Pre-existing or
chronic pain is an established risk factor for severe
postoperative pain. In this prospective observational cohort study, we investigated whether a history of
chronic pain, beyond the presence of hip-related
pain, affected other postoperative factors including
early mobilization, function, and psychological distress after hip surgery. Patients who underwent
total hip replacement surgery were observed from the preoperative day until the seventh postoperative day. Before surgery, they were characterized by their
pain history,
pain intensity, function, and psychological characteristics. Postoperatively,
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 greater psychological distress in addition to increased
postoperative pain intensity. The comorbidity of a
chronic pain disorder resulted in greater
pain intensity after surgery, and also impeded postoperative rehabilitation. Identification of patients with a
chronic pain disorder is necessary preoperatively so that appropriate
pain management and rehabilitation can be planned to facilitate recovery.
PERSPECTIVE:
Chronic pain, beyond the presence of hip-related
pain, is associated with slower postoperative mobilization, poorer physical function, and greater psychological distress after
total hip replacement surgery. Identification of patients with
chronic pain and establishment of multiprofessional perioperative management might improve postoperative rehabilitation of patients with
chronic pain.