Search

We conducted this study to determine the short-term treatment outcomes of multidisciplinary approaches to chronic pain management for outpatients in Japan. We evaluated pain reduction and improvement in quality of life (QOL) after treatment. We analyzed 32 patients who had experienced intractable chronic pain for > 3 months. The patients received multidisciplinary therapeutic self-managed exercise instructions and then underwent evaluations 1 and 3 months after the treatment. We used the Pain Disability Short Form-36 (SF-36), Pain Catastrophizing Scale (PCS), and Pain Disability Assessment Scale (PDAS) to evaluate QOL. Although the pain levels were the same before and after the physical exercise program, the patients showed significant improvements in physical function on the SF-36 (48.5 vs. 54.5, 3 months vs. 1 month; p=0.0124), the magnification subscale on the PCS (6.8 vs. 5.9, 1 month vs. before; p=0.0164) and the PDAS (29.2 vs. 23.4, 3 months vs. before; p=0.0055). Chronic pain should be treated with a biopsychosocial approach, but time constraints and costs have limited the implementation of multidisciplinary and behavioral approaches to chronic pain management. Our findings demonstrate that clinical improvements are possible for patients with chronic pain, using multidisciplinary team resources widely available in Japanese clinical practice., Competing Interests: No potential conflict of interest relevant to this article was reported.

We examined whether the preoperative time required for the Timed "Up and Go" (TUG) test could predict the risk for deep venous thrombosis (DVT) in patients with hip osteoarthritis after total hip arthroplasty (THA). Eighteen patients with DVT diagnosed by venography were selected, and 18 without DVT of the same age and sex and with the same operated side as the DVT group were selected as a control group. We evaluated the 5 preoperative factors that might affect the occurrence of DVT complications, as follows:disease duration, body mass index, serum total cholesterol, subjective pain evaluated by the visual analog scale, and TUG. The JOA hip score (pain, range of motion, walking ability, and daily life) was also evaluated before surgery. As a postoperative factor, we checked the postoperative day when weight-bearing was initiated. As a result, TUG (DVT, 18.4+/-4.0 sec vs. control, 15.0+/-3.2 sec;p0.01) was only significantly different between the 2 groups. The ROC curve revealed that the cut-off point of 15.3 sec in preoperative time for TUG was sensitive (83.3%) and specific (61.1%) for DVT after THA (odds ratio7.0;95% confidence interval, 1.6-30.8). These results suggested that low preoperative ambulatory ability in patients with hip osteoarthritis might be associated with DVT after THA. An improvement in TUG before surgery might contribute to a decrease in the occurrence of DVT after THA.

We examined whether ambulatory ability before surgery might influence the post-operative D-dimer level after total hip arthroplasty (THA). One hundred two patients with hip osteoarthritis receiving THA were included in the current study. The patients were all female, and their ages ranged from 45 to 81 (average 65.0 +- 9.3 years). Age, operated side, body mass index (BMI), disease duration before surgery, pre-operative pain evaluated by visual analogue scale (VAS), total cholesterol value, maximal circumference of the lower leg of the operated side, and timed "Up & Go"test (TUG) before surgery, were retrospectively investigated to examine their relationship with D-dimer levels on post-operative day 7. Patients were divided into 2 groups according to the D-dimer value: over 10 microg/ml (Group D), and under (Group N). Patients in group D (N= 52)were older, had a higher BMI, and had less ambulatory ability than patients in group N (N= 50). As age showed a relationship with the D-dimer value on the 7th day and TUG results, patients in the 2 groups were further subdivided into 50's, 60's, and 70's age brackets. In the 50's bracket, patients in group D had higher BMI than patients in group N, but time for TUG was not significantly different. In the 60's and 70's bracket, patients in group D had less ambulatory ability than patients in group N, but the time for TUG was not directly correlated with the D-dimer value. The results suggest that pre-operative low ambulatory ability in patients with osteoarthritis over 60 years might influence the postoperative D-dimer after THA, indicating the potential risk for post-operative deep venous thrombosis.