Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery
Patient Guideline Summary
- Management of pain after surgery or injury is a major concern since it retards healing, slows the return of function, and raises the risk of complications.
- Pain is also closely tied to mental and social health.
- The use of opioids/narcotics risks dependence and is therefore avoided or minimized whenever possible.
- This patient summary focuses on pain relief with a minimum of adverse side effects.
- The effects of treatment were evaluated for pain relief, improvement in function, and reduction in opioid use.
- Some evaluations were based on comparison with “standard treatment” or between two similar treatments.
- Neuromuscular electrical stimulation: improves function but not pain.
- Continuous regional anesthesia in total shoulder arthroplasty.
- Cox-2 agents (celecoxib): to limit opioid use.
- Intravenous ketamine in the first 24 hrs after hip and knee arthroplasty.
- Music therapy
- Patient education
- Acupuncture including auricular – may improve function but not pain.
- Intra-articular opioid/NSAIDs injections
- Acetaminophen/NSAID combination
- Pregabalin: concern for dizziness and sedation
These treatments are no more effective than “standard treatment”:
- Cold treatments
- Earlier mobilization
- Transcutaneous electrical nerve stimulation (TENS)
- Cognitive behavioral therapy during total knee arthroplasty
- Guided relaxation therapy
- Virtual reality
- Oral relaxants given postoperatively
- AAOS was unable to evaluate the effectiveness of duloxetine.
- No difference in patient outcomes between local and regional anesthesia for patients undergoing total knee and hip arthroplasty.
- No difference in patient outcomes between fentanyl patch and morphine.
- No difference in pain intensity and opioid use between oral acetaminophen and intravenous acetaminophen.
- No difference in patient outcomes between tramadol and NSAIDs.
- AAOS: American Academy Of Orthopedic Surgeons
- TENS: Transcutaneous Electrical Nerve Stimulation
American Academy of Orthopaedic Surgeons Evidence- Based Clinical Practice Guideline for Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery https://www.aaos.org/painalleviationcpg Published 07/19/21