An interdisciplinary pain team (IPT) was established at our institution to explore options for improving pain control in patients undergoing orthopaedic surgery by identifying traits that put a patient at increased risk for inadequate pain control post-operatively.
The IPT identified seven potential risk factors that may lead to inadequate pain control post-operatively including (1) history of physical, emotional, or sexual abuse; (2) history of anxiety; (3) history of drug or alcohol abuse; (4) pre-operative non-steroidal anti-inflammatory drug (NSAID), or disease-modifying anti-rheumatic drug (DMARD) use; (5) current opioid use; (6) psychologic conditions other than anxiety; and (7) current smoker. Statistical analysis determined which risk factors were associated with increased pre- and post-operative pain scores.
1,923 patients undergoing elective orthopaedic surgery were retrospectively identified. Hip, knee and shoulder replacements accounted for 76.0% of the procedures. 78.5% of patients had 3 or fewer risk factors and 17.1% had no risk factors. Anxiety, other psychological conditions, current opioid use, and current smoking were significantly associated with higher pre- and post-operative pain scores.
We found a significant association between anxiety, current smoking, psychological conditions, and current opioid use with increased pre- and post-operative reported pain score. We propose that identification of these risk factors should prompt more attention to post-operative pain control plans and will improve communication with patients and providers. We recommend a multimodal approach to post-operative pain control, and developed a pain orderset to help guide providers.