Yorkshire Knee Clinic’s Jim Newman explores the relationship between mental health and knee pain.
In one of the least surprising research outcomes I can remember, a study from the University of Virginia recently revealed patients with knee pain “have lower subjective mental health and physical health than healthy individuals”.
It’s difficult to argue with the finding that someone who has knee pain is less likely to be as physically or mentally healthy as someone who doesn’t. If you’re suffering from knee pain, of course you can’t be as physically healthy – because it hurts. Over time that may well also affect your mental wellbeing. But does pain and/or depression affect the success of your knee surgery?
The effect of pain and depression on knee surgery
Last year, a study was presented to the 2017 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS) which explored the relationship between mental health and total hip and knee replacement outcomes. Of the 20,000 patients studied over an eight year period, almost 6.5% had been diagnosed with depression. Of those, the risk of a joint infection post-surgery doubled while the overall long-term risk of revisions (further corrective procedures post-op) increased.
An older, much smaller study found that men and women suffering from anxiety were more likely to suffer higher levels of post-op pain and spend longer in hospital. And yet another study, this time into hip replacements, found that patients taking antidepressants up to three years prior to their operation “were more likely to report greater pain before and after surgery and less satisfaction with their procedure”.
Finally, and just to compound the issue, a study in the Journal of Bone and Joint Surgery found that patients who took prescription opioids (high dose painkillers) for more than 60 days before total knee or hip replacement surgery showed a “significantly increased risk of early revision and significantly increased risk of 30-day readmission.”
So, if you suffer anxiety or depression, or have taken high dose painkillers for a prolonged period, there is a greater likelihood that your knee surgery will carry a greater risk of pain, infection and revision. If I’m talking with a patient who has, for example, fibromyalgia or has used opioid patches for a prolonged period, I know their recovery from knee surgery is likely to be a longer, more complex journey and I will always discuss this with them. But does that mean they shouldn’t have the surgery at all? Far from it.
Cause for hope
First, there are the medical advances that may be able to counterbalance the negative effects of pain or depression on surgery. In the 2017 study mentioned above, selective use of serotonin reuptake inhibitors (SSRIs), a type of antidepressant, was shown to reduce the risk of revision surgery following total hip or total knee replacement.
And for those patients worried about the effects of depression or chronic pain on their knee surgery, a 2007 study found that “most patients with pain one year after surgery can be reassured pain ultimately improves.”
Benefits still outweigh risks
As with so many things, it’s a case of managing expectations. The road to a pain free knee may be longer and rockier if you enter treatment taking anti-depressants or opioids, but the benefits – the ability to move in a way you haven’t for years; to resume activities you had to stop; to be (ultimately) pain free – can be hugely beneficial to your mental and physical wellbeing.
If you’re suffering from chronic pain and/or anxiety talk to me or any of the knee surgeons at Yorkshire Knee Clinic about the many ways we could help you. Call us now on 03453 052 579.
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