Pain in Postsurgical Orthopedic Rehabilitation: A Multicenter Study

• Published in: Pain medicine (Malden, Mass.) Vol. 13; no. 6; pp. 769 - 776
• Main Authors: Padua, Luca, Aprile, Irene, Cecchi, Francesca, Molino Lova, Raffaele, Arezzo, Maria Felice, Pazzaglia, Costanza
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-06-2012; Oxford University Press
• Subjects: Aged; Cross-Sectional Studies; Disability Evaluation; Female; Humans; Leg - surgery; Lower Limb; Male; Neuralgia - epidemiology; Nociceptive Pain - epidemiology; Orthopedic; Orthopedic Procedures - adverse effects; Orthopedic Procedures - rehabilitation; Pain; Pain management; Quality of Life; Rehabilitation; Surgery
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2012.01395.x

Objective.  The aim of this study was to quantify and characterize pain in patients undergoing lower limb postsurgical orthopedic rehabilitation and to investigate the impact of pain in slowing or interrupting their rehabilitation.
Design.  The study was designed as a multicenter cross‐sectional study.
Setting.  The study was set in rehabilitation departments of the Don Gnocchi Foundation.
Subjects.  The study subjects were the inpatients attending rehabilitation.
Interventions.  There were no interventions used in the study.
Outcome Measures.  Pain intensity was measured with a numeric rating scale (NRS); pain characteristics were assessed with the McGill Pain Questionnaire and the ID Pain (able to discriminate nociceptive from neuropathic pain). Quality of life (QoL) was measured with the Short Form 36 Health Status Survey. A semi‐structured questionnaire on pain occurrence, impact, and management was administered by the physiotherapist in charge of the patients and by the physician.
Results.  We studied 139 patients, 82% of whom complained of at least moderate pain (NRS ≥ 3). According to ID pain, 45.6% patients complained of probable (33.8%) or highly probable (11.8%) neuropathic pain. A higher pain intensity was significantly related to the probability of having neuropathic pain (P < 0.001). Patients with more severe pain reported lower physical and mental QoL scores. In 38.6% of cases, pain interfered with the rehabilitation process, and in 18.5% it was the cause of physical therapy discontinuation.
Conclusions.  In light of the high occurrence and intensity of pain in the sample, and of the significant impact on the rehabilitation program, clinicians should pay more attention to pain, especially neuropathic pain, in postsurgical patients. Tailored pain pharmacological therapy could possibly improve patient compliance during the rehabilitation process and enhance long‐term outcomes.