ABSTRACT
BACKGROUND: Psychological distress is presumed to be an important factor that can adversely impact the outcome of orthopaedic procedures. The Distress and Risk Assessment Method (DRAM) is an evaluation tool which assesses psychological distress in patients with low back pain. The purpose of this prospective study was to assess the influence of preoperative psychological distress, as determined by the DRAM score, on the functional outcomes of total joint arthroplasty (TJA). MATERIALS AND METHODS: A prospective study of 61 TJAs was performed at a single institution. The DRAM questionnaire and a variety of functional measures (12-Item Short Form Health Survey [SF-12], visual analogue scale [VAS], Oxford Hip Score [OHS], Oxford Knee Score [OKS], and Oswestry Disability Questionnaire [ODQ]) were administered to the patient at baseline, 1 month, and 6 months postoperatively. Mixed model regressions and Mann-Whitney tests were utilised to evaluate the relationship of the DRAM score with functional outcomes. RESULTS: The summed quantitative DRAM score was predictive of functional outcomes. With each 1 point increase in psychological distress, VAS pain increased by 0.023 (p = 0.015), OKS decreased by 0.34 (p = 0.01), ODQ increased by 0.065 (p = 0.02), and MCS decreased by 0.14 (p = 0.015). In addition, patients with lower preoperative distress scores had higher rates of improvement than patients with higher preoperative distress scores for VAS pain (p = 0.034). DISCUSSION: Psychological distress was associated with decreased baseline mental health and function in the early postoperative period, which has important implications for bundled payments. However, patients with psychological distress still demonstrated functional improvements and TJA should thus not be contraindicated in these patients.
Subject(s)
Arthroplasty, Replacement, Hip/psychology , Arthroplasty, Replacement, Knee/psychology , Joint Diseases/surgery , Mental Health , Range of Motion, Articular/physiology , Risk Assessment/methods , Stress, Psychological/diagnosis , Humans , Joint Diseases/psychology , Prognosis , Prospective Studies , Stress, Psychological/etiology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Topical ketamine, an N-methyl-D-aspartate antagonist, has been shown to be effective in certain neuropathic pain syndromes. The objective of this study was to determine the efficacy of topical ketamine in spinal cord injury patients with neuropathic pain. An open label trial enrolled five subjects at an outpatient rehabilitation hospital with traumatic spinal cord injuries who had neuropathic pain at or below the level of injury. Subjects applied topical ketamine 10% three times a day for a two-week duration. Subjects recorded their numerical pain score-ranging from 0 to 10, with 0 representing "no pain, 5 representing "moderate pain," and 10 being described as "worst possible pain"-in a journal at the time of application of topical ketamine and one hour after application. Using a numerical pain scale allows for something as subjective as pain to be given an objective quantification. Subjects also recorded any occurrence of adverse events and level of satisfaction. All five subjects had a decrease in their numerical pain scale by the end of two weeks, ranging from 14% to 63%. The duration ranged from one hour in one subject to the next application in other subjects. There were no adverse effects. Overall, four out of the five subjects stated they were satisfied. Topical ketamine 10% is an effective neuropathic pain medicine in patients with spinal cord injuries; however, further studies need to be done with a placebo and larger sample size.
