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The question

Intense pain can be expected for a while after knee replacement surgery, but reliance on opioids raises the possibility of developing a dependency on the powerful painkillers. Can supplemental drug-free treatments help ease the pain?

This study

The researchers analyzed data from 39 studies involving 2,391 adults who had total knee replacement surgery and had been randomly assigned to standard drug treatment for pain or to supplement that with a commonly used nonpharmacological therapy: preoperative exercise, use of a continuous passive motion machine, cryotherapy (treatment with cold), electrotherapy or acupuncture.

Researchers found that adding treatment with electrotherapy or acupuncture reduced or delayed the use of opioids for pain relief. Acupuncture was found to be most valuable for easing pain right after surgery, whereas with electrotherapy, pain was less severe up to six months after surgery. Neither continuous passive motion nor preoperative exercise had an effect on pain, although the researchersdescribed the data on that as low-quality. Cryotherapy also did not improve pain, but it was linked to a slight reduction in opioid use.

Who may be affected?

People who have knee replacement surgery. More than a million joint replacements are done in the United States each year, about three-fourths of them knee replacements. Opioids are a standard prescription for pain relief after the surgery because of their effectiveness, but the drugs are highly addictive. Their misuse and overuse have created an epidemic in the country.

Caveats

The researchers described the findings as “modest but clinically significant,” adding that further research was needed. The study reported only on the effect the nondrug treatments had on pain relief and opioid use; other potential benefits, such as improved mobility or function, were not evaluated.

Find this study

Online Aug. 16 in JAMA Sugery (jamasurgery.com). Click on “New Online.”

Learn more

Information on knee replacement surgery can be found at orthoinfo.aaos.org (search for “total knee”). More on opioids is available at hhs.gov/opioids.

The research described in Quick Study comes from credible, peer-reviewed journals.