La gestione del dolore persistente in ortopedia

Pain secondary to degenerative osteoarticular pathologies is one of the main symptoms in orthopedics. Owing to the chronic pain, associated with functional limitation, patients turn to the orthopedist and decide to undergo knee or hip replacements. In most cases, the waiting period prior to operation is characterised by the moderate-severe pain which limits the patients' function and activity. Control of pain is also important postoperatively. In fact severe pain is associated with longer hospitalisation, poor compliance with the rehabilitation programme, a delay in starting to walk again or to an increase in postoperative complications. Among the conventional pain-killing treatments we would mention the non-steroid anti-inflammatory drugs and the opioids. Generally speaking the former should be administered for a maximum period of 15-20 days as they are poorly tolerated; the latter on the other hand can prove difficult to manage for the physician and unpopular with patients owing to their pharmacological interactions, the poor gastrointestinal tolerance and the dependence phenomenon. A new molecule (tapentadol) has recently been introduced in Italy. This possesses a particular action mechanism which differentiates it from all the analgesics thus far available to the point where a new therapeutic class, MOR-NRI, has been hypothesised. In orthopaedic clinical practice this can translate into the possibility of a more appropriate and effective analgesie therapy in patients with persistent pain, thus enabling the orthopedist to find a simple, correct approach in situations where other therapeutic options can prove complex or unsuitable.