Effectiveness of pharmacological-based interventions including education and prescribing strategies to reduce subacute pain following total hip or knee arthroplasty: a systematic review of randomised controlled trials

• Published in: Pain medicine (Malden, Mass.)
• Main Authors: Liu, Shania, Genel, Furkan, Harris, Ian A, Patanwala, Asad E, Adie, Sam, Stevens, Jennifer, Hassett, Geraldine, Luckie, Kate, Penm, Jonathan, Naylor, Justine
• Format: Journal Article
• Language: English
• Published: England 24-03-2022
• Subjects: total hip arthroplasty; total knee arthroplasty; subacute pain; intervention; joint replacement
• ISSN: 1526-4637

Total knee and hip arthroplasty (TKA, 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 post-discharge pharmacological interventions, including educational and prescribing strategies, and their effect on reducing pain during the subacute period after TKA or THA.
We searched seven electronic databases from inception to 22 April 2021. Published randomised controlled trials of adults who underwent TKA or THA and received a pharmacological-based intervention commencing within one week after hospital discharge and conducted for up to three months postoperatively were compared to any treatment. Two reviewers independently extracted data on the primary outcome, pain intensity. This review was registered prospectively on PROSPERO (ID: CRD42021250384).
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 (Coeff -0.81; 95% CI -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 to usual care.
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 following TKA and THA.