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Multidisciplinary pain treatment a viable treatment for chronic pain following THR, TKR

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Multidisciplinary pain treatment carries short- and mid-term benefits for patients experiencing chronic pain following total hip or knee replacement, according to a recently presented study.

Christian Merle, MD, shared his findings at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting, in San Francisco.

“Despite the great success of total hip replacement (THR) and total knee replacement (TKR), there is a subgroup of patients who remain dissatisfied with these procedures and develop persistent, unexplained pain and functional limitations,” Merle said. “Chronic pain of unclear etiology poses a great therapeutic challenge and data on treatment strategies and clinical outcomes are very limited.”

Merle and his team performed a retrospective analysis of 40 patients experiencing chronic pain following THR or TKR and reporting failed previous monodisciplinary and/or outpatient therapies between April 2007 and April 2010.

The researchers ruled out infection, instability, malpositioning, loosening, mechanical failure and other causes of pain prior to including patients in the study, according to the abstract. The patients were assessed for sociodemographic parameters, pain intensity and psychological status before multidisciplinary pain treatment (MPT), after 4 weeks of therapy and finally at a 12-month minimum follow-up.

With a mean follow-up of 32 months and 10 patients being lost to final follow-up, Merle reported all scores within the cohort improved significantly over those at baseline. By the final follow-up, the majority of the scores were still significantly better than those at baseline — although they had deteriorated slightly. Merle noted anxiety scores had deteriorated fully back to the baseline measurements.

“[MPT] has a beneficial short- and mid-term effect on subjective pain intensity, physical capability and depression in patients with chronic pain following [THR] and [TKR],” he concluded. “We also observed significant reductions in morphine use in the subgroup of patients.”

“Our findings support the relevance of psychological and socioeconomic factors on the clinical outcome of total joint replacements,” he said.

Reference:

• Merle C, Brendle S, Wang H, et al. Conservative multidisciplinary treatment in patients with persistent pain after total hip and knee replacement. Paper 268. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
• Disclosure: Merle has no relevant financial disclosures.