Preoperative management of patients with chronic moderate to severe shoulder pain to improve postoperative outcomes: A systematic review.

Objectives: To assess if implementing interventions to effectively manage preoperative chronic moderate to severe shoulder pain in patients undergoing rotator cuff repair (RCR) can improve shoulder surgery outcomes.

Methods: A systematic review was conducted following the PRISMA and SIGN guidelines. Randomized clinical trials (RCTs), metanalysis, systematic revisions and cohort studies in Spanish/English, published within the last 10 years, evaluating interventions to control preoperative chronic moderate to severe shoulder pain in patients undergoing RCR and their impact in postoperative shoulder outcomes were included. Selected records were graded following the 2011 Oxford Centre for Evidence-Based Medicine levels of evidence (OCEBML). RCTs were graded using the PEDro scale.

Results: Twenty-nine records were included in the analysis. Evidence suggests that preoperative chronic moderate to severe shoulder pain is the strongest risk factor for postoperative shoulder pain (OCEBML III). Patient-related factors and shoulder pain characteristics can also influence surgery outcomes (OCEBML II/III). Predictors of better shoulder function at 2 years after surgery include higher preoperative scores on the Western Ontario Rotator Cuff index and the Constant-Murley score in the contralateral shoulder (OCEBML III). Preoperative analgesia to control shoulder pain can improve postoperative pain (OCEBML I). Preoperative patient teaching and intensive postoperative follow-up also improve pain intensity and function (OCEBML II).

Discussion: Preoperative chronic shoulder pain together with patient-related factors are significant predictors of postoperative shoulder outcomes, emphasizing the need for proactive pain assessment and tailored therapeutic programs.