Primary care consultations and pain medicine prescriptions: a comparison between patients with and without chronic pain after total knee replacement

Rafael Pinedo-Villanueva*, Spyros Kolovos, Christopher Maronga, Antonella Delmestri, Nicholas R Howells, Andrew Judge, Rachael Gooberman-Hill, Vikki Wylde

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

7 Citations (Scopus)
40 Downloads (Pure)

Abstract

Background
Approximately 20% of patients experience chronic pain after total knee replacement (TKR). The impact of chronic pain after TKR on primary care services in the UK is currently unknown. The aim of this study was to compare primary care consultations and pain medicine prescriptions between patients with and without chronic pain after TKR.

Methods
Data from 5,055 patients who received TKR between 2009 and 2016 with anonymised linked data from the Clinical Practice Research Datalink Gold (CPRD) and English Hospital Episode Statistics (HES) Patient Reported Outcome Measures (PROMs) programme were analysed. The exposure time was from 10 years pre-operative to eight years post-operative. Patients with a score ≤ 14 on the Oxford Knee Score pain component scale at 6 months post-operative were classified as having chronic pain after TKR. Primary care consultations and prescribed pain medicines were quantified, and costs calculated based on national cost data.

Results
721 patients (14%) had chronic pain after TKR. The prevalence and costs of primary care consultations and pain medicine prescriptions per year were consistently higher for patients with chronic pain after TKR compared with those without chronic pain after TKR; these differences were observed both before and after surgery. There was a substantial and sustained increase in the cost of opioid prescriptions after surgery for patients with chronic pain after TKR, peaking at seven years post-operative.

Conclusions
Increased primary care consultations and pain medicine prescriptions associated with chronic pain after TKR represent a considerable financial cost to primary care services. Evaluation of interventions to reduce the risk of developing this pain condition and improve the early management of pain after TKR are needed to improve outcomes for patients and reduce costs to healthcare services.
Original languageEnglish
Article number548
Number of pages9
JournalBMC Musculoskeletal Disorders
Volume23
Issue number1
DOIs
Publication statusPublished - 7 Jun 2022

Bibliographical note

Funding Information:
This study is funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research (Grant Reference Number RP-PG-0613-20001)]. This work was also supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (Grant Reference number: IS-BRC-1215-20011). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funder had no role in the study design, collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

Funding Information:
This publication is part of the ‘Support and Treatment After joint Replacement’ (STAR) Programme and as such it benefits from involvement of the whole STAR team.

Publisher Copyright:
© 2022, The Author(s).

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