The realm of hip surgery, vast and diverse, brings to the fore a myriad of challenges and complexities—especially when it involves teenagers. The prolonged symptom duration in teenagers with painful hip pathologies requiring surgery can exacerbate the condition and significantly influence postoperative outcomes. In some instances, it can even stimulate the development of a nociplastic pain condition. The case of a 19-year-old patient with a history of delayed diagnosis and multiple surgeries for left-sided hip physeolysis brings this critical issue into sharp focus.
Psychological Processes and Pain Perception
Central to this troublesome progression of orthopedic pain conditions are psychological processes. These are not merely secondary effects, but crucial drivers that shape the pain experience and functional outcomes. The young patient's case, despite multiple surgeries, continued to grapple with severe pain, sleep disturbances, and functional limitations—a triad of complications that hinted at a complex pain condition.
The Role of Multi-Professional Care
Addressing this intricate mix of neuropathic, nociceptive, and nociplastic pain components required an equally multifaceted approach. A pain team, comprising a psychologist, physiotherapist, and doctor, assessed the situation and initiated an exposure treatment eschewing opioids. The focus was on reducing the perceived threat of the pain and enhancing functionality, rather than merely numbing the sensation.
Remarkable Progress with a Holistic Approach
After six months of this rigorous intervention, including video sessions, the patient experienced substantial improvements. The pain intensity lessened, the mood improved, and sleep disturbances became less frequent—even though pain was still a constant companion. This improvement underscores the influence of psychological factors on pain intensity and functional level in patients with hip pathologies.
Preoperative mental health, as this case illustrates, can be a powerful predictor for postoperative outcomes. Therefore, it is of paramount importance that healthcare professionals recognize and address these psychological factors. Providing multi-professional care, including psychological expertise, for young patients showing pre- and postoperative risk factors could be the key to preventing the negative progression of an orthopedic pain condition.