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Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery

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Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery Clinical Practice Guideline Adopted by: The American Academy of Orthopaedic Surgeons Board of Directors July 19, 2021 Endorsed by: Please cite this Appropriate Use Criteria as: American Academy of Orthopaedic Surgeons Evidence- Based Clinical Practice Guideline for Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery https://www.aaos.org/painalleviationcpg Published 07/19/21 Disclaimer This clinical practice guideline (CPG) was developed by a physician volunteer clinical practice guideline development group based on a formal systematic review of the available scientific and clinical information and accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s specific clinical circumstances. Disclosure Requirement In accordance with AAOS policy, all individuals whose names appear as authors or contributors to this clinical practice guideline filed a disclosure statement as part of the submission process. All panel members provided full disclosure of potential conflicts of interest prior to voting on the recommendations contained within this clinical practice guideline. Funding Source This clinical practice guideline was funded exclusively through a research grant provided by the United States Department of Defense with no funding from outside commercial sources to support the development of this document. FDA Clearance Some drugs or medical devices referenced or described in this Clinical practice guideline may not have been cleared by the Food and Drug Administration (FDA) or may have been cleared for a specific use only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice. Copyright All rights reserved. No part of this clinical practice guideline may be reproduced, stored in a retrieval system, or transmitted, in any form, or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from METRC. If you wish to request permission please contact METRC by clicking here or AAOS by clicking here. Published 2021 by the Major Extremity Trauma and Rehabilitation Consortium (METRC) in collaboration with the American Academy of Orthopaedic Surgeons (AAOS) 9400 W Higgins Rosemont, IL First Edition Copyright 2021 by the Major Extremity Trauma and Rehabilitation Consortium (METRC) and the American Academy of Orthopaedic Surgeons (AAOS) 2 View background material via the Pain Alleviation CPG eAppendix 1 View data summaries via the Pain Alleviation CPG eAppendix 2 To View All AAOS and AAOS-Endorsed Evidence-Based clinical practice guidelines and Appropriate Use Criteria in a User-Friendly Format, Please Visit the OrthoGuidelines Web-Based App at www.orthoguidelines.org or by downloading to your smartphone or tablet via the Apple and Google Play stores! 3 Contents SUMMARY OF RECOMMENDATIONS ............................................................................................... 7 Acupuncture ............................................................................................................................................ 7 Acupressure ............................................................................................................................................. 7 Compression ............................................................................................................................................ 7 Cryotherapy ............................................................................................................................................. 8 Early Mobilization .................................................................................................................................. 8 Massage .................................................................................................................................................... 8 Neuromuscular Electrical Stimulations ................................................................................................ 8 Transcutaneous Electrical Nerve Stimulation ...................................................................................... 9 Peri-op Injections .................................................................................................................................... 9 Peri-op Injections Total Shoulder Arthroplasty .................................................................................. 9 Cognitive/Behavioral Treatment ........................................................................................................... 9 Guided Relaxation Therapy ................................................................................................................. 10 Music Therapy ...................................................................................................................................... 10 Patient Education .................................................................................................................................. 10 Virtual Reality ....................................................................................................................................... 10 Intra-Articular Opioids vs NSAIDs ..................................................................................................... 11 Opioid Combo/NSAID .......................................................................................................................... 11 Fentanyl Patch vs Morphine ................................................................................................................ 11 Tramadol vs NSAID ............................................................................................................................. 11 Cox-2 ...................................................................................................................................................... 12 Oral Acetaminophen ............................................................................................................................. 12 Acetaminophen ...................................................................................................................................... 12 Acetaminophen/NSAID Combination Treatment .............................................................................. 12 Gabapentin ............................................................................................................................................ 13 Pregabalin .............................................................................................................................................. 13 Ketamine ................................................................................................................................................ 13 Oral Relaxants ....................................................................................................................................... 14 Summary of Consensus Statement .......................................................................................................... 15 Anti-Depressants ................................................................................................................................... 15 DEVELOPMENT GROUP ROSTER .................................................................................................... 16 4 View background material via the Pain Alleviation CPG eAppendix 1 View data summaries via the Pain Alleviation CPG eAppendix 2 Voting Members .................................................................................................................................... 16 Non-Voting Members ........................................................................................................................... 16 AAOS/METRC Staff ............................................................................................................................ 16 INTRODUCTION ..................................................................................................................................... 18 Overview ................................................................................................................................................ 18 Goals and Rationale .............................................................................................................................. 18 Intended Users and Patient Population .............................................................................................. 18 Etiology and Incidence ......................................................................................................................... 19 Emotional and Physical Impact ........................................................................................................... 19 Potential Benefits, Harms, and Contraindications ............................................................................. 19 Future Research ...................................................................................................................................
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