Willemen Jasmijn E, van Kruining-Kodele Sanda, Vossen Catherine J, Lousberg Richel, van Amelsvoort Therese A M J, Balthasar Andrea J R
School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
Section Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Universiteit Maastricht, 6229 ER Maastricht, The Netherlands.
J Clin Med. 2025 May 16;14(10):3506. doi: 10.3390/jcm14103506.
: The inadequate management of postsurgical pain represents a major clinical issue, often leading to suboptimal outcomes in the immediate postoperative period and an increased risk of developing chronic postsurgical pain. The present study aimed to examine the relationship between postsurgical pain, mood, and the use of prescribed analgesics after total knee arthroplasty (TKA). : This prospective observational explorative study enrolled 28 patients scheduled for TKA between February 2018 and March 2019. Using a digital experience sampling method (ESM) tool that included questions on pain, analgesic use, and both positive and negative effects, patients reported their current status up to ten times daily. The questions were administered over five days following postoperative discharge. Data analysis was performed using descriptive statistics and multilevel regression, accounting for the hierarchical structure of the data. : On 85.5% of the days post-discharge, the patients did not adhere to the prescribed acetaminophen regimen. Multilevel analyses revealed that the groups who overused or underused acetaminophen reported significantly heightened levels of pain. NSAIDs were generally underused. Post-discharge opioid use decreased over time, with no evidence of abuse. Overall, the non-adherent group reported lower mood levels and higher pain scores than the adherent group. : Most patients did not adhere to the prescribed analgesics despite experiencing pain. Therefore, clinical interventions should prioritize identifying patient subtypes to tailor analgesic use effectively. This approach will facilitate the development and improvement of personalized acute postsurgical pain treatment protocols, ensuring more precise and effective pain management strategies for patients.
术后疼痛管理不当是一个重大的临床问题，常常导致术后短期内结果不理想，并增加发生慢性术后疼痛的风险。本研究旨在探讨全膝关节置换术（TKA）后术后疼痛、情绪与处方镇痛药使用之间的关系。
这项前瞻性观察性探索性研究纳入了2018年2月至2019年3月期间计划进行TKA的28例患者。使用一种数字经验抽样方法（ESM）工具，其中包括有关疼痛、镇痛药使用以及正负效应的问题，患者每天报告其当前状态多达十次。这些问题在术后出院后的五天内进行询问。使用描述性统计和多水平回归进行数据分析，同时考虑到数据的层次结构。
出院后85.5%的日子里，患者未遵守规定的对乙酰氨基酚用药方案。多水平分析显示，对乙酰氨基酚使用过量或不足的组报告的疼痛水平明显更高。非甾体抗炎药（NSAIDs）普遍使用不足。出院后阿片类药物的使用随时间减少，没有滥用的迹象。总体而言，不依从组的情绪水平低于依从组，疼痛评分高于依从组。
尽管大多数患者经历疼痛，但他们并未遵守规定的镇痛药使用方案。因此，临床干预应优先识别患者亚型，以有效调整镇痛药的使用。这种方法将有助于制定和改进个性化的急性术后疼痛治疗方案，确保为患者提供更精确有效的疼痛管理策略。
