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Contemporary Pain Management in Elderly Patients After Hip Fracture Surgery: Cross-sectional Analyses at Baseline of a Randomized Controlled Trial

Mak, Jenson C.S. MBBS, FRACP, FAFRM(RACP)*,†; Klein, Linda BSc, MSc, PhD; Mason, Rebecca S. MBBS, PhD§; Cameron, Ian D. MBBS, PhD(Med), FAFRM(RACP)

doi: 10.1097/AJP.0000000000000158
Original Articles

Background: Adequate pain management following hip fracture surgery reduces length of stay, reduces incidence of delirium, promotes recovery, and improves mobility. Previous research suggests that hip fracture pain is undertreated in some patient subgroups, and that hypovitaminosis D can further aggravate pain which could hinder active rehabilitation. We provide a cross-sectional analysis of the baseline characteristics of participants in the REVITAHIP study with the aim of documenting pain intensity and its associations after hip fracture and to explore the characteristics of people who report higher levels of pain.

Method: We analyzed the baseline characteristics with a focus on pain scores in patients admitted with a hip fracture (undergoing surgery) to 3 teaching hospitals over New South Wales, Australia, between January 2011 and April 2013. Patients were evaluated using the Verbal Rating Scale (VRS). Secondary measures including 25-hydroxyvitamin D levels at baseline, hip fracture subtype, type of surgical intervention, quality of life score, and cognitive and mobility status were correlated with the VRS using the Pearson correlation, ANOVA, and regression analysis.

Results: The 218 participants had a mean age of 83.9±7.2 years and 77.1% were women of whom 16.0% had a Mini Mental State Examination score of ≤23 of 30. The mean and SD VRS pain score was 3.5±2.3. More than half (61.9%, n=113) had VRS≥3 and 18.1% (n=52) had VRS≥5. Using the EuroQOL pain subscore, 78.1% had moderate pain or discomfort and 7.9% had extreme pain or discomfort. Using a multivariate regression model, postoperative VRS was significantly higher in persons with a higher comorbidity count, those previously living independently alone, and surgical fixative modality with hemiarthroplasty.

Conclusions: Overall, the levels of pain reported by this cohort are acceptable although approximately 10% to 15% had higher than reasonable levels of pain. This study provides an insight into pain assessment and management by identifying certain patient subtypes who are vulnerable to undertreatment of pain.

*Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales

John Walsh Centre for Rehabilitation Research

Office of Medical Education, Sydney Medical School

§Department of Physiology, School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia

Presented at the 20th IAGG World Congress of Gerontology and Geriatrics, June 2013, Seoul, Korea.

J.C.S.M. received financial support for the research through a scholarship from the Royal Australasian College of Physician (RACP) (Sydney, New South Wales, Australia), AFRM Research Establishment Scholarship, the RACP Foundation Arnott Research Foundation, and the Central Coast Area Health Research Advisory Committee (Gosford, New South Wales, Australia); from the Central Coast Area Health Service (University of Newcastle, Australia). The authors declare no conflict of interest.

Reprints: Jenson C.S. Mak, MBBS FRACP FAFRM(RACP), Department of Geriatric Medicine, Gosford Hospital, Holden St, Gosford, New South Wales, 2250, Australia.

Received May 16, 2014

Received in revised form October 6, 2014

Accepted August 31, 2014

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