title: Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty.
abstract: OBJECTIVE
  The purpose of this study was to compare pain and anxiety in orthopaedic patients scheduled for elective total hip or knee arthroplasty who have received a kit of nonpharmacologic strategies for pain and anxiety in addition to their regularly prescribed analgesics to those who receive the usual pharmacologic management alone.
  
  
  METHODS
  Descriptive comparative and correlational design using surveys and chart audits.
  
  
  METHODS
  Sixty-five patients randomized to receive usual care or usual care plus a kit of nonpharmacologic strategies.
  
  
  RESULTS
  Patients who received the kit used nonpharmacologic measures for pain and anxiety more often than patients who did not receive the kit. The kit group tended to use less opioid and have less anxiety on postoperative day 1 (not statistically significant) and use significantly less opioid on postoperative day 2 than the patients who did not receive the kit. There were no between-group differences in pain intensity. There were significant correlations among postoperative pain intensity, opioid use, and anxiety. The coping method of diverting attention was related to lower present (now) pain scores, and ignoring the pain was associated with higher worst pain.
  
  
  CONCLUSIONS
  Providing a kit of nonpharmacologic strategies can increase the use of these methods for postoperative pain and anxiety and decrease the amount of opioid taken. The influence of coping strategies in acute postoperative pain needs to be examined further.
authors.affiliation: University of Wisconsin Hospitals & Clinics, Madison, WI, USA.
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Pellino
authors.forename: Debra B
authors.initials: DB
authors.lastname: Gordon
authors.forename: Zeena K
authors.initials: ZK
authors.lastname: Engelke
authors.forename: Kjersten L
authors.initials: KL
authors.lastname: Busse
authors.forename: Mary A
authors.initials: MA
authors.lastname: Collins
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Silver
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Norcross
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000193:education / Q000379:methods; D008297:Male; D008405:Massage / Q000193:education / Q000379:methods; D008875:Middle Aged; D009147:Music Therapy / Q000193:education / Q000379:methods; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D012044:Regression Analysis; D012064:Relaxation Therapy / Q000193:education / Q000592:standards; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome