect on reducing pain during the subacute period after TKA or THA. METHODS: We searched seven electronic databases from inception to April 22, 2021. Published randomized controlled trials of adults who underwent TKA or THA and received a pharmacological-based intervention commencing within 1 week after hospital discharge and conducted for up to 3 months postoperatively were compared with any treatment. Two reviewers independently extracted data on the primary outcome, pain intensity. This review was registered prospectively on PROSPERO (ID: CRD42021250384). RESULTS: Four trials involving 660 participants were included. Interventions included changing analgesic prescribing practices upon hospital discharge and education on analgesic use. Providing multimodal non-opioid analgesia in addition to reduced opioid quantity was associated with lower subacute pain (coefficient –0.81; 95% confidence interval –1.33 to –0.29; P = 0.003). Education on analgesic use during multidisciplinary home visits was effective for reducing pain intensity during the subacute period (6.25 ± 10.13 vs 35.67 ± 22.05; P < 0.001) compared with usual care. CONCLUSIONS: Interventions involving the provision of multimodal non-opioid analgesia and education on analgesic use show positive effects on reducing pain intensity during the subacute period after TKA and THA.
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spelling pubmed-94342762022-09-01 Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials Liu, Shania Genel, Furkan Harris, Ian A Patanwala, Asad E Adie, Sam Stevens, Jennifer Hassett, Geraldine Luckie, Kate Penm, Jonathan Naylor, Justine Pain Med Acute, Regional Anesthesiology & Perioperative Pain Section BACKGROUND: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) surgeries are among the most common elective procedures. Moderate to severe postoperative pain during the subacute period (defined here as the period from hospital discharge to 3 months postoperatively) is a predictor of persistent pain 12 months postoperatively. This review aimed to examine the available postdischarge pharmacological interventions, including educational and prescribing strategies, and their effect on reducing pain during the subacute period after TKA or THA. METHODS: We searched seven electronic databases from inception to April 22, 2021. Published randomized controlled trials of adults who underwent TKA or THA and received a pharmacological-based intervention commencing within 1 week after hospital discharge and conducted for up to 3 months postoperatively were compared with any treatment. Two reviewers independently extracted data on the primary outcome, pain intensity. This review was registered prospectively on PROSPERO (ID: CRD42021250384). RESULTS: Four trials involving 660 participants were included. Interventions included changing analgesic prescribing practices upon hospital discharge and education on analgesic use. Providing multimodal non-opioid analgesia in addition to reduced opioid quantity was associated with lower subacute pain (coefficient –0.81; 95% confidence interval –1.33 to –0.29; P = 0.003). Education on analgesic use during multidisciplinary home visits was effective for reducing pain intensity during the subacute period (6.25 ± 10.13 vs 35.67 ± 22.05; P < 0.001) compared with usual care. CONCLUSIONS: Interventions involving the provision of multimodal non-opioid analgesia and education on analgesic use show positive effects on reducing pain intensity during the subacute period after TKA and THA. Oxford University Press 2022-03-24 /pmc/articles/PMC9434276/ /pubmed/35325201 http://dx.doi.org/10.1093/pm/pnac052 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Acute, Regional Anesthesiology & Perioperative Pain Section
Liu, Shania
Genel, Furkan
Harris, Ian A
Patanwala, Asad E
Adie, Sam
Stevens, Jennifer
Hassett, Geraldine
Luckie, Kate
Penm, Jonathan
Naylor, Justine
Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title_full Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title_fullStr Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title_full_unstemmed Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title_short Effectiveness of Pharmacological-Based Interventions, Including Education and Prescribing Strategies, to Reduce Subacute Pain After Total Hip or Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials
title_sort effectiveness of pharmacological-based interventions, including education and prescribing strategies, to reduce subacute pain after total hip or knee arthroplasty: a systematic review of randomized controlled trials
topic Acute, Regional Anesthesiology & Perioperative Pain Section
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9434276/
https://www.ncbi.nlm.nih.gov/pubmed/35325201
http://dx.doi.org/10.1093/pm/pnac052
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