Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery

Patient Guideline Summary

Publication Date: July 13, 2021
Last Updated: November 1, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the American Academy of Orthopaedic Surgeons (AAOS) for Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Management of pain after surgery or injury is a major concern since it retards healing, slows the return of function, and raises the risk of complications.
  • Pain is also closely tied to mental and social health.
  • The use of opioids/narcotics risks dependence and is therefore avoided or minimized whenever possible.
  • This patient summary focuses on pain relief with a minimum of adverse side effects.
    • The effects of treatment were evaluated for pain relief, improvement in function, and reduction in opioid use.
    • Some evaluations were based on comparison with “standard treatment” or between two similar treatments.

Treatment

Treatment

Your healthcare provider may prescribe one or more of these treatments:
  • Neuromuscular electrical stimulation: improves function but not pain.
  • Continuous regional anesthesia in total shoulder arthroplasty.
  • Cox-2 agents (celecoxib): to limit opioid use.
  • Acetaminophen
  • Intravenous ketamine in the first 24 hrs after hip and knee arthroplasty.
  • Massage
  • Music therapy
  • Patient education
  • Acupuncture including auricular (ear) acupuncture – may improve function but not pain.
  • Acupressure
  • Intra-articular opioid/NSAIDs injections
  • Acetaminophen/NSAID combination
  • Pregabalin: concern for dizziness and sedation

These treatments are no more effective than “standard treatment”:
  • Compression
  • Cold treatments
  • Earlier mobilization
  • Transcutaneous electrical nerve stimulation (TENS)
  • Cognitive behavioral therapy during total knee arthroplasty
  • Guided relaxation therapy
  • Virtual reality
  • Gabapentin
  • Oral relaxants given postoperatively
  • AAOS was unable to evaluate the effectiveness of duloxetine.

Comparisons
  • No difference in patient outcomes between local and regional anesthesia for patients undergoing total knee and hip arthroplasty.
  • No difference in patient outcomes between fentanyl patch and morphine.
  • No difference in pain intensity and opioid use between oral acetaminophen and intravenous acetaminophen.
  • No difference in patient outcomes between tramadol and NSAIDs.

Abbreviations

  • AAOS: American Academy Of Orthopedic Surgeons
  • TENS: Transcutaneous Electrical Nerve Stimulation

Source Citation

American Academy of Orthopaedic Surgeons Evidence- Based Clinical Practice Guideline for Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery https://www.aaos.org/painalleviationcpg Published 07/19/21

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.