Comparing Pain and Pain Coping Mechanisms in Patients Undergoing Total Joint Arthroplasty as Part of a Mission Trip to Those in the United States

Background: Access to total joint arthroplasty can be difficult in low-resource settings. Service trips are conducted to provide arthroplasty care to populations in need around the world. This study aimed to compare the pain, function, surgical expectations, and coping mechanisms of patients from one such service trip to the United States. Methods: In 2019, the Operation Walk program conducted a service trip in Guyana during which 50 patients had hip or knee arthroplasties. Patient demographics, patient-reported outcome measures, questionnaires assessing pain attitudes and coping, and pain visual analog scales were collected preoperatively and at 3 months postoperatively. These outcomes were compared with a matched cohort of elective total joint arthroplasty at a US tertiary care medical center. There were 37 patients matched between the 2 cohorts. Results: The mission cohort had significantly lower preoperative self-reported function scores than the US cohort (38.3 versus 47.5, P =.003), as well as a significantly larger improvement at 3 months (42.4 versus 26.4, P =.014). The mission cohort had significantly higher initial pain (8.0 versus 7.0, P =.015), but there were no differences with regard to pain at 3 months (P =.420) or change in pain (P =.175). The mission cohort had significantly greater preoperative scores in pain attitude and coping responses. Conclusion: Patients in low-resource settings were more likely to have preoperative functional limitations and pain, and they coped with pain through prayer. Understanding the key differences between these 2 types of populations and how they approach pain and functional limitations may help improve care for each group. Level of Evidence: II, prospective study.