"Pain Prehabilitation" in Major Joint Surgery: The Way Forward to Improve Outcomes and Prevent Pain Chronicity

Osteoarthritis (OA) is one of the most frequent orthopedic disorders and a common cause of chronic pain, which is one of the most important factors in recommending total joint arthroplasty (TJA). Due to a greater need for pain relief and improved mobility in the OA population, TJA procedures are in high demand, and most patients with OA experience long waiting times. Waiting for TJA places a significant burden on patients as a result of worsening pain and functional deterioration. Therefore, optimizing pre-operative circumstances in these patients is essential to target analgesic interventions, preserve post-operative quality of life, and minimize post-operative outcomes such as chronic post-surgical pain. Achieving optimal pain control before surgery remains an unmet need, and it is difficult to devise a one-size-fits-all analgesic regimen. Pain is a challenge for orthopedic healthcare professionals (OHCPs), and orthopedic patients are notably less satisfied than patients undergoing other surgeries in terms of pain management. We reviewed the latest clinical evidence on pain management in patients with OA wait-listed for TJA to help OHCPs effectively manage their pain. Here, we provide actionable suggestions to strengthen orthopedic surgeons' competency in pain assessment and therapy selection. By integrating the perspectives of an orthopedic surgeon and a pain therapist, we also introduce the concept of "pain prehabilitation" and propose integrating it into standard care protocols during the TJA wait-list period to optimize TJA outcomes and prevent the development of chronic post-surgical pain.