Research Article
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Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty

Year 2023, Volume: 13 Issue: 2, 250 - 256, 15.06.2023

Selin Balta Muhammet Zeki Gültekin

https://doi.org/10.33808/clinexphealthsci.1078755

Abstract

Objective: Arthroplasty constitutes a major procedure commonly used in orthopaedic and traumatology surgery, and chronic pain develops in 7%–34% of patients after arthroplasty. This study aims to evaluate the experience, thoughts and attitudes of orthopaedic surgeons about chronic postsurgical pain after arthroplasty.
Methods: The survey was sent to orthopaedic surgeons via the Google survey system. The questionnaire consisted of 17 questions in total; four were related to demographic information, two asked about the surgeons’ experience, three asked for their thoughts, and eight queried their attitudes.
Results: The study evaluated 319 participants. All the orthopaedic surgeons reported that they routinely prescribe for postoperative pain control when discharging patients after arthroplasty. Of those surveyed, 69.7% have used multimodal analgesic therapy to treat chronic postsurgical
pain after arthroplasty. Consultation rates were 5% and 20% for psychiatry and pain physician, respectively. A weak positive correlation was
found between the rate of referring patients with chronic postsurgical pain after arthroplasty to pain physician and the beliefs of orthopaedic surgeons that pain physician can help patients with chronic postsurgical pain after arthroplasty who are unresponsive to pharmacological treatments (p = 0.008, r = 0.148).
Conclusion: Orthopaedic surgeons employ pre-emptive approaches to chronic postsurgical pain after arthroplasty and engage in pharmacological management of chronic postsurgical pain after arthroplasty, but they need to advance further with multidisciplinary treatments and directions.

Keywords

Chronic postsurgical pain arthroplasty orthopaedic surgeon multidisciplinary pain management multimodal pain treatment

Supporting Institution

none

Project Number

-

Thanks

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References

  • Lubbeke A, Rees JL, Barea C, Combescure C, Carr AJ, Silman AJ. International variation in shoulder arthroplasty incidence, indication, type of procedure, and outcomes evaluation in 9 countries. Acta Orthop. 2017;88(6):592-599. DOI: 10.1080/17453.674.2017.1368884.
  • Pabinger C, Geissler A. Utilization rates of hip arthroplasty in OECD countries. Osteoarthritis Cartilage 2014;22(6):734-741. DOI: 10.1016/j.joca.2014.04.009.
  • Pabinger C, Lothaller H, Geissler A. Utilization rates of kneearthroplasty in OECD countries. Osteoarthritis Cartilage 2015;23(10):1664-1673. DOI: 10.1016/j.joca.2015.05.008.
  • Murray DW, Frost SJ. Pain in the assessment of total knee replacement. J Bone Joint Surg Br. 1998;80(3):426-431. DOI:10.1302/0301-620x.80b3.7820.
  • Bullens PHJ, van Loon CJM, Malefijt MCD, Laan RFJM, Veth RPH. Patient satisfaction after total knee arthroplasty – A comparison between subjective and objective outcome assessments. J Arthroplasty 2001;16(6):740-747. DOI: 10.1054/arth.2001.23922.
  • Werner M, Kongsgaard UI. Defining persistent post-surgical pain: Is an update required? Br J Anaesth. 2014;113(1):1-4. DOI: 10.1093/bja/aeu012.
  • Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012;2(1): e000435. DOI: 10.1136/bmjopen-2011-000435.
  • Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L. Persistent pain is common 1–2 years after shoulder replacement: a nationwide registry-based questionnaire study of 538 patients. Acta Orthop. 2015;86(1):71-77. DOI: 10.3109/17453.674.2014.987065.
  • Pinto PR, McIntyre T, Ferrero R, Araujo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res. 2013;6:691-703. DOI: 10.2147/JPR.S45827.
  • Neil MJ, Macrae WA. Post surgical pain-the transition from acute to chronic pain. Rev Pain. 2009;3(2):6-9. DOI: 10.1177/204.946.370900300203.
  • Lee FK, Ray JB, Dunn GP. Chronic pain management and the surgeon: barriers and opportunities. J Am Coll Surg. 2001;193(6):689-701. DOI: 10.1016/s1072-7515(01)01091-2.
  • Kissin I, Gelman S. Chronic postsurgical pain: still a neglected topic? J Pain Res. 2012;5:473. DOI: 10.2147/JPR.S35145.
  • Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 2021;325(6):568-578. DOI: 10.1001/jama.2020.22171.
  • Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, Nizard R, Bergman JF, Perrot S, Lloret-Lincret C. Predictive factors of chronic post-surgical pain at 6 months following knee replacement: influence of postoperative pain trajectory and genetics. Pain Physician 2016;19(5):E729-E741.
  • Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg. 2012;115(2):428-442. DOI: 10.1213/ANE.0b013e318249d36e
  • Kinney MAO, Jacob AK, Passe MA, Mantilla CB. Increased risk of postthoracotomy pain syndrome in patients with prolonged hospitalization and increased postoperative opioid use. Pain Res Treat. 2016; 2016: 7945145. DOI: 10.1155/2016/7945145.
  • Baratta JL, Schwenk ES, Viscusi ER. Clinical consequences of inadequate pain relief: barriers to optimal pain management. Plast Reconstr Surg. 2014;134(4 Suppl 2):15S-21S. DOI: 10.1097/PRS.000.000.0000000681.
  • Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman- Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev. 2018;3(8):461-470. DOI: 10.1302/2058-5241.3.180004.
  • Elmofty DH, Buvanendran A. Regional anesthesia in total joint arthroplasty: What is the evidence? J Arthroplasty 2017;32(9):S74-S76. DOI: 10.1016/j.arth.2017.05.017.
  • Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, Chan VWS. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98(5):1486-1490. DOI: 10.1213/01.ane.000.011.3549.98873.b1.
  • Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711-720. DOI: 10.1093/bja/aet213.
  • El-Boghdadly K, Chin KJ, Chan VW. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. Anesthesiology 2017;127(1):173-191. DOI: 10.1097/ ALN.000.000.0000001668.
  • Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250-255. DOI: 10.1097/01.blo.000.019.2355.71966.8e.
  • Kopp SL, Borglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG, Neal JM, Rawal N, Wegener JT. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2017;42(6):683-697. DOI: 10.1097/ AAP.000.000.0000000673.
  • Wylde V, MacKichan F, Bruce J, Gooberman-Hill R. Assessment of chronic post-surgical pain after knee replacement: development of a core outcome set. Eur J Pain 2015;19(5):611- 620. DOI: 10.1002/ejp.582.
  • Kremer M, Salvat E, Muller A, Yalcin I, Barrot M. Antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience 2016;338:183-206. DOI: 10.1016/j. neuroscience.2016.06.057.
  • Moulin D, Boulanger A, Clark A, Clarke H, Dao T, Finley G, Furlan A, Gilron I, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamsin OD. Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328-335. DOI: 10.1155/2014/754693.
  • Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chitenden EH, Degenhardt E, Griffith S, Manworren R, Mc Carbery B, Montogomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17(2):131-157. DOI: 10.1016/j.jpain.2015.12.008.
  • Beswick AD, Wylde V, Gooberman-Hill R. Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2015;5(5):e007387. DOI: 10.1136/ bmjopen-2014-007387.
  • Erdem Y, Sir E. The efficacy of ultrasound-guided pulsed radiofrequency of genicular nerves in the treatment of chronic knee pain due to severe degenerative disease or previous total knee arthroplasty. Med Sci Monitor. 2019;25:1857-1863. DOI: 10.12659/MSM.915359.
  • Qudsi-Sinclair S, Borras-Rubio E, Abellan-Guillen JF, del Rey MLP, Ruiz-Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: a doubleblind, randomized clinical study. Pain Practice 2017;17(5):578- 588. DOI: 10.1111/papr.12481.
  • Albayrak I, Apiliogullari S, Dal CN, Levendoglu F, Ozerbil OM. Efficacy of pulsed radiofrequency therapy to dorsal root ganglion adding to tens and exercise for persistent pain after total knee arthroplasty. J Knee Surg. 2017;30(2):134-142. DOI: 10.1055/s-0036.158.3268.
  • Kim DJ, Shen S, Hanna GM. Ultrasound-guided radiofrequency lesioning of the articular branches of the femoral nerve for the treatment of chronic post-arthroplasty hip pain. Pain Physician 2017;20(2):E323-E327.
  • Orhurhu V, Akinola O, Grandhi R, Urits I, Abd-Elsayed A. Radiofrequency ablation for management of shoulder pain. Curr Pain Headache Rep. 2019;23(8):56. DOI: 10.1007/s11916.019.0791-z.
  • Weinrib AZ, Azam MA, Birnie KA, Burns LC, Clarke H, Katz J. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain. 2017;11(4):169-177. DOI: 10.1177/204.946.3717720636.
  • Lavand’homme P. ‘Why me?’The problem of chronic pain after surgery. Br J Pain. 2017;11(4):162-165. DOI: 10.1177/204.946.3717722119.

Year 2023, Volume: 13 Issue: 2, 250 - 256, 15.06.2023

Selin Balta Muhammet Zeki Gültekin

https://doi.org/10.33808/clinexphealthsci.1078755

Abstract

Project Number

-

References

  • Lubbeke A, Rees JL, Barea C, Combescure C, Carr AJ, Silman AJ. International variation in shoulder arthroplasty incidence, indication, type of procedure, and outcomes evaluation in 9 countries. Acta Orthop. 2017;88(6):592-599. DOI: 10.1080/17453.674.2017.1368884.
  • Pabinger C, Geissler A. Utilization rates of hip arthroplasty in OECD countries. Osteoarthritis Cartilage 2014;22(6):734-741. DOI: 10.1016/j.joca.2014.04.009.
  • Pabinger C, Lothaller H, Geissler A. Utilization rates of kneearthroplasty in OECD countries. Osteoarthritis Cartilage 2015;23(10):1664-1673. DOI: 10.1016/j.joca.2015.05.008.
  • Murray DW, Frost SJ. Pain in the assessment of total knee replacement. J Bone Joint Surg Br. 1998;80(3):426-431. DOI:10.1302/0301-620x.80b3.7820.
  • Bullens PHJ, van Loon CJM, Malefijt MCD, Laan RFJM, Veth RPH. Patient satisfaction after total knee arthroplasty – A comparison between subjective and objective outcome assessments. J Arthroplasty 2001;16(6):740-747. DOI: 10.1054/arth.2001.23922.
  • Werner M, Kongsgaard UI. Defining persistent post-surgical pain: Is an update required? Br J Anaesth. 2014;113(1):1-4. DOI: 10.1093/bja/aeu012.
  • Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012;2(1): e000435. DOI: 10.1136/bmjopen-2011-000435.
  • Bjørnholdt KT, Brandsborg B, Søballe K, Nikolajsen L. Persistent pain is common 1–2 years after shoulder replacement: a nationwide registry-based questionnaire study of 538 patients. Acta Orthop. 2015;86(1):71-77. DOI: 10.3109/17453.674.2014.987065.
  • Pinto PR, McIntyre T, Ferrero R, Araujo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res. 2013;6:691-703. DOI: 10.2147/JPR.S45827.
  • Neil MJ, Macrae WA. Post surgical pain-the transition from acute to chronic pain. Rev Pain. 2009;3(2):6-9. DOI: 10.1177/204.946.370900300203.
  • Lee FK, Ray JB, Dunn GP. Chronic pain management and the surgeon: barriers and opportunities. J Am Coll Surg. 2001;193(6):689-701. DOI: 10.1016/s1072-7515(01)01091-2.
  • Kissin I, Gelman S. Chronic postsurgical pain: still a neglected topic? J Pain Res. 2012;5:473. DOI: 10.2147/JPR.S35145.
  • Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA 2021;325(6):568-578. DOI: 10.1001/jama.2020.22171.
  • Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, Nizard R, Bergman JF, Perrot S, Lloret-Lincret C. Predictive factors of chronic post-surgical pain at 6 months following knee replacement: influence of postoperative pain trajectory and genetics. Pain Physician 2016;19(5):E729-E741.
  • Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg. 2012;115(2):428-442. DOI: 10.1213/ANE.0b013e318249d36e
  • Kinney MAO, Jacob AK, Passe MA, Mantilla CB. Increased risk of postthoracotomy pain syndrome in patients with prolonged hospitalization and increased postoperative opioid use. Pain Res Treat. 2016; 2016: 7945145. DOI: 10.1155/2016/7945145.
  • Baratta JL, Schwenk ES, Viscusi ER. Clinical consequences of inadequate pain relief: barriers to optimal pain management. Plast Reconstr Surg. 2014;134(4 Suppl 2):15S-21S. DOI: 10.1097/PRS.000.000.0000000681.
  • Wylde V, Beswick A, Bruce J, Blom A, Howells N, Gooberman- Hill R. Chronic pain after total knee arthroplasty. EFORT Open Rev. 2018;3(8):461-470. DOI: 10.1302/2058-5241.3.180004.
  • Elmofty DH, Buvanendran A. Regional anesthesia in total joint arthroplasty: What is the evidence? J Arthroplasty 2017;32(9):S74-S76. DOI: 10.1016/j.arth.2017.05.017.
  • Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, Chan VWS. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98(5):1486-1490. DOI: 10.1213/01.ane.000.011.3549.98873.b1.
  • Andreae MH, Andreae DA. Regional anaesthesia to prevent chronic pain after surgery: a Cochrane systematic review and meta-analysis. Br J Anaesth. 2013;111(5):711-720. DOI: 10.1093/bja/aet213.
  • El-Boghdadly K, Chin KJ, Chan VW. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. Anesthesiology 2017;127(1):173-191. DOI: 10.1097/ ALN.000.000.0000001668.
  • Indelli PF, Grant SA, Nielsen K, Vail TP. Regional anesthesia in hip surgery. Clin Orthop Relat Res. 2005;441:250-255. DOI: 10.1097/01.blo.000.019.2355.71966.8e.
  • Kopp SL, Borglum J, Buvanendran A, Horlocker TT, Ilfeld BM, Memtsoudis SG, Neal JM, Rawal N, Wegener JT. Anesthesia and analgesia practice pathway options for total knee arthroplasty: an evidence-based review by the American and European Societies of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2017;42(6):683-697. DOI: 10.1097/ AAP.000.000.0000000673.
  • Wylde V, MacKichan F, Bruce J, Gooberman-Hill R. Assessment of chronic post-surgical pain after knee replacement: development of a core outcome set. Eur J Pain 2015;19(5):611- 620. DOI: 10.1002/ejp.582.
  • Kremer M, Salvat E, Muller A, Yalcin I, Barrot M. Antidepressants and gabapentinoids in neuropathic pain: mechanistic insights. Neuroscience 2016;338:183-206. DOI: 10.1016/j. neuroscience.2016.06.057.
  • Moulin D, Boulanger A, Clark A, Clarke H, Dao T, Finley G, Furlan A, Gilron I, Morley-Forster PK, Sessle BJ, Squire P, Stinson J, Taenzer P, Velly A, Ware MA, Weinberg EL, Williamsin OD. Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328-335. DOI: 10.1155/2014/754693.
  • Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chitenden EH, Degenhardt E, Griffith S, Manworren R, Mc Carbery B, Montogomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 2016;17(2):131-157. DOI: 10.1016/j.jpain.2015.12.008.
  • Beswick AD, Wylde V, Gooberman-Hill R. Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2015;5(5):e007387. DOI: 10.1136/ bmjopen-2014-007387.
  • Erdem Y, Sir E. The efficacy of ultrasound-guided pulsed radiofrequency of genicular nerves in the treatment of chronic knee pain due to severe degenerative disease or previous total knee arthroplasty. Med Sci Monitor. 2019;25:1857-1863. DOI: 10.12659/MSM.915359.
  • Qudsi-Sinclair S, Borras-Rubio E, Abellan-Guillen JF, del Rey MLP, Ruiz-Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: a doubleblind, randomized clinical study. Pain Practice 2017;17(5):578- 588. DOI: 10.1111/papr.12481.
  • Albayrak I, Apiliogullari S, Dal CN, Levendoglu F, Ozerbil OM. Efficacy of pulsed radiofrequency therapy to dorsal root ganglion adding to tens and exercise for persistent pain after total knee arthroplasty. J Knee Surg. 2017;30(2):134-142. DOI: 10.1055/s-0036.158.3268.
  • Kim DJ, Shen S, Hanna GM. Ultrasound-guided radiofrequency lesioning of the articular branches of the femoral nerve for the treatment of chronic post-arthroplasty hip pain. Pain Physician 2017;20(2):E323-E327.
  • Orhurhu V, Akinola O, Grandhi R, Urits I, Abd-Elsayed A. Radiofrequency ablation for management of shoulder pain. Curr Pain Headache Rep. 2019;23(8):56. DOI: 10.1007/s11916.019.0791-z.
  • Weinrib AZ, Azam MA, Birnie KA, Burns LC, Clarke H, Katz J. The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain. 2017;11(4):169-177. DOI: 10.1177/204.946.3717720636.
  • Lavand’homme P. ‘Why me?’The problem of chronic pain after surgery. Br J Pain. 2017;11(4):162-165. DOI: 10.1177/204.946.3717722119.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Selin Balta 0000-0002-9248-6778

Muhammet Zeki Gültekin 0000-0003-2160-8237

Project Number -
Publication Date June 15, 2023
Submission Date February 25, 2022
Published in Issue Year 2023 Volume: 13 Issue: 2

Cite

APA Balta, S., & Gültekin, M. Z. (2023). Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty. Clinical and Experimental Health Sciences, 13(2), 250-256. https://doi.org/10.33808/clinexphealthsci.1078755
AMA Balta S, Gültekin MZ. Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty. Clinical and Experimental Health Sciences. June 2023;13(2):250-256. doi:10.33808/clinexphealthsci.1078755
Chicago Balta, Selin, and Muhammet Zeki Gültekin. “Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain After Arthroplasty”. Clinical and Experimental Health Sciences 13, no. 2 (June 2023): 250-56. https://doi.org/10.33808/clinexphealthsci.1078755.
EndNote Balta S, Gültekin MZ (June 1, 2023) Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty. Clinical and Experimental Health Sciences 13 2 250–256.
IEEE S. Balta and M. Z. Gültekin, “Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty”, Clinical and Experimental Health Sciences, vol. 13, no. 2, pp. 250–256, 2023, doi: 10.33808/clinexphealthsci.1078755.
ISNAD Balta, Selin - Gültekin, Muhammet Zeki. “Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain After Arthroplasty”. Clinical and Experimental Health Sciences 13/2 (June 2023), 250-256. https://doi.org/10.33808/clinexphealthsci.1078755.
JAMA Balta S, Gültekin MZ. Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty. Clinical and Experimental Health Sciences. 2023;13:250–256.
MLA Balta, Selin and Muhammet Zeki Gültekin. “Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain After Arthroplasty”. Clinical and Experimental Health Sciences, vol. 13, no. 2, 2023, pp. 250-6, doi:10.33808/clinexphealthsci.1078755.
Vancouver Balta S, Gültekin MZ. Experience, Thoughts, and Attitudes of Orthopaedic Surgeons about Chronic Postsurgical Pain after Arthroplasty. Clinical and Experimental Health Sciences. 2023;13(2):250-6.
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