NEW YORK (Reuters Health) - Among older adults who have undergone orthopedic surgery, an interdisciplinary analgesic program can improve postoperative pain, reduce chronic pain, and improve function, according to Dr. R. Sean Morrison, of Mount Sinai School of Medicine, New York, and colleagues.

"Uncontrolled pain is a major impediment to postoperative functional recovery and is a persistent problem in the United States," they continue. Elderly adults who undergo orthopedic surgery of the hip or knee experience intense postoperative pain and may receive suboptimal analgesic therapy.

In a clinical trial, the researchers assessed the effect of a multi-component interdisciplinary intervention on pain and function in 248 patients admitted to rehabilitation after hip fracture repair, or hip or knee arthroplasty - replacement or reconstruction of the joint.

Pain was assessed at rest and with physical therapy using 5-point numeric rating scales. In the intervention group, physician protocols for standing analgesia, preemptive analgesia, rescue analgesia, and mixing analgesia were implemented. The control group received usual care.

Further analysis by Morrison's group demonstrated that for the first 7 days of rehabilitation, patients in the intervention group were significantly more likely than controls to report no or mild pain at rest (66 percent versus 51 percent) and during physical therapy (52 percent versus 38 percent).

Intervention patients were also significantly less likely than controls to report moderate to very severe pain at discharge and during their last physical therapy session before discharge.

The investigators found that 8-foot walk times were significantly faster in the intervention group than the control group on rehabilitation day 4 (9.3 seconds versus 13.2 seconds) and on day 7 (6.9 seconds versus 9.2 seconds).

Patients in the intervention group had significantly shorter average length of hospital stay than controls (10.1 days versus 11.3 days).

Intervention patients received more analgesia compared to controls (23.6 mg/d morphine sulfate equivalents versus 15.6 mg/d). Those in the intervention group were also significantly more likely than controls to receive standing orders for analgesia (98 percent versus 48).

"At 6 months, intervention patients were less likely to report moderate to very severe pain with walking -- 4 percent versus 15 percent of controls, to report that pain interfered with walking (7 percent versus 18 percent of controls, or to still be taking analgesics (35 percent versus 51 percent of controls) than control patients," Morrison's team reports.

They add that it's intriguing that "aggressive pain management in the postoperative setting may reduce the development of chronic postoperative pain."

SOURCE: Journal of the American Geriatric Society, January 2009.

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