Pain Assessment and Management in Orthopedic Patients in a Tertiary Care Hospital: A Prospective Observational Study

Pain is a complex and subjective experience that plays a critical role in orthopedic care. Defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” 4. pain is now regarded as the fifth vital sign in clinical settings. It is especially prevalent in orthopedic patients due to musculoskeletal injuries, surgeries, and degenerative conditions 5.       Pain can be acute or chronic. Acute pain serves as a protective mechanism and usually resolves once the underlying cause is treated. In contrast, chronic pain persists beyond normal healing time and may involve pathological changes in pain perception, including central sensitization 6.       Orthopedic conditions—such as fractures, arthritis, dislocations, and post-surgical trauma—are major contributors to pain and disability 1. Elderly patients are particularly at risk due to age-related bone degeneration, comorbidities, and decreased mobility. In these patients, self-reported pain scales like the Wong-Baker Faces Pain Rating Scale provide a simple and effective method of assessing pain, especially when literacy may be limited 1 .       Effective pain assessment is foundational to pain management. It informs diagnosis, guides treatment choices, and helps evaluate the effectiveness of interventions 2. Furthermore, the role of drug-drug interactions (DDIs) in pain therapy is increasingly recognized. Polypharmacy, especially in older adults, raises the risk of DDIs which can reduce therapeutic efficacy or increase adverse effects 4.        Additionally, obesity has emerged as a significant factor influencing orthopedic pain. Excess body weight puts increased stress on joints, delays recovery, and complicates both surgical and non-surgical interventions 3.        This study was therefore conducted to evaluate the pain assessment techniques, medication patterns, and risks of DDIs among orthopedic patients, along with the influence of demographic and lifestyle factors such as age, gender, and obesity.

MATERIAL AND METHODS

This was a prospective, observational study carried out at Sahyadri Super Specialty Hospital, Pune, over a period of six months. A total of 309 patients admitted to the orthopedic ward were enrolled in the study based on specific inclusion and exclusion criteria. Patients from all age groups, including geriatric and pediatric patients, were included, while pregnant women, outpatient department (OPD) cases, and patients allergic to NSAIDs and opioids were excluded.

Data were collected using a structured data collection form, which recorded information on patient demographics (age, gender, weight, BMI), social habits (smoking, alcohol use), comorbidities, diagnosis, pain severity, medications prescribed, and hospitalization details. Pain severity was assessed daily using the Wong-Baker Faces Pain Rating Scale, which is a simple tool involving facial expressions that helps patients, including young and elderly ones, to express their level of pain. Medication records were carefully reviewed to identify commonly prescribed pain medications such as NSAIDs, opioids, and acetaminophen. Potential drug-drug interactions (DDIs) were detected and analyzed using Lexicomp software, categorizing the interactions based on severity (severe, moderate, or minor) and mechanism. Data were entered into Microsoft Excel for analysis, and descriptive statistics were used to interpret the findings.

The study aimed to evaluate how demographic factors and obesity affect pain perception, assess pain management practices, monitor the risk of drug interactions, and suggest improvements for safer and more effective orthopedic care.

Excel spreadsheet and subjected to descriptive statistical analysis to determine trends in utilization, comorbidity patterns, and the frequency and severity of drug interactions.

Inclusion- 

1) All age group like geriatric,pediatric.

2) Patients admitted to orthopedic ward.

Exclusion-  

1) Pregnant women

2) OPD Patients 

3) Patient allergic to NSAIDS’S and Opioids

RESULT

Gender wise distribution: - The study was done in 309 inpatients of orthopedic department in tertiary care hospital .Out of 309 patients,174(56.3%) were male and 135(43.7%) were female.

Gender	Frequency (N)	Percentage (%)
Male	174	56.3 %
Female	135	43.7 %

 

 

Fig.1- Gender wise Distribution

 

 

Fig. 2 – Age wise Distribution

 

 

Fig.3- Social Habits  Wise Distribution

 

 

Fig. 4- Comorbidities Wise Distribution

 

 

Fig.5- Weight Wise Distribution

 

 

Fig. 6- Wong baker faces pain rating scale(WBS)

 

 

Fig. 7- pain score distribution of 309 patients

 

 

Fig.8- Class of drug prescribed in orthopedic patients

 

 

Fig. 9- Potential Drug – Drug Interaction

DISCUSSION

This study was done to understand how pain is assessed and managed in orthopedic patients. We found that pain is a common and serious problem in patients with bone and joint issues, especially after fractures or surgeries. If not treated well, this pain can slow down healing and affect the patient’s mood, sleep, and overall recovery.

 In our study, most healthcare providers used tools like the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) to check pain levels. These are simple and effective tools that help patients show how much pain they feel. However, in many cases, pain was not checked regularly or updated during the patient’s stay, which can lead to poor pain control. Most patients were treated with painkillers such as NSAIDs, paracetamol, and opioids. Opioids were given carefully, mainly in patients with high levels of pain. This is important because using too many opioids can cause addiction or side effects. It was good to see that NSAIDs and paracetamol were used in many cases as safer options.

We also noticed that non-drug treatments like physiotherapy, hot or cold packs, and proper positioning were not used as much as they should be.

These methods can help reduce pain without side effects, especially when used along with medicines. Many healthcare workers believed in these methods but didn’t use them regularly, mostly because of time limits, less staff, or lack of training. Another important point was the lack of teamwork. Nurses, physiotherapists, and doctors all play a role in pain management, but sometimes there was poor communication between them. Pain treatment works better when everyone shares information and follows the same plan. Lastly, we saw that there is no fixed protocol or guideline in many cases. Each doctor or nurse was using their own method. This can lead to confusion and different levels of care for different patients.

CONCLUSION

This study showed that pain is a serious and common problem in orthopedic patients. Most patients had moderate to severe pain due to fractures, joint conditions, or surgeries. Healthcare providers mostly used pain scales like the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) to check pain, but many times pain was not reassessed regularly. Pain relief was mainly done using medicines such as NSAIDs, paracetamol, and opioids. While these medicines helped reduce pain, opioids were used carefully due to concerns about side effects and addiction. Non-drug treatments like physiotherapy, cold or hot packs, and positioning were helpful but not used often in all cases. The study also found some problems in pain management, such as lack of proper guidelines, poor documentation, and weak communication between doctors, nurses, and physiotherapists. These problems made it harder to give proper pain relief to patients.

To improve pain management, there is a need for:

•      Standard protocols for pain assessment and treatment

•      Regular training for all healthcare staff

•      Better teamwork and communication among staff

•      More focus on non-pharmacological methods of pain relief

Overall, this study shows that with proper assessment tools, correct use of medicines, and team-based care, pain in orthopedic patients can be managed more effectivel

REFERENCES

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