Pain after surgery for knee replacement in Norway and for traumatic injury in Ethiopia: Observational cohort studies

Abstract

Pain after orthopedic surgery is a considerable clinical problem. There is a lack of knowledge on acute pain trajectories, as well as how psychological, clinical, surgical, and lifestyle risk factors may be related to severe acute pain in patients undergoing surgery following traumatic fracture in Ethiopia. While several predictors of chronic pain after total knee arthroplasty (TKA) have been identified, further knowledge is needed on the contributions of co‐occurring preoperative symptoms (pain, fatigue, sleep problems, depression), acute pain intensity and opioid intake during the early postoperative period, on chronic pain outcomes after TKA. The doctoral thesis “Pain after surgery for knee replacement in Norway and for traumatic fractures in Ethiopia: Observational cohort studies” aimed to identify the association between pre, intra and postoperative factors, and acute pain trajectories after traumatic fracture surgery and chronic knee pain following TKA. Mestawet Getachew and co-authors found that higher levels of preoperative pain and fatigue were associated with moderate-severe knee pain 12 months after TKA. Furthermore, neither the patients’ trajectories of pain nor opioid intake during the early postoperative period were associated with moderate-severe pain 12 months after TKA. In the Ethiopian sample, two subgroups of patients with distinct pain trajectories following fracture surgery were identified: The rapid pain relief group (48% of the sample) and the consistently high pain group (52% of the sample). Patients who had longer duration of surgery, received general anesthesia and had higher levels of preoperative pain were more likely to be in the consistently high pain group. The findings in this thesis are of importance for clinicians when evaluating orthopedic patients, as this knowledge may help to identify patients at higher risk for poor pain outcome and may help researchers in developing preventive measures for patients at risk for poor pain outcome.