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The Relationship Between Nonsurgical Pain and Interference With Activity in Patients Undergoing a Total Knee Arthroplasty

Wittig-Wells, Deborah R.; Higgins, Melinda K.; Shapiro, Susan E.; Samms-McPherson, Jacqueline; Winterboer, Donald Shane

doi: 10.1097/NOR.0000000000000113

BACKGROUND: Patients with nonsurgical pain (NSP) after a total knee arthroplasty (TKA) report different patterns of pain interference than those without NSP.

PURPOSE: This study explores the severity and ways in which NSP interferes with activities 48 hours and 6–7 weeks post surgery.

ANALYSIS: Univariate and multivariate analyses were used. The mean score for intensity at 48 hours was 1.78, and at 6–7 weeks it was 1.15. The mean score for interference with activities at 48 hours was 1.62 and at 6–7 weeks it was 0.91. Highest NSP pain interference at 48 hours was for “activity,” “sleep,” and “enjoyment of life.” At 6–7 weeks, the highest scores were for “activity,” “sleep,” and “walking.” No significant differences were noted for age, race, education, or gender.

IMPLICATIONS: Although rated “mild,” this pain should be addressed. The NSP indicates a baseline of chronic and persistent pain, which is an opportunity to work with our patients to mitigate this pain. Total knee arthroplasty, a common and effective treatment for painful knee conditions attributed to various forms of arthritis, is known to be a painful surgical procedure. Two of the major concerns voiced by patients awaiting TKA are about postoperative pain management and rehabilitation efforts after the procedure (J. Rudan, M. Harrison, & H. Grant, 2009). Healthcare providers offer a range of methods and strategies to deal with postoperative TKA pain, yet to date no single method offers complete satisfaction (H. Anderson, J. Gyrn, B. Christensen, & D. Zaric, 2013; H. B. J. Fischer et al., 2008; I. Koh et al., 2010; A. Maheshwari, Y. Blum, L. Shekhar, A. Ranawat, & C. Ranawat, 2009).

Deborah R. Wittig-Wells, PhD, MSN, NE-BC, Director, Nursing Research, Emory University Orthopaedics and Spine Hospital, Tucker, Georgia.

Melinda K. Higgins, PhD, Associate Professor, Emory University School of Nursing and Spine Hospital, Tucker, Georgia.

Susan E. Shapiro, PhD, RN, FAAN, Corporate Director for Research, Emory Healthcare and Spine Hospital, Tucker, Georgia.

Jacqueline Samms-McPherson, MSN/MHA, RN, Emory University Orthopaedics and Spine Hospital and Spine Hospital, Tucker, Georgia.

Donald Shane Winterboer, BSN, RN, Nursing, Emory University Orthopaedics and Spine Hospital and Spine Hospital, Tucker, Georgia.

The authors declare no conflicts of interest.

© 2015 National Association of Orthopaedic Nurses