Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietyJuly 2024
Pain education sessions, with or without physical therapy, resulted in clinically meaningful improvement in one-third of patients.
A nontrivial minority of patients still have chronic knee pain after undergoing total knee arthroplasty; many of these patients are likely to consult their primary care physicians for advice. In this Danish randomised study, researchers explored the value of a structured neuromuscular exercise program in 69 adults (median age, 67 years) who underwent total knee arthroplasty at least one year previously (median, three years) and who were still experiencing moderate-to-severe pain. Patients with implant failure or major surgical complications were excluded. Intervention patients received a supervised 12week neuromuscular exercise program (twice weekly, 24 sessions total) plus two one-hour educational sessions on pain neuroscience that focused on pain conceptualisation and maladaptive pain responses. Control patients received the two educational sessions only.
Adherence to the protocol was about 70% overall. At 12 months of follow up, the two groups reported similar overall pain, with improvement from baseline of about 8 points on a 100-point scale. About onethird of each group experienced clinically meaningful improvement of at least 10 points.
Comment: Patients with chronic persistent knee pain after total knee arthroplasty understandably are disappointed and frustrated. The takehome point here is that at even one year or longer after total knee arthroplasty surgery, pain neuro science education, structured physical therapy or both can lead to meaningful improvements in chronic pain.
Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.
Larsen JB, et al. Exercise and pain neuro- science education for patients with chronic pain after total knee arthroplasty:a randomized clinical trial. JAMA Netw Open 2024; 7: e2412179.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.