ROSEMONT, IL--(Marketwire - January 29, 2009) - In a first-of-its-kind study published in the
November 2008 Foot & Ankle International, the official journal of the
American Orthopaedic Foot & Ankle Society
(AOFAS), the expectation of orthopaedic post-operative pain was directly
correlated with the actual incidence of pain following
foot and ankle surgery. The lead author,
AOFAS member Loretta B. Chou, MD, is an orthopaedic foot and ankle surgeon
in the Department of Orthopaedic Surgery, Stanford University Medical
Center, Stanford, CA, so she is very familiar with the pain complaints of
orthopaedic patients.
Orthopaedic procedures have been reported to have the highest incidence of
pain compared to other types of operations. Dr. Chou and associates
conducted a prospective study of 98 patients undergoing orthopaedic foot
and ankle operations at the same hospital. The goal of the study was to
evaluate each patient's pain experience both preoperatively and
postoperatively. Surgeries were a mixture of inpatient and outpatient
procedures, on both male and female patients, with the average age being
46.5 years. The patients were given a Short-Form McGill Pain Questionnaire
(SF-MPQ) before and after surgery to evaluate their levels of pain at both
times. The SF-MPQ is a patient questionnaire with three questions
concerning pain. It consists of 15 pain descriptors, the Present Pain
Intensity (PPI) index, and a visual analogue scale for pain (VAS). Their
study suggests that the expectation of pain going into surgery may
contribute to its subsequent occurrence.
"Our hypothesis that anticipated pain would predict postoperative pain
experience was based on preliminary studies that show that expectation of
pain modulates changes in the brain," said Dr. Chou. "This may be the brain
sending projections to the spinal cord that increases pain signals. To make
a long story short, we found that believing there will be pain after
surgery leads to just that, pain."
Results showed that pain severity was highest following foot and ankle
surgery at the 3-Day Post-Operative Pain assessment whereas, six weeks out
after surgery, the majority of patients felt little or no pain. This early
pain was even greater than that anticipated by the patients. The severity
of preoperative pain was highly predictive of the group's anticipated
postoperative pain as well as their level of pain at 6-weeks after
surgery. It was also important that both preoperative pain and anticipated
pain predicted higher immediate postoperative pain following foot and ankle
operations.
A similar study, which was published in the July 2008 issue of the Journal
of Pain and Symptom Management, found that cancer patients who had a more
optimistic outlook experienced less severe pain.
"While we cannot isolate the exact cause, optimistic patients suffered much
less postoperative pain than their pessimistic counterparts," continued Dr.
Chou. "This result may demonstrate that patients are good at predicting
pain, or that their expectation of greater pain may contribute to its
subsequent occurrence."
This is the first study evaluating preoperative and postoperative pain
experienced by patients undergoing orthopaedic foot and ankle surgery. This
study may help surgeon's choice of treatment of acute pain following
surgery to prevent increased illness associated with poorly-controlled pain
after orthopaedic foot and ankle operations.
"Future studies have already commenced. These will address some of the
limitations of the initial study, such as inclusion of the use of pain
medication and limiting the types of operations to two. A criticism of this
publication is that all types of foot and ankle procedures were included.
In the follow up studies, one study focuses on ankle fractures and the
other, removal of painful hardware from the foot and ankle," said Dr. Chou.
Dr. Chou is a member of the American Orthopaedic Foot & Ankle Society.
Members of the American Orthopaedic Foot & Ankle Society are orthopaedic
surgeons (MD or DO) who have extensive training in the diagnosis,
non-surgical care and surgical treatment of the musculoskeletal system,
including bones, joints, ligaments, tendons, muscles, and nerves with a
special interest in the foot and ankle.
About AOFAS
The AOFAS promotes quality, ethical and cost-effective patient care through
education, research and training of orthopaedic surgeons and other health
care providers. It creates public awareness for the prevention and
treatment of foot and ankle disorders, provides leadership, and serves as a
resource for government, industry and the national and international health
care community.
To find an AOFAS orthopaedic foot and ankle surgeon in your area, go to
www.aofas.org.
About Orthopaedic Foot and Ankle Surgeons
Orthopaedic foot and ankle surgeons are medical doctors (MD and DO) who
specialize in the diagnosis, care, and treatment of patients with disorders
of the musculoskeletal system of the foot and ankle. This includes the
bones, joints, ligaments, muscles, tendons, nerves, and skin. Orthopaedic
foot and ankle surgeons use medical, physical, and rehabilitative methods
as well as surgery to treat patients of all ages. They perform
reconstructive procedures, treat sports injuries, and manage and treat
trauma of the foot and ankle.
Orthopaedic foot and ankle surgeons work with physicians of many other
specialties, including internal medicine, pediatrics, vascular surgery,
endocrinology, radiology, anesthesiology, and others. Medical school
curriculum and post-graduate training provides the solid clinical
background necessary to recognize medical problems, admit patients to a
hospital when necessary, and contribute significantly to the coordination
of care appropriate for each patient.
Education
AOFAS members have the following credentials:
-- Completed four years of medical school. The curriculum covers basic
and clinical sciences, surgery, internal medicine, pediatrics, family
medicine and all other medical specialties.
-- Completed five years of accredited graduate medical education
(residency training) in orthopaedic surgery.
-- Many orthopaedic foot and ankle surgeons also complete advanced
fellowship training in foot and ankle surgery.
-- Satisfactory completion of the national medical licensing examination.
-- Continuing medical education credits over a specific time period.
-- Board certification: Certified by or eligible for examination and
certification by the American Board of Orthopaedic Surgery or the American
Osteopathic Board of Orthopedic Surgery.
-- Each member must hold membership in the American Academy of
Orthopaedic Surgeons (AAOS).
When selecting a medical provider to care for your feet and ankles, be sure
to ask him/her about:
-- Medical school education
-- Accredited residency training
-- Areas of practice specialization
-- Experience in your prescribed treatment (surgical and/or non-surgical)
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Contact Information: CONTACT
Judy Datz
Communications Manager
847-384-4379