DOS Kongressen 2014 ·
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Persistent pain after shoulder replacement:
A nationwide questionnaire study.
Karen Toftdahl Bjørnholdt, Birgitte Brandsborg, Kjeld Søballe, Lone Nikolajsen
Department of Orthopaedic Surgery, Horsens Hospital; Department of
Anaesthesiology, Aarhus University Hospital; Danish Pain Research Center/
Department of Anaesthesiology, Aarhus University Hospital
Background:
Persistent postsurgical pain is a well- recognized problem after
various types of surgery such as amputation, thoracotomy and inguinal hernia
repair. The prevalence of persistent pain, and to which degree it involves neuro-
pathic pain, is highly dependent on the type of surgery. Persistent pain following
shoulder replacement has not previously been investigated.
Purpose / Aim of Study:
This study aimed to investigate the prevalence, char-
acteristics and risk factors of persistent pain 1-2 years after shoulder replace-
ment surgery performed in Denmark.
Materials and Methods:
A questionnaire was sent to patients who had un-
dergone primary shoulder replacement between April 2011 and April 2012,
and whose operations had been reported to the Danish Shoulder Arthroplasty
Register. Patients who had undergone reoperation or bilateral replacements
were excluded. The outcome of persistent pain was defined as pain experienced
daily or constantly within the last month at a level that interfered much or very
much with daily activities. A multivariate logistic regression model was used to
assess risk factors.
Findings / Results:
538 patients were available for analysis. The prevalence of
persistent pain was 22% (CI 18-25%), and the prevalence of neuropathic pain
was 13% (CI 10-16%). Risk factors were pain intensity the first postopera-
tive week, pain elsewhere, diagnosis of fracture, and previous osteosynthesis,
but not age or sex. Also, prosthesis type and supplemental cuff reconstruction
seemed to influence the risk of persistent pain, but these findings may have
various explanations.
Conclusions:
Persistent pain occurs in a considerable amount of patients after
shoulder replacement, and this study emphasizes the need to intensify early
postoperative pain management and to further study patients at risk, so pos-
sible causes can be identified and treatment can be engaged.
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