Status Quo Of Postoperative Pain And Pain Self-management Behavior In Patients With Knee And Hip Arthroplasty

Background:Painless has become the basic rights of patients, which requires not only advanced analgesia technology and professional health care providers, but also be related to the patient’s own pain management ability. The new ideas of patient-centered put forward should provide personalized care and help patients to participate in health decisions.Objective:To explore the status quo of postoperative pain and pain self-management behavior in patients with total knee and hip arthroplasty(TKA/THA), and analyze the correlations between them.To explore patients’ attitude toward postoperative pain self-management and pain education.Methods:First part, A cross-sectional design was employed. 127 participants with TKA or THA were recruited using convenience sample from a third-grade A-level hospitals of Anhui Province. Basic information were collected at admission;And 24h、48h、72h after surgery, patients were asked to rate their pain intensity in four items within the past 24 h using Brief Pain Inventory(BPI) : the current pain, the worst pain, the lightest pain and the average pain; Three days after surgery, Postoperative Pain Self-management Behavior(PPSMB) Questionnaire was used to investigate via face to face interview,then analyze the correlation between pain intensity and pain self-management behavior.Second part, based on the Q-methodological approach, purposive sampling was used to recruit 15 participants with TKA or THA from the same hospital. 49 statements were rank-ordered to the 11 levels(-5 to +5) Q-sort table, and through interviews to understand the reasons of the sort prior to discharge.Results:First postoperative day, the proportion of the currently pain, the worst pain, the lightest pain and average pain which reached moderate or above was 74.80%, 100%,19.69% and 91.34% respectively. Second postoperative day was 22.05%, 99.21%,3.15% and 57.48% respectively. Third postoperative day was 5.51%, 79.53%, 0 and9.45% respectively. The total score of postoperative pain self-management behavior was lower. Rank sum test showed that the score of postoperative pain self-management behaviors have statistic different in gender, place of residence and education level(P<0.05; P<0.01). There is a negative correlation between pain intensity and pain self-management behavior(P<0.01).3 types of attitude were identified about patients treated with postoperative pain self-management: Traditionalists, Supporters, and Worriers. Traditionalists who held negative attitudes due to the existence of cognitive errors in pain and analgesic drugs;Supporters who had a good faith in pain control and support patients participantion in postoperative pain self-management; Worriers had good faith in pain relief, but exsited anxiety in the use of analgesic drugs and hesitate to paticipate in pain management. Of the 15 completed Q sorts, 13 loaded on the three factors and they were 7 cases, 4 cases and 2 cases respectively. Studies showed that a considerable number of patients with pain self-management behavior is not positive, there are certain problems.in the knowledge and attitude of analgesia.Conclusion:Pain control and pain self-management ability in patients with TKA or THA was poor, most patients hold negative attitude about pain self-management. Health care workers should be patient-centered, help patients recognize their own important role in pain management, promote patients’ active engagement in their own health management,constantly improve the patient’s pain self-management ability, so as to reach the outcome of effectively pain control and the improvement in quality of life.