A place for resilience in pain management

Author: Jessica Boh

Pain management is critical to orthopaedic practice because less pain is related to better patient reported outcomes and patient satisfaction. Movement away from opioid medication has led to adoption of multimodal and integrated pain management programs. A recent article by Zale, Wring and Vranceanu (2018) suggests that resilience skills training has a place in these programs.

Pain management is a critical element of orthopaedic practice. Post-operative pain control is necessary to quickly restore patient mobility, thus reducing costs related to longer hospital stay. Furthermore, research shows that pain levels are an important predictor of post-operative patient satisfaction (Trasolini, McKnight & Dorr, 2018). For these reasons, pain management strategies are frequently tested and reviewed in orthopaedic literature.

The most recent revision has occurred as a result of mounting evidence of the risks posed by opioid use in surgical settings. Use of opioid medication in total knee arthroplasty is recognised to be at the risk of significant adverse side effects (Gonzales, Lovald, Lau & Ong, 2018). Similarly, pre-operative opioid use has been related to increased risk of surgical complications (Trasolini et al., 2018).

Orthopaedic research highlights the benefits of multimodal and integrated pain management programs, which are cost effective and shown to improve patient outcomes (Trasolini et al., 2018). These programs use a range of methods to reduce pain, including nerve blocks, ice packs, non-opioid pain medication, physiotherapy and education. Notably, there is emphasis on physiological pain management methods. This is understandable as the orthopaedic field is focused on pathophysiology.

However, there is potential to further improve the effectiveness of pain management through adoption of psychosocial care. Psychological resilience (the ability to cope and bounce back from adversity) is a concept that has been gaining traction in healthcare literature over the past decades. A recent paper by Zale, Wring and Vranceanu (2018) brings resilience into the orthopaedic context. Zale and colleagues (2018) argue that resilience has a role in orthopaedic practice because it is associated with less reported pain.

Orthopaedic professionals are aware of the impact that psychosocial factors have on symptom intensity and clinical outcomes; thus, screening is conducted for risk factors such as depression. Zale and colleagues (2018) suggest that screening is of little use if it is not followed by intervention to mitigate the risk, such as resilience skills training. Ideally, resilience skills training would work by normalising the experience of pain after surgery and teaching patients how to use adaptive coping methods. Existing online resilience interventions prove that resilience skills training is easily scaleable and thus cost effective.

Orthopaedic research is just starting to investigate the impact of resilience on patient outcomes. Nonetheless, resilience skills training offers huge potential as a non-pharmacologic strategy to complement pain management programs. Now is the time to research ways to incorporate resilience into your orthopaedic practice and stay at the forefront of the field.

References:

1. Gonzales, J., Lovald, S. T., Lau, E. C., & Ong, K. L. (2018). Risk of Opioid-Related Adverse Events After Primary and Revision Total Knee Arthroplasty. Journal of Surgical Orthopaedic Advances, 27(2), 148–154.

2. Trasolini, N. A., McKnight, B. M., & Dorr, L. D. (2018). The Opioid Crisis and the Orthopedic Surgeon. The Journal of Arthroplasty. https://doi.org/10.1016/j.arth.2018.07.002

3. Zale, E. L., Ring, D., & Vranceanu, A.-M. (2018). The Future of Orthopaedic Care: Promoting Psychosocial Resiliency in Orthopaedic Surgical Practices. The Journal of Bone and Joint Surgery. American Volume, 100(13), e89.