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Postoperative Pain Management Among Dominican and American Health-Care Providers

A Qualitative Analysis

Devine, Christopher A. MPhil1,2; Yu, Amy BS1,2; Kasdin, Rachel G.1; Bogart, Laura M. PhD2,3; Davis, Aileen M. PhD4; Alcántara Abreu, Luis MD5; Ghazinouri, Roya DPT, MS1; Thornhill, Thomas S. MD1,2; Katz, Jeffrey N. MD, MSc1,2,6,a

doi: 10.2106/JBJS.15.01004
The Orthopaedic Forum

Background: U.S. practitioners have prescribed opioid analgesics increasingly in recent years, contributing to what has been declared an opioid epidemic by the U.S. Centers for Disease Control and Prevention (CDC). Opioids are used frequently in the preoperative and postoperative periods for patients undergoing total joint replacement in developed countries, but cross-cultural comparisons of this practice are limited. An international medical mission such as Operation Walk Boston, which provides total joint replacement to financially vulnerable patients in the Dominican Republic, offers a unique opportunity to compare postoperative pain management approaches in a developed nation and a developing nation.

Methods: We interviewed American and Dominican surgeons and nurses (n = 22) during Operation Walk Boston 2015. We used a moderator’s guide with open-ended questions to inquire about postoperative pain management and factors influencing prescribing practices. Interviews were recorded and transcripts were analyzed using content analysis.

Results: Providers highlighted differences in the patient-provider relationship, pain medication prescribing variability, and access to medications. Dominican surgeons emphasized adherence to standardized pain protocols and employed a paternalistic model of care, and American surgeons reported prescribing variability and described shared decision-making with patients. Dominican providers described limited availability of potent opioid preparations in the Dominican Republic, in contrast to American providers, who discussed opioid accessibility in the United States.

Conclusions: Our findings suggest that cross-cultural comparisons provide insight into how opioid prescribing practices, approaches to the patient-provider relationship, and medication access inform distinct pain management strategies in American and Dominican surgical settings. Integrating lessons from cross-cultural pain management studies may yield more effective pain management strategies for surgical procedures performed in the United States and abroad.

1Orthopedic and Arthritis Center for Outcomes Research (C.A.D, A.Y., R.G.K., R.G., T.S.T., and J.N.K.), Department of Orthopedic Surgery (T.S.T. and J.N.K.), and Division of Rheumatology, Immunology, and Allergy (J.N.K.), Brigham and Women’s Hospital, Boston, Massachusetts

2Harvard Medical School, Boston, Massachusetts

3Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts

4Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada

5Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic

6Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

aE-mail address for J.N. Katz:

Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated
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