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Physiother Can. 2011 Summer;63(3):289-304. doi: 10.3138/ptc.2009-49P. Epub 2011 Aug 10.

Strategies Aimed at Preventing Chronic Post-surgical Pain: Comprehensive Perioperative Pain Management after Total Joint Replacement Surgery.

Author information

1
Hance Clarke, MSc, MD, FRCPC: Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto; Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre; and Department of Anesthesia, University of Toronto, Toronto, Ontario.

Abstract

PURPOSE:

Chronic post-surgical pain (CPSP) is a frequent outcome of musculoskeletal surgery. Physiotherapists often treat patients with pain before and after musculoskeletal surgery. The purposes of this paper are (1) to raise awareness of the nature, mechanisms, and significance of CPSP; and (2) to highlight the necessity for an inter-professional team to understand and address its complexity. Using total joint replacement surgeries as a model, we provide a review of pain mechanisms and pain management strategies.

SUMMARY OF KEY POINTS:

By understanding the mechanisms by which pain alters the body's normal physiological responses to surgery, clinicians selectively target pain in post-surgical patients through the use of multi-modal management strategies. Clinicians should not assume that patients receiving multiple medications have a problem with pain. Rather, the modern-day approach is to manage pain using preventive strategies, with the aims of reducing the intensity of acute postoperative pain and minimizing the development of CPSP.

CONCLUSIONS:

The roles of biological, surgical, psychosocial, and patient-related risk factors in the transition to pain chronicity require further investigation if we are to better understand their relationships with pain. Measuring pain intensity and analgesic use is not sufficient. Proper evaluation and management of risk factors for CPSP require inter-professional teams to characterize a patient's experience of postoperative pain and to examine pain arising during functional activities.

KEYWORDS:

chronic post-surgical pain; inter-professional teams; multi-modal analgesia; preventive analgesia; total joint replacement

PMID:
22654235
PMCID:
PMC3157989
DOI:
10.3138/ptc.2009-49P
[Indexed for MEDLINE]
Free PMC Article
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