Pain Management Strategies After Orthopaedic Trauma: A Mixed-Methods Study with a View to Optimizing Practices

Abstract

Sonia Grzelak,1,2 Mélanie Bérubé,1,2 Marc-Aurèle Gagnon,1 Caroline Côté,1,2 Valérie Turcotte,3 Stéphane Pelet,4 Étienne Belzile4 1Population Health and Optimal Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus), Quebec City, QC, Canada; 2Faculty of Nursing, Laval University, Quebec City, QC, Canada; 3Nursing Department, CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada; 4Department of Orthopedic Surgery, CHU de Québec-Université Laval (Hôpital de l’Enfant-Jésus), Quebec City, QC, CanadaCorrespondence: Sonia GrzelakPopulation Health and Optimal Practices Research Unit, Laval University Research Center (Hôpital de l’Enfant-Jésus), 1401, 18 e rue, Quebec City, QC, G1V 1Z4, Canada, Tel [phone], ext 66600, Fax [phone], Email [email protected]: To examine 1) pain management strategies within the care trajectory of orthopaedic trauma patients and patients’ perception of their effectiveness, 2) adverse effects (AEs) associated with pharmacological treatments, particularly opioids and cannabis, and 3) patients’ perceptions of strategies that should be applied after an orthopaedic trauma and support that they should obtain from health professionals for their use.Patients and Methods: This study was conducted with orthopaedic trauma patients in a level 1 trauma center. A convergent mixed-methods design was used. Data on pain experience, pain management strategies used and AEs were collected with self-administered questionnaires at hospital discharge (T1) and at 3 months after injury (T2). Patients’ preferences about the pain management strategies used, the required support and AEs were further examined through semi-structured individual interviews at the same time measures. Descriptive statistics and thematic analyses were performed.Results: Seventy-one patients were recruited and 30 individual interviews were undertaken. Pharmacological pain management strategies used at T1 and T2 were mainly opioids (95.8%; 20.8%) and acetaminophen (91.5%; 37.5%). The most frequently applied non-pharmacological strategies were sleep (95.6%) and physical positioning (89.7%) at T1 and massage (46.3%) and relaxation (32.5%) at T2. Findings from quantitative and qualitative analyses highlighted that non-pharmacological strategies, such as comfort, massage, distraction, and physical therapy, were perceived as the most effective by participants. Most common AEs related to opioids were dry mouth (78.8%) and fatigue (66.1%) at T1 and insomnia (30.0%) and fatigue (20.0%) at T2. Dry mouth (28.6%) and drowsiness (14.3%) were the most reported AEs by patients using recreational cannabis. An important need for information at hospital discharge and for a personalized follow-up was identified by participants during interviews.Conclusion: Despite its AEs, we found that opioids are still the leading pain management strategy after an orthopaedic trauma and that more efforts are needed to implement non-pharmacological strategies. Cannabis was taken for recreational purposes but patients also used it for pain relief. Support from health professionals is needed to promote the adequate use of these strategies.Keywords: orthopaedic trauma, pain, pharmacological strategies, non-pharmacological strategies, opioids, cannabis

Keywords

• orthopeadic trauma
• pain
• pharmacological strategies
• non-pharmacological strategies
• opioids
• cannabis.