Factors Predicting Frequency and Severity of Postoperative Pain After Arthroscopic Rotator Cuff Repair Surgery

Abstract

Background: Postoperative pain after arthroscopic rotator cuff repair (RCR) is difficult to predict and manage. The experience of pain is thought to be influenced by a range of different factors. Determining which patient factors contribute to the pain may help us to better understand and manage it. Purpose: To evaluate the preoperative patient characteristics that may be predictive of, and correlated with, postoperative pain after arthroscopic RCR. Study Design: Cohort study; Level of evidence, 3. Methods: The study evaluated 2172 patients who underwent an arthroscopic RCR between February 2004 and December 2015. Pain frequency and severity were measured preoperatively and at 6 weeks after surgery using a modified L’Insalata questionnaire with Likert scales. This 6-week time point was chosen as previous studies have shown patients rank this time point as high in terms of pain after RCR. Logistic regression analysis was conducted to examine the relationship between postoperative pain scores and preoperative pain scores, age, sex, tear size, strength, level of sporting and work activity, and work-related injury status. Results: The severity of preoperative pain at night ( r = 0.33; P < .001), preoperative pain at rest ( r = 0.32; P < .001), and frequency of extreme pain ( r = 0.31; P < .001) were the strongest independent associations with the frequency of pain at 6 weeks postoperatively. Other associations with postoperative pain frequency included reduced liftoff strength ( r = −0.21; P < .001), work-related injury status ( P < .001), younger age ( P = .001), and female sex ( P = .04). Tear size was inversely related with pain severity ( R2 = 0.85). The severity of preoperative pain had the strongest independent association with the severity of postoperative pain at 6 weeks after surgery ( r = 0.35; P < .001). Other associations with postoperative pain severity included increased patient-ranked preoperative stiffness ( P < .001), a poorer impression of one’s shoulder ( P < .001), reduced level of sporting activity ( P <.001), and work-related injury status ( P < .001). Conclusion: Multiple risk factors have been identified for postoperative pain after RCR, the strongest of which is preoperative pain. However, of note, the magnitude of the correlations between preoperative severity and frequency of pain and postoperative severity and frequency of pain were found to be weak to moderate ( r = 0.30-0.35). This suggests that while preoperative pain and its severity are associated with postoperative pain, other factors are likely involved in predicting pain. Smaller tear size, younger age, female sex, and work-related injuries were also associated with postoperative pain at 6 weeks after surgery.

Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair

“…Recent literature has shown that preoperative pain is a strong predictor for postoperative pain following RCR. 20 This study also suggested that alongside the association of severity and frequency of preoperative pain with postoperative pain, other factors such as smaller tear size, young age, female sex, and worker’s compensation status were associated with 6-week postoperative pain after RCR. 20 Leroux et al.…”

“… 20 This study also suggested that alongside the association of severity and frequency of preoperative pain with postoperative pain, other factors such as smaller tear size, young age, female sex, and worker’s compensation status were associated with 6-week postoperative pain after RCR. 20 Leroux et al. 21 reviewed 79,287 patients who underwent elective shoulder surgery and found that history of alcohol abuse, depression, or anxiety and female sex all had the most significant influence on risk of developing long-term opioid use.…”

Female and Younger Orthopaedic Sport Medicine Patients Are More Negatively Affected by COVID-19–Related Health Care Closures

“…Although older individuals are at increased risk of degenerative conditions, such as arthritis and rotator cuff disease, younger patients report increased pain following rotator cuff repair surgery. 6 Younger age is also a significant risk factor for graft failure following anterior cruciate ligament (ACL) reconstruction. 7 Although further research is needed to better explain the reason for these differences, it is clear that sex and age are important determinants of the burden of musculoskeletal (MSK) disease, as well as the response to treatment.…”

Evaluation of Analgesic Efficacy and Opioid-sparing Effect of Duloxetine After Arthroscopic Rotator Cuff Repair

“…Arthroscopic rotator cuff repair is becoming the main surgical method. Despite being characterized as a “minimally invasive” procedure, arthroscopic rotator cuff repair is associated with significant postoperative pain in the acute perioperative period 2. Opioids are commonly used for postoperative pain reduction; however, their use is associated with adverse effects (AEs) and should be limited 3.…”

“…Despite being characterized as a "minimally invasive" procedure, arthroscopic rotator cuff repair is associated with significant postoperative pain in the acute perioperative period. 2 Opioids are commonly used for postoperative pain reduction; however, their use is associated with adverse effects (AEs) and should be limited. 3 Therefore, multimodal analgesia has been introduced to reduce postoperative pain and side effects during the use of postoperative opioids.…”