Background/Purpose: Pain management is a major focus of the post-arthroplasty rehabilitation.  A variety of pain treatments are used, including narcotics and non-narcotic analgesics.  To our knowledge, there are limited or no data regarding the use of non-pharmacologic treatment modalities in post-total joint replacement (TJR) period.  

Methods:  A subset of patients from a national joint registry undergoing primary TJR (total knee or hip replacement, TKR/THR) between 5/2013 and 6/2014 were queried at 2- and 8-weeks regarding pain severity and use of non-pharmacologic modalities. Frequency distributions were used to describe the cohort. We used bivariate statistical tests to compare groups including the chi-square, Fisher’s exact, t tests and Wilcoxon-Mann-Whitney test.

Results: There were 969 primary TKR and 584 primary THR respondents at 2-weeks and 1,022 primary TKR and 563 primary THR respondents at 8-weeks. The use of non-medication modalities was common in primary TKR patients at 2-weeks: cold packs (86%), meditation (6%), deep breathing (20%), heat (15%), relaxation (20%), walking (33%), distraction (51%), prayer (32%), massage (28%), listening to music (11%) and imagery (2%); numbers were similar and slightly lower for the 8-week follow-up.  Use of most non-medication modalities was significantly lower in primary THR patients. 

Compared to non-users, users of non-medication pain management strategies at 2-weeks were significantly: younger (65.6 vs. 68.8 years), more likely to be female (61% vs. 51%), White (93% vs. 89%), have college education or higher (70% vs. 62%) and had household income of $45K or higher (55% vs. 48%).  There were no significant differences in race distribution or mean body mass index (30.6 vs. 30.0).  

Compared to non-users, patients who reported using non-medication pain management strategies at 2-weeks and 8-weeks had significantly higher mean pain levels (3.0 vs. 2.0 on 0-10 scale; p<0.0001) and pain interference with activities of daily living (p-values <0.02) and physical therapy (p=0.007).     

Conclusion: Use of non-medication pain management strategies was common 2- and 8-weeks after primary TKR and THR. Certain patient groups used these modalities more than others. Use of these strategies was associated with more pain and pain interference, which might indicate that patients with higher pain severity and impact were more likely to use these strategies.  This hypothesis needs to be tested with examination of longitudinal data.