Abstract
BackgroundAlthough many people are satisfied with their outcome after total knee replacement surgery for osteoarthritis, around 20% report chronic post‐surgical pain. People are often disappointed and unsure about whether their pain is normal and what can be done about it. Given the high prevalence of long‐term post‐operative pain after knee replacement, there is potentially a large hidden population with an unaddressed need for care.ObjectiveIn this study, we focus on understanding why some people choose not to consult health care for chronic post‐surgical pain after knee replacement.MethodsSemi‐structured interviews were conducted with people who had received total knee replacement, at either of two National Health Service hospitals in the United Kingdom, and who had chronic post‐surgical pain (n = 34, age 55‐93 years). Data were audio‐recorded, transcribed and analysed thematically.ResultsWe found an overall sense of futility amongst participants who believed that nothing further could be done for their on‐going pain. People's perception of their pain was often discordant with that of surgeons and physicians. Other factors that contributed to decisions not to seek help included low expectations about effectiveness and the risks involved in further treatment, treatment burden, participants' prioritization of other health conditions and views about candidacy. Many accepted their on‐going pain.ConclusionOur study indicates why some people with chronic pain after knee replacement do not seek further health care. Understanding patients' beliefs and expectations about chronic post‐surgical pain can inform approaches that might enable people to seek help in the future.
Highlights
Osteoarthritis is a long-term condition that is associated with joint pain, swelling and stiffness that can lead to loss of function.[1]
Our findings suggest that health care professionals' responses to patients' disclosure of pain can powerfully affect patients' beliefs about whether they have a legitimate reason to consult for on-going pain
We recommend that all patients should be informed about the possibility that there may be some persistent pain post-operatively, and that while some pain in the early post-operative period is normal, patients should re-consult if pain persists
Summary
Osteoarthritis is a long-term condition that is associated with joint pain, swelling and stiffness that can lead to loss of function.[1] Ten per cent of UK adults consult primary care for osteoarthritis every year.[2] UK guidelines for the management of osteoarthritis recommend non-surgical treatments in the first instance (information, education, exercise, physiotherapy, weight-loss, medication). Other factors that contributed to decisions not to seek help included low expectations about effectiveness and the risks involved in further treatment, treatment burden, participants' prioritization of other health conditions and views about candidacy Understanding patients' beliefs and expectations about chronic post-surgical pain can inform approaches that might enable people to seek help in the future
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