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Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty

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Abstract

Purpose

The aim of this study was to explore acute movement-evoked postoperative pain intensity trajectories over the first 5 days after total hip arthroplasty (THA) and to examine how these pain trajectories are associated with pain-related outcomes 6 weeks and 6 months later.

Methods

A total of 150 adult patients [72 women (48.0 %); mean age 60.0 ± 9.2 (standard deviation) years] completed pain questionnaires preoperatively, several times daily postoperatively until hospital discharge, and 6 weeks and 6 months after surgery.

Results

Results showed that the best model had four different acute postoperative pain trajectories and a significant quadratic term. The trajectories varied in terms of initial pain intensity levels and rates of decline/increase in pain over the first 4 postoperative days. Significant predictors of pain trajectory membership were preoperative pain disability and anxiety as well as cumulative morphine consumption 24 h following surgery. Pain trajectories were significantly associated with levels of pain intensity and anxiety at 6 weeks but not at 6 months postoperatively.

Conclusion

This study showed that during the postoperative period patients differed in terms of pain intensity profiles and that these differences were associated with outcomes for up to 6 weeks following surgery. Pain trajectories were not predictive of persistent postoperative pain status at 6 months. Nonetheless, these results highlight the importance of patient heterogeneity in acute postoperative pain and pain-related outcomes months after THA.

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Acknowledgments

MGP is supported by a Canada Graduate Scholarship—Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR). JK is supported by a CIHR Canada Research Chair in Health Psychology at York University. HC is supported by a Merit Award from the Department of Anesthesia at the University of Toronto. The data collection was enabled by a Pfizer Canada physician-initiated peer-reviewed Neuropathic Pain Competition award.

Author information

Authors and Affiliations

  1. Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Montréal, QC, Canada

    M. Gabrielle Pagé

  2. Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Canada

    Joel Katz, Noga Lutzky-Cohen & Hance A. Clarke

  3. Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada

    Joel Katz, Kathryn Curtis & E. Manolo Romero Escobar

  4. Department of Anesthesia, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317 , Toronto, ON, M5G 2C4, Canada

    Hance A. Clarke

Authors
  1. M. Gabrielle Pagé
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  2. Joel Katz
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  4. Noga Lutzky-Cohen
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  5. E. Manolo Romero Escobar
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  6. Hance A. Clarke
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Correspondence to Hance A. Clarke.

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Pagé, M.G., Katz, J., Curtis, K. et al. Acute pain trajectories and the persistence of post-surgical pain: a longitudinal study after total hip arthroplasty. J Anesth 30, 568–577 (2016). https://doi.org/10.1007/s00540-016-2183-4

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  • DOI: https://doi.org/10.1007/s00540-016-2183-4

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