Pre-existing or chronic pain is an established risk factor for severe post-operative pain. In this prospective observational cohort-study, we investigate whether a history of chronic pain, beyond the presence of hip-related pain, affects other post-operative factors including early mobilization, function, and psychological distress following hip surgery.
Patients undergoing total hip replacement surgery were observed from the pre-operative day until the seventh post-operative day. Prior to surgery, they were characterized by their pain history, pain intensity, function and psychological characteristics. Post-operatively, pain intensity was evaluated on day 1, 3, 5 and 7 and the analgesic consumption was recorded for each of these days. Measures of function (functional questionnaire, ability to mobilize and to climb stairs and range of hip motion) and psychological distress were re-evaluated on day 7. A history of chronic pain was associated with slower postoperative mobilization, poorer physical function and higher psychological distress in addition to increased post-operative pain intensity. The co-morbidity of a chronic pain disorder results in higher pain intensity post-surgery, and also impedes postoperative rehabilitation. Identifying patients with a chronic pain disorder is necessary pre-operatively so that appropriate pain management and rehabilitation can be planned to facilitate recovery.
Chronic pain, beyond the presence of hip-related pain, is associated with slower postoperative mobilization, poorer physical function and higher psychological distress following total hip replacement surgery. Identifying patients with chronic pain and establishing multiprofessional perioperative management might improve postoperative rehabilitation of patients with chronic pain.