# Analgesic Use After Discharge Following Total Knee Arthroplasty Evaluated Using the Experience Sampling Method

## TL;DR

This study found that most patients after knee surgery don't follow their pain medication prescriptions, leading to higher pain and lower mood.

## Contribution

The study introduces the use of experience sampling to track real-time analgesic adherence and its impact on pain and mood after surgery.

## Key findings

- 85.5% of patients didn't follow their acetaminophen regimen after discharge.
- Non-adherent patients reported higher pain and lower mood compared to adherent patients.
- Opioid use decreased over time without signs of abuse.

## Abstract

Background/Objectives: The inadequate management of postsurgical pain represents a major clinical issue, often leading to suboptimal outcomes in the immediate postoperative period and an increased risk of developing chronic postsurgical pain. The present study aimed to examine the relationship between postsurgical pain, mood, and the use of prescribed analgesics after total knee arthroplasty (TKA). Methods: This prospective observational explorative study enrolled 28 patients scheduled for TKA between February 2018 and March 2019. Using a digital experience sampling method (ESM) tool that included questions on pain, analgesic use, and both positive and negative effects, patients reported their current status up to ten times daily. The questions were administered over five days following postoperative discharge. Data analysis was performed using descriptive statistics and multilevel regression, accounting for the hierarchical structure of the data. Results: On 85.5% of the days post-discharge, the patients did not adhere to the prescribed acetaminophen regimen. Multilevel analyses revealed that the groups who overused or underused acetaminophen reported significantly heightened levels of pain. NSAIDs were generally underused. Post-discharge opioid use decreased over time, with no evidence of abuse. Overall, the non-adherent group reported lower mood levels and higher pain scores than the adherent group. Conclusions: Most patients did not adhere to the prescribed analgesics despite experiencing pain. Therefore, clinical interventions should prioritize identifying patient subtypes to tailor analgesic use effectively. This approach will facilitate the development and improvement of personalized acute postsurgical pain treatment protocols, ensuring more precise and effective pain management strategies for patients.