title: "It's there and I'm stuck with it": patients' experiences of chronic pain following total knee replacement surgery.
abstract: OBJECTIVE
  To gain insight into patients' experiences of adjustment to chronic pain following recovery from total knee replacement (TKR) surgery.
  
  
  METHODS
  Participants were purposively sampled and comprised 28 individuals, 18 women and 10 men, ages 57-87 years, who had undergone a TKR between 2 and 5 years previously. Semistructured interviews explored participants' perceptions of their condition and its impact, including its causes and consequences. Thematic analysis, using the constant comparison technique, was used to identify and analyze patterns and themes from the transcripts.
  
  
  RESULTS
  Although some individuals expressed acceptance of their continuing pain, others reported that it caused them considerable distress. Variation in expressed acceptance and distress was not related to self-reported pain severity. Various factors relating to adjustment emerged, including perceived improvement or deterioration in circumstances since TKR, surgeon input pre- and postsurgery, and beliefs about pain in the context of an individual's life. Participants described a sense of abandonment following TKR and discussed the support they felt they should have received.
  
  
  CONCLUSIONS
  The data suggest that adjustment to chronic pain following recovery from TKR surgery is influenced by biomedical and psychosocial factors, including an individual's pain-related illness cognitions, beliefs, and their perceptions of their condition in a social context. Patient care could be improved by clinicians utilizing a biopsychosocial framework to acknowledge the impact of osteoarthritis of the knee as a multidimensional health condition.
authors.affiliation: University of Bristol, and Musculoskeletal Research Unit, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK. Alison.Jeffery@bristol.ac.uk
authors.forename: Alison E
authors.initials: AE
authors.lastname: Jeffery
authors.forename: Vikki
authors.initials: V
authors.lastname: Wylde
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
authors.forename: Jeremy P
authors.initials: JP
authors.lastname: Horwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology*