title: Pain management among Dominican patients with advanced osteoarthritis: a qualitative study.
abstract: Advanced osteoarthritis and total joint replacement (TJR) recovery are painful experiences and often prompt opioid use in developed countries. Physicians participating in the philanthropic medical mission Operation Walk Boston (OpWalk) to the Dominican Republic have observed that Dominican patients require substantially less opioid medication following TJR than US patients. We conducted a qualitative study to investigate approaches to pain management and expectations for postoperative recovery in patients with advanced arthritis undergoing TJR in the Dominican Republic.
  
  
  
  We interviewed 20 patients before TJR about their pain coping mechanisms and expectations for postoperative pain management and recovery. Interviews were conducted in Spanish, translated, and analyzed in English using content analysis.
  
  
  
  Patients reported modest use of pain medications and limited knowledge of opioids, and many relied on non-pharmacologic therapies and family support to cope with pain. They held strong religious beliefs that offered them strength to cope with chronic arthritis pain and prepare for acute pain following surgery. Patients exhibited a great deal of trust in powerful others, expecting God and doctors to cure their pain through surgery.
  
  
  
  We note the importance of understanding a patient's individual pain coping mechanisms and identifying strategies to support these coping behaviors in pain management. Such an approach has the potential to reduce the burden of chronic arthritis pain while limiting reliance on opioids, particularly for patients who do not traditionally utilize powerful analgesics.
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Yu
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Devine
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
authors.forename: Rachel G
authors.initials: RG
authors.lastname: Kasdin
authors.affiliation: Universidad Iberoamericana, Av. Francia 129, Gazcue, Santo Domingo, Dominican Republic.
authors.forename: Mónica
authors.initials: M
authors.lastname: Orizondo
authors.affiliation: Universidad Iberoamericana, Av. Francia 129, Gazcue, Santo Domingo, Dominican Republic.
authors.forename: Wendy
authors.initials: W
authors.lastname: Perdomo
authors.affiliation: Toronto Western Research Institute, University Health Network, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.|Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, 02115, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bogart
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. jnkatz@partners.org.|Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA. jnkatz@partners.org.|Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. jnkatz@partners.org.|Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave., Boston, MA, 02115, USA. jnkatz@partners.org.|Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D059350:Chronic Pain / Q000628:therapy*; D004293:Dominican Republic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000150:complications* / Q000523:psychology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000523:psychology / Q000601:surgery; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000628:therapy*; D011184:Postoperative Period; D036301:Qualitative Research; D012067:Religion; D055815:Young Adult
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid
keywords: International; Osteoarthritis; Pain management; Qualitative; Total joint replacement