High prevalence of persistent pain 6 months after arthroscopic subacromial decompression and/or acromioclavicular joint resection

Brix, Lone Dragnes; Thillemann, Theis Muncholm; Bjørnholdt, Karen Toftdahl; Nikolajsen, Lone

doi:10.1051/sicotj/2019021

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…Dragoo et al, 37 Levine et al 38 and Daluga and Dobozi 39 all found good outcomes including whether a direct or bursal approach was used. Brix et al 40 found persistent pain at 6 months after the operation in approximately one-third of participants, with associations to compensation cases and a propensity to anxiety amongst those suffering ongoing symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies also commented that participants who fared badly from surgery were worker compensation cases or those with predisposition to altered pain experience. Brix 40 with 6 months follow-up, found that 36% of participants had persistent pain with significant associations of unemployment, insurance/compensation and anxiety traits to a worse outcome. A number of other studies 41,44,45 found that work-related injury participants had a significantly decreased functional score post-surgery or worse outcomes.…”

Section: Rcrmentioning

confidence: 99%

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A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

et al. 2023

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Background This systematic review aims to comprehensively summarise and present the available evidence for the treatment of primary acromioclavicular joint (ACJ) osteoarthritis (OA). Methods Five databases were searched for studies investigating the management of ACJ OA. Included were studies with participants with clinical/radiological signs of primary ACJ OA, an intervention and included a functional outcome measure. Results Forty-eight studies were included. Treatments consisted of physiotherapy (n = 1 study), medical only (n = 11) and operative management (n = 36). Operative studies included five comparative trials – physiotherapy versus surgery (n = 1) and open versus arthroscopic resection (n = 4). A total of 1902 shoulders were treated for ACJ OA, mean age (51 years), 58% male and mean follow-up (28.5 months). Treatment with injection showed a mean improvement of 50% in pain levels at follow-up (mean = 7.5 months). The commonest surgical procedure was arthroscopic excision of the distal clavicle and operative studies averaged 6 months of conservative management and a mean functional outcome of 87.8%. Conclusion Studies varied in indication, intervention and quality but it did not provide evidence that both non-operative and operative interventions are effective. There was no significant difference between open or arthroscopic distal clavicle excision (DCE). Participants having between 0.5 and 2 cm of clavicle excised had good outcomes and those requiring concomitant shoulder procedures had similarly good outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Rcrmentioning

confidence: 99%

A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

et al. 2023

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“…The International Association for the Study of Pain defines PPSP in the International Classification of Diseases 11 as a chronic pain that develops or increases in intensity after a surgical procedure. 60 Other causes of pain, including preexisting pain conditions, have to be excluded, 5,8 and a careful clinical examination is sometimes needed to assess if there is remaining pathology with persistent preexisting pain (Fig. 1E).…”

Section: Persistent Presurgical Painmentioning

confidence: 99%

Transition from acute to chronic pain: a misleading concept?

Finnerup

Nikolajsen

Rice

2022

Pain

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C hronic pain is a major health problem and the leading cause of years lived with disability. 57 In the absence of disease-modifying therapies and adequate symptomatic treatment, prevention is important. In recent years, there has been a focus on "transition of acute to chronic pain" or "pain chronification." It has been postulated that some forms of chronic pain might be regarded as a continuum of acute pain, possibly with a transition point or period where acute pain progresses into chronic pain, sometimes also referred to as the shift from physiological to pathological pain 14,45,55,67 (Fig. 1A). Such terminology implies that one mechanistic type of pain transforms into another pain, for example, that acute pain caused by tissue damage and inflammation changes into a neuropathic pain, which is unlikely or at least not proven. In the following, we challenge the concept of "transition" of pain. Transition of pain or development of pain?For many years, there has been a focus on the phenomena of central sensitization, spinal amplification, and altered descending pain modulation as underlying mechanisms of chronic pain. 6,23,24,34 In an editorial in PAIN from 1988, Patrick Wall speculated that acute and chronic pain after surgery could be prevented by treatments, for example, nerve blocks or opioids, that would block nerve discharges caused by injury or preexisting pain, thereby reducing central sensitization. 68 Although there is ample evidence from preclinical and clinical studies that excessive afferent discharges consequential to tissue injury evoke a peripheral and central sensitization resulting in sensory hypersensitivity, 12,16,70 it has never been proven in humans that central sensitization is sustained after the tissue has healed and the afferent input has ceased and that it drives chronic pain. 24 Similarly, studies addressing clinical signs of central sensitization before surgery show some evidence for a link to chronic pain only for total joint arthroplasty, and with conflicting results. 52,54 Nevertheless, the association between severe acute and persistent postsurgical

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“…More than 300,000 rotator cuff repairs were performed in the United States between 2007 and 2016 [ 7 ], with postsurgical costs reaching US $34,249 per patient [ 8 ]. Moreover, a significant proportion of patients will experience persistent postsurgical pain after surgery, with 1 study finding a rate of 35.6% (95% CI 26.1%-45.8%) in 101 patients who underwent arthroscopic subacromial decompression or acromioclavicular joint resection [ 9 ]. These observations contrast with evidence showing that exercise-based rehabilitation yields similar reductions in disability and pain outcomes compared to rotator cuff repair [ 10 , 11 ] and subacromial decompression [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial

Pak¹,

Janela²,

Freitas³

et al. 2023

J Med Internet Res

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Background Chronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. Objective The aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. Methods We conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. Results A total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (–1.8, 95% CI –13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. Conclusions This study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial Registration ClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528

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High prevalence of persistent pain 6 months after arthroscopic subacromial decompression and/or acromioclavicular joint resection

Cited by 5 publications

References 29 publications

A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

Transition from acute to chronic pain: a misleading concept?

Comparing Digital to Conventional Physical Therapy for Chronic Shoulder Pain: Randomized Controlled Trial

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