Management of Refractory Pain After Total Joint Replacement

• Published in: Current pain and headache reports Vol. 25; no. 6; p. 42
• Main Authors: Willinger, Max L., Heimroth, Jamie, Sodhi, Nipun, Garbarino, Luke J., Gold, Peter A., Rasquinha, Vijay, Danoff, Jonathan R., Boraiah, Sreevathsa
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2021; Springer Nature B.V
• Subjects: Alternative Treatments for Pain Medicine (M Jones; Analgesics; Bone surgery; Internal Medicine; Joint surgery; Medicine; Medicine & Public Health; Mental depression; Narcotics; Nonsteroidal anti-inflammatory drugs; Orthopedics; Pain; Pain Medicine; Patient satisfaction; Section Editor; Topical Collection on Alternative Treatments for Pain Medicine; Genicular nerve radiofrequency ablation; Knee osteoarthritis; Total joint arthroplasty; Postoperative analgesia; Chronic pain; Refractory pain
• ISSN: 1531-3433; 1534-3081
• DOI: 10.1007/s11916-021-00956-1

Purpose of Review Chronic pain after total joint replacement (TJA), specifically total knee replacement (TKA), is becoming more of a burden on patients, physicians, and the healthcare system as the number of joint replacements performed increases year after year. The management of this type of pain is critical, and therefore, understanding the various modalities physicians can use to help patients with refractory pain after TJA is essential. Recent Findings The modalities by which chronic pain can be successfully managed include genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). Meta-analyses and case reports have demonstrated the effectiveness of these treatment options in improving pain and functional outcomes in patients with chronic pain after TKA. Summary The purpose of this paper is to review and synthesize the current literature investigating the different ways that refractory pain is managed after TJA, with the goal being to provide treatment recommendations for providers treating these patients.