Open AccessSuccessful Management of Chronic Postsurgical Pain Following Total Knee Replacement
Author(s) -
Vas Lakshmi,
Khandagale Nishigandha,
Pai Renuka
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12508
Subject(s) - medicine , neuropathic pain , dry needling , visual analogue scale , physical therapy , rating scale , chronic pain , anesthesia , knee replacement , pain relief , surgery , orthopedic surgery , acupuncture , psychology , developmental psychology , alternative medicine , pathology
We report reversal of chronic postsurgical pain ( CPSP ) along with functional restoration after total knee replacement ( TKR ) in two patients, using a combination therapy that included ultrasonography‐guided pulsed radiofrequency ( PRF ) of nerves supplying the knee to provide pain relief, along with dry needling ( DN ) to relax myofascial triggers/bands that caused painful stiffness and restricted movement of muscles acting across the knee. Both patients showed demonstrable pain relief, as evidenced by changes in pain as assessed on the Numeric Rating Scale (patient 1: 4–9/10 [pre‐treatment] to 0–3/10 [6 months post‐treatment]; patient 2: 5–9/10 to 0–4/10), O xford Knee Score (patient 1: 17 to 40; patient 2: 12 to 39), Self‐Administered Leeds Assessment of Neuropathic Symptoms and Signs score (patient 1: 16 to 0; patient 2: 18 to 0), and Patient Health Questionnaire‐9 score (patient 1: 17 to 2; patient 2: 20 to 2). The selection of the PRF ‐and‐ DN combination for treating post‐ TKR CPSP was based on a new idea that CPSP is a neuromyopathic phenomenon involving both sensory and motor neuropathy. It has evolved from our experience of 8 years. Physiotherapy worked synergistically with DN , optimizing muscle performance and pain relief.