Pain after joint replacement
A number of people experience pain after joint replacement, therefore it is important to identify those who are potentially at risk, devise ways to minimise the risk and ensure that post-operatively each individual receives what they need to resume a meaningful life. Knee and hip replacements are being increasingly performed and hence we are likely to see more people suffering persistent pain. Pain is already one of the largest global health burdens, so understanding pain and what we can do is vital for the global community.
2016 was the Global Year Against Pain in the Joints
There are several key facts to understand about pain:
- The pain that we feel is poorly related to the extent of tissue damage, tissue changes or injury.
- Pain is contextual and the likelihood of feeling pain is determined by the perception of threat, both consciously and by body systems that are designed to protect us. In essence, any situation that is judged to be threatening will have implications for a pain experience. This is why stress (a perceived threat) and tiredness play such a role in pain.
- There is no actual, specific biology of pain, instead a state of protect. In the case of chronic pain, this state is ‘on’ much of the time (a habit) and the person must learn how to change this with different types of training (The Pain Coach Programme). There are no pain signals, pain receptors, pain molecules or pain centres. The biology that is involved with the experience of pain is largely found NOT where we actually feel the pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.
- And now for some good news! Pain can and does change, but you need to understand it and know what to do.
Risk factors for chronic postoperative pain ~ what to look out for
- Preoperative pain: if uncontrolled, high intensity and impacting, there is a risk of chronic pain after joint replacement (Arendt-Nielsen et al. 2015). The pain and the person must be addressed before the procedure.
- Widespread pain is associated with chronic pain after joint replacement (Petersen et al. 2016; Wylde et al. 2011).
- In some cases of osteoarthritis (OA), temporal summation has been shown to be associated with pain after joint replacement, so evidence of this should be noted.
- People with fibromyalgia tend to have a higher risk of suffering postoperative pain (D’Apuzzo et al. 2012).
- When the person has OA that affects a number of joints (Perruccio et al. 2012).
- Catastrophising about the pain and a lack of effective coping strategies predicted postoperative pain after knee replacement (Baert et al. 2016).
- Genetic factors, prior experiences (previous surgeries and the quality of the experience and outcomes), beliefs and other influences should be considered.
What can we do?
On deeply listening to the person, we will hear about their experiences and understand the causes of their suffering. If indeed a joint replacement is indicated, then we must ensure the person who will live the experience has a working knowledge of what will happen, who will do what, their role and what they can do to focus on being healthy and well for the best possible recovery.
A simple preoperative education session with the relevant information, an opportunity to ask questions and to learn practices that create the best conditions for healing and recovery would benefit all, but in particular those with identified risk factors. Understanding pain is a key skill and will put the person in a good position to recover whilst they are administered the right pain medications.
The early days set the scene for the coming rehabilitation. Simple breathing and mindful exercises, movements, motor imagery and pain relief all have a role to play. Monitoring how the person is feeling and gauging their belief in their own ability to recover provides insight and opportunities to motivate, encourage and guide compassionately.
Simple, low cost interventions such as these are very likely to make a difference. We can identify the needs of the individual, address any areas of concern before and after the joint replacement and then closely observe the recovery and rehabilitation plan.
Pain Coach Programme ~ preoperative assessment and practices | t. 07518 445493 or contact us using the form below
Common terms used include total joint replacement, total hip replacement, total knee replacement and total joint arthroplasty