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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

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      Is Open Access

      A comparison of predictors and intensity of acute postsurgical pain in patients undergoing total hip and knee arthroplasty

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          Abstract

          Background

          Acute pain is an expected result after surgery. Nevertheless, when not appropriately controlled, acute pain has a very negative impact on individual clinical outcomes, impairing healing and recovery, and has clear consequences on health care system costs. Augmenting knowledge on predictors and potentially modifiable determinants of acute postsurgical pain can facilitate early identification of and intervention in patients at risk. However, only a few studies have examined and compared acute pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aim of this study was to compare THA and TKA in acute postsurgical pain intensity and its predictors.

          Methods

          A consecutive sample of 124 patients with osteoarthritis (64 undergoing THA and 60 TKA) was assessed 24 hours before (T1) and 48 hours after (T2) surgery. Demographic, clinical, and psychological factors were assessed at T1, and acute postsurgical pain experience was examined at T2. Additionally, the same hierarchical regression analysis was performed separately for each arthroplasty type.

          Results

          TKA patients reported higher levels of acute postsurgical pain compared with THA ( t=8.490, p=0.004, d=0.527, 95% confidence interval, 0.196–0.878). In the final THA predictive model, presurgical pain was the only variable approaching significant results ( t[57]=1.746, β=0.254, p=0.086). In the final TKA predictive model, optimism was the only predictor of pain ( t[51]=−2.518, β=−0.339, p=0.015), with emotional representation ( t[51]=1.895, β=0.254, p=0.064) presenting a trend toward significance.

          Conclusion

          The current study is the first examining THA and TKA differences on acute postsurgical pain intensity and its predictors using a multivariate approach. Results from this study could prove useful for the design of distinct interventions targeting acute postsurgical pain management depending on whether the site of arthroplasty is the hip or the knee. Finally, the current results also support the argument that these two surgeries, at least with regard to acute pain, should be approached separately.

          Most cited references54

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          Coefficient alpha and the internal structure of tests

          Psychometrika, 16(3), 297-334
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            Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test.

            Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
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              Predictors of postoperative pain and analgesic consumption: a qualitative systematic review.

              Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                09 May 2017
                : 10
                : 1087-1098
                Affiliations
                [1 ]Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
                [2 ]ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal
                [3 ]Department of Psychology, Houston Baptist University, Houston, TX, USA
                [4 ]Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
                [5 ]Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
                [6 ]Orthopedics Unit, Alto Ave Hospital Center, Guimarães, Portugal
                Author notes
                Correspondence: Patrícia R Pinto, Life and Health Sciences Research Institute (ICVS), School of Medicine, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal, Tel +351 253 60 4926, Fax +351 253 60 4809, Email patipinto@ 123456med.uminho.pt
                Article
                jpr-10-1087
                10.2147/JPR.S126467
                5431693
                28533697
                1c38f982-e034-4e52-8cd7-281df423d5b7
                © 2017 Pinto et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Original Research

                Anesthesiology & Pain management
                acute post-surgical pain,total knee arthroplasty,total hip arthroplasty,psychological factors,multivariate analyses,presurgical psychological intervention

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