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Pain management should be as important to surgeons as it is to patients
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During the 25 years in which I have been interested in the diagnosis and management of pain in orthopaedic patients, I often wondered what my orthopaedic colleagues’ level of interest and skill was on this issue. I noticed that when I attended international pain meetings, mainly those of the International Association for the Study of Pain, and when I organized and presented at pain-related symposia during national and international meetings, there were always few orthopaedic surgeons in attendance.
This situation perplexes me since most of our orthopaedic patients have pain either as a main reason for consulting us or, in trauma cases, have pain to such a great extent that we must act quickly and include pain management in their initial treatment.
I often wonder why orthopaedic surgeons do not usually involve themselves in pain management and why they are not typically present when pain diagnostics and treatment are discussed.
Pain management requires collaboration
In Denmark, it may be due to a historical trend. General practitioners are usually very close with individual patients and those physicians are, therefore, typically the main health care providers to help patients deal with pain treatment in elective cases. At most clinics, pain treatment is for trauma patients, which is carried out under the leadership and guidance of anesthetists during the postoperative period.
However, my experience is that close collaboration between general practitioners and anesthetists improves patients’ pain treatment and outcomes, helps introduce new programs and drugs, and establishes a forum in which discussion of real-life pain treatment is a daily event that benefits everyone and patients in particular.
I have participated in a program of accelerated rehabilitation after total hip and knee replacement in the last 13 years, which has shown me that the in-depth involvement of an orthopaedic surgeon in pain treatment truly makes a difference in outcomes. During that time, we reduced the patients’ length of stay in the clinic after surgery considerably and increased 10-fold the number of cases performed annually in our unit. This was also associated with improved patient satisfaction, and over time, it gradually changed the postoperative pain treatment approach used.
Orthopaedic surgeons should lead
The initial pain treatment used in the postoperative period, ie, epidural pain catheter, was done over a period of time with local infiltration analgesia. It has evolved into what today is a multimodal drug treatment program with minimal use of opioids. Seventy percent of our patients leave the clinic within the first 24 hours after surgery and at discharge have less pain than that of patients operated on 5 years to 10 years ago. What has made this possible is a multidisciplinary involvement in pain treatment with the orthopaedic surgeon as the main “driver.”
The future will involve more short-stay and ambulatory surgical procedures, better knowledge of pain diagnostics and types of pain, as well as a variety of pain-management programs that incorporate modern approaches. We, as orthopaedic surgeons, must improve our knowledge in these areas and update ourselves through literature, courses and meetings that focus on pain and its management.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.