Author(s):
Syeda Zuleqaunnisa Begum, Saritha Chukka, Mohd Akram
Email(s):
syedazuleqaunnisa@gmail.com
DOI:
10.52711/0974-360X.2025.00566 
Address:
Syeda Zuleqaunnisa Begum1, Saritha Chukka2, Mohd Akram3
1Research Scholar, Chaitanya (Deemed to be University), Himayatnagar, Telangana 500075.
2Associate Professor, Chaitanya (Deemed to be University), Himayatnagar, Telangana 500075.
3Assistant Professor, Deccan College of Medical Sciences, Hyderabad, Telangana 500058.
*Corresponding Author
Published In:
Volume - 18,
Issue - 8,
Year - 2025
ABSTRACT:
Orthopedic pain management is complex and challenging in healthcare due to its characteristics, causes and frequency of recovery. Nociceptive and Neuropathic pain pathway are the underlying mechanism involved with numerous symptoms aching, stiffness, burning sensations, pain worsening with movement, severe bruising, inflammation, cramping, localized tenderness. Unidimensional scale, multidimensional scale and postoperative pain measurement techniques are used to assess the appropriate pain intensity and relief. Pharmacological management involves a combination of non-opioid analgesics, opioids, adjuvant agents, and emerging therapies, with a focus on multimodal analgesia to enhance pain relief and minimize opioid use. The review also highlights challenges in managing orthopedic pain, including diagnostic complexity, imaging limitations, the need for individualized treatment plans and psychological and social factors. Pain should be considered during preoperative, intraoperative, postoperative and at the time of discharge. Effective pain management requires constant reassessment with individualized treatment regimen. Major efforts should be taken by the healthcare professional and patients during the postoperative pain period as it involves the healing period associated with several risk factors like hospital discharge, severity of surgery, physiotherapy mobilization. Implementation of multimodal pain management along with physiotherapy, exercise and patients counselling are effective for reducing postoperative pain.
Cite this article:
Syeda Zuleqaunnisa Begum, Saritha Chukka, Mohd Akram. A Comprehensive Review on Orthopedic Pain. Research Journal Pharmacy and Technology. 2025;18(8):3939-4. doi: 10.52711/0974-360X.2025.00566
Cite(Electronic):
Syeda Zuleqaunnisa Begum, Saritha Chukka, Mohd Akram. A Comprehensive Review on Orthopedic Pain. Research Journal Pharmacy and Technology. 2025;18(8):3939-4. doi: 10.52711/0974-360X.2025.00566 Available on: https://www.rjptonline.org/AbstractView.aspx?PID=2025-18-8-69
REFERENCES:
1. Hiren Tilala, Suneesh P.M., Jeenath Justin Doss. K.A Study to Assess the Effectiveness of Cryotherapy on level of pain among patient with Arthralgia in selected Orthopedic Hospital at Rajkot. Int. J. of Advances in Nur. Management. 2020; 8(1): 69-71.
2. V. Indra. Effective Pain Management to Improve Patient satisfaction – A Review. Int. J. Nur. Edu. and Research. 2019; 7(4): 613-615.
3. Dinesh Kumar Suganandam, Jasmin Ruby Anand, Amala Rajan, Georgene Singh, Bijesh Kumar Yadav. Procedural pain on Satisfaction. Asian J. Nursing Education and Research. 2020; 10(2): 171-174.
4. Cousins M.J. Introduction to Acute and Chronic Pain: Neural Blockade in Clinical Anesthesia and Management of Pain. Philadelphia: JB Lippincott, Inc.; 1988.
5. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10: 2287-98.
6. Syed MA, Azim SR, Baig M. Frequency of orthopedic problems among patients attending an orthopedic outpatient department: a retrospective analysis of 23,495 cases. Ann Saudi Med. 2019; May-Jun; 39(3): 172-7. doi: 10.5144/0256-4947.2019.172. PMID: 31215227; PMCID: PMC6832329.
7. Dafny N. Pain Principles. In: Neuroscience Online: An Electronic Textbook for the Neurosciences. Department of Neurobiology and Anatomy, The University of Texas Medical School at Houston. [Accessed 21 October 2022].
8. Phillips WJ, Currier BL. Analgesic pharmacology: I. Neurophysiology. J Am Acad Orthop Surg. 2004; 12: 213-20. doi: 10.5435/00124635-200407000-00002.
9. Levine JD, Reichling DB. Peripheral mechanisms of inflammatory pain. In: Wall PD, Melzack R, editors. Textbook of Pain. 4th ed. Edinburgh: Churchill Livingstone; 1999. p. 59-84.
10. Graefe SB, Rahimi N, Mohiuddin SS. Biochemistry, Substance P. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 30. [Updated 2024 Jan-]. PMID: 32119470
11. Sudireddy R, Venkateswarlu BS. A Study on Pain Assessment and Management in Post-Operative patients. Res J Pharm Technol. 2021; 14(3): 1612-4. doi: 10.5958/0974-360X.2021.00286.
12. Lakshmi Ramamoorthy. Post-operative Pain Management Strategies: Nursing Perspectives. Asian J. Nursing Education and Research. 2021; 11(2): 189-192.
13. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS), Numeric Rating Scale for Pain (NRS), McGill Pain Questionnaire (MPQ), Short Form McGill Pain Questionnaire (SFMPQ), Chronic Pain Grade Scale (CPGS), Short Form36 Bodily Pain Scale (SF36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res. 2011; 63(S11)
14. Safikhani S, Gries KS, Trudeau JJ, Reasner D, Rüdell K, Coons SJ, Bush EN, Hanlon J, Abraham L, Vernon M. Response scale selection in adult pain measures: results from a literature review. J Patient Rep Outcomes. 2018; Sep 6; 2: 40. doi: 10.1186/s41687-018-0053-6. PMID: 30238085; PMCID: PMC6127068.
15. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1994; 27(1): 117-26.
16. Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975; 1(3): 277-99.
17. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994; 23(2): 129-38.
18. Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: psychometric properties. Pain. 1990; 40(2): 171-82.
19. Singla N, Hunsinger M, Chang PD, McDermott MP, Chowdhry AK, Desjardins PJ, Turk DC, Dworkin RH. Assay sensitivity of pain intensity versus pain relief in acute pain clinical trials: Acttion systematic review and meta-analysis. J Pain. 2015; 16: 683-91.
20. Khemchand R. Surana, Abhijeet G. Parkhe, Eknath D. Ahire, Anuprita R. Pawar, Survarna Khairnar, Sunil K. Mahajan, Dhananjay M. Patil, Deepak D. Sonawane, Sanjay J. Kshirsagar. Current Therapeutic Targets for Neuropathic Pain. Asian Journal of Pharmaceutical Research. 2022; 12(1): 96-4.
21. DA Helen Sheeba, V Gauthami Yadav. Complex Regional Pain Syndrome and Its Treatment: An Overview. Research J. Pharmacology and Pharmacodynamics. 2012; 4(3): 133-143.
22. Morshed Nasir, Rawshon Ara Parveen, Nazmun Nahar Alam. Pattern of Analgesic Use in Post-Operative Pain Management in a Tertiary Level Teaching Hospital in Bangladesh. Research J. Pharm. and Tech. 2016; 9(5): 493-496.
23. Nageeb AGM Hassan, Alhabib SM, Alghamdi AH, Nasser NA, Alshehri SM. Prevalence of pain and self-medication pattern of Paracetamol and NSAIDs among university students in United Arab Emirates. Res J Pharm Technol. 2021; 14(6): 3393-8. doi: 10.52711/0974-360X.2021.00590.
24. Syeda Zuleqaunnisa Begum, Mohammed Jalal Mohiuddin, Kauser Nazima Hassan, Khair Unnisa Sadaf, Khudsiya Taher, Salman Ali, Mohd Akram. A Comparative Study of NSAIDs + Opioids V/S NSAIDs + TCAs Perioperatively for Pain Management in the Department of Orthopedics. Res J Pharm Technol. 2022; 15(12): 5501-6. doi: 10.52711/0974-360X.2022.00928.
25. Queremel Milani DA, Davis DD. Pain Management Medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 ;Jul 3.
26. Van Tulder MW, Furlan AD, Bombardier C, Bouter LM. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2003; (2).
27. Baranidharan G, McCarthy A, Lunt M, et al. The role of capsaicin in pain management. Br J Pain. 2020; 14(2): 73-82.
28. Moore RA, Derry S, Aldington D, et al. Combination therapy for the treatment of pain. Pain. 2019;160(S1)
29. Whiting PF, Wolff RF, Deshpande A, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015; 313(24): 2456-73.
30. Gaur V, Patel M, Kumar P, et al. Gene therapy approaches for pain management. Pain Res Manag. 2021; 2021: 1-12.
31. Finnerup NB, Kuner R, Jensen TS. Advances in pharmacotherapy for neuropathic pain. Nat Rev Neurol. 2017; 13(9): 583-97.
32. Queremel Milani DA, Davis DD. Pain Management Medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jul 3.
33. Wickham R. The role of advanced practitioners in oncology. J Adv Pract Oncol. 2017; 8: 475-90. doi: 10.6004/jadpro.2017.8.5.4.
34. Goodman LS, Gilman AG. Goodman and Gilman Manual of Pharmacology and Therapeutics. Section II, Neuropharmacology, Chapter 18, Opioids, Analgesia, and Pain Management.
35. Smith T, Johnson K. Socioeconomic barriers in orthopedic patient management. Orthop Care Rev. 2020; 29(1): 92-104.
36. Jones M, Patel R. Limitations of diagnostic imaging in orthopedic practice. Orthop Imaging J. 2017; 22(3): 312-20.
37. Brown C, Jones M, Smith L. Challenges in individualized treatment plans for orthopedic patients. J Orthop Res. 2019;37(4):567-79.
38. Garach Bhavikkumar D., Parth D. Raiyani. Postoperative pain after spine surgery: Comparative efficacy of diclofenac and etoricoxib in combination with tramadol and paracetamol at lower doses. Research J. Pharmacology and Pharmacodynamics. 2013; 5(1): 62-69.
39. Miller D, Johnson R, Thompson A. Surgical risks and complications in orthopedic procedures. J Surg Orthop. 2020;42(5):678-85.
40. Lee H, Chen P. Multimodal pain management in orthopedic patients. Pain Manag J. 2018; 15(2): 145-58.
41. Smith T, Lee H, Johnson K. Diagnostic challenges in musculoskeletal disorders. Int J Musculoskelet Med. 2018; 34(6): 543-59.
42. Smith T, Johnson K. Socioeconomic barriers in orthopedic patient management. Orthop Care Rev. 2020; 29(1): 92-104.
43. Williams S, MacAuley D. Psychological impact of chronic orthopedic conditions. J Orthop Psychol. 2019; 10(3): 234-42.