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Patient Comprehension and Compliance Survey to Assess Postoperative Pain Regimens in the Orthopaedic Trauma Population

Gangavalli, Anup K. MD*; Malige, Ajith BS; Rehman, Saqib MD; Nwachuku, Chinenye O. MD*

doi: 10.1097/BOT.0000000000000822
Current Opinions and Surveys

Objective: This study aims to determine the groups of patients who are at risk for noncompliance and misunderstanding of their pain regimen.

Design: Survey-based cohort study.

Setting: Suburban Level-I trauma center.

Patients/Participants: A total of 171 patients between the ages of 18–89 years who underwent surgical fixation of fractures involving the pelvis, long bones, or periarticular regions of the knee, ankle, elbow, and wrist.

Main Outcome Measurements: Patients who cannot accurately reproduce their prescribed pain medication list and patients who modify this pain medication regimen were analyzed by age, employment status, income level, education level, time between surgery and follow-up, and whether pain interfered with activities of daily living.

Results: Overall, 147 patients completed the survey. Seventy percent (n = 114) of patients could not accurately reproduce their pain medication regimen, regardless of age, employment status, income level, education level, time between surgery and follow-up, and whether pain interfered with activities of daily living. Patients (61.2%; n = 90), regardless of the 6 aforementioned demographic factors, also admitted to modifying their pain medication regimen with non-prescribed medications, with 55.8% (n = 82) of patients adding over-the-counter medications to surgeon-prescribed narcotic medications.

Conclusions: Misunderstanding and noncompliance of surgeon-prescribed pain regimens are prevalent across all patient demographics. Knowledge of the potential effects these augmentative medications can have on fracture healing and any drug-drug interactions that may arise is an important aspect of patient postoperative care. Surgeons must be wary of these trends and screen for any unintended side effects a patient's pain regimen may have.

Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*St. Luke's University Health Network, Bethlehem, PA;

Temple University/St. Luke's University School of Medicine, Bethlehem, PA; and

Temple University Hospital, Philadelphia, PA.

Reprints: Ajith Malige, BS, Department of Orthopaedic Surgery, St. Luke's University, 801 Ostrum St, Bethlehem, PA 18015 (e-mail:

A. K. Gangavalli and A. Malige are co-first authors.

The authors report no conflict of interest.

This manuscript will be presented at the Pennsylvania Orthopaedic Society Spring 2017 Meeting. IRB Approval: IRB approval was obtained both from the St. Luke's University Health Network IRB Committee and the Temple University School of Medicine IRB Committee.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted February 10, 2017

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