Letter re: Letter to the editor: Superior analgesic efficacy of preemptive low-dose ketorolac compared with parecoxib after total knee arthroplasty: A retrospective propensity score matching study

To the editor,

Recently, we had the pleasure of reading the article “Superior analgesic efficacy of preemptive low-dose ketorolac compared with parecoxib after total knee arthroplasty: A retrospective propensity score matching study” by Iamthanaporn et al. ¹ In this study, the authors delved into whether there was a significant difference in the analgesic effect of low-dose ketorolac and parecoxib after total knee arthroplasty (TKA). The findings suggest that preemptive analgesia with low-dose ketorolac showed superior analgesia compared to parecoxib during the first 24 hours after TKA. We are very grateful to the authors for their contribution. However, there are still some issues in this article that need to be further explored.

First, although the Visual Numeric Rating Scale (VNRS) was used in this study to assess patients’ postoperative pain, ratings on this metric may be influenced by factors other than pain intensity, such as depressive symptoms, pain unpleasantness, catastrophizing, and interference. Notably, as a standardized instrument developed by the EuroQol group, the EuroQol-5D (EQ-5D) provides a detailed analysis of the aforementioned non-pain intensity factors. Hence, the joint use of the VNRS and the EQ-5D can further enhance the reliability and validity as well as the sensitivity of the study results to a certain extent. Moreover, Nielsen et al. found that the variability in pain ratings of patients with the same disease or trauma is enormous. This is largely attributed to the fact that pain sensitivity has individual differences. ² Therefore, it is essential to preoperatively test patients for pain sensitivity and thus correct postoperative statistical scores.

Secondly, as an effective conservative treatment, physiotherapy plays an important role in the postoperative management of TKA. Currently, Tedesco et al. has demonstrated that electrotherapy and acupuncture are effective in alleviating pain after TKA. ³ However, the present study did not provide a detailed description of patients’ postoperative physiotherapy regimens. Additionally, electrotherapy and acupuncture can potentially reduce and delay opioid depletion, which strongly reduces the side effects of the drugs and provides new ideas for clinical treatment. ³ Therefore, further studies should be conducted to delve deeper into the role of physiotherapy in improving postoperative pain to replace pharmacological therapies.

Finally, despite these confusions, the author has made significant contributions to this field. We once again appreciate the author’s research and hope that our explanations and observations will help readers of this valuable journal.