Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand.
Br J Anaesth. 2015 Apr;114(4):551-61. doi: 10.1093/bja/aeu441. Epub 2014 Dec 26.
Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain; however, the relative effect of these variables has yet to be quantified. The aim of the study was to provide a systematic review and meta-analysis of predictor variables associated with persistent pain after total knee arthroplasty (TKA).
Included studies were required to measure predictor variables prior to or at the time of surgery, include a pain outcome measure at least 3 months post-TKA, and include a statistical analysis of the effect of the predictor variable(s) on the outcome measure. Counts were undertaken of the number of times each predictor was analysed and the number of times it was found to have a significant relationship with persistent pain. Separate meta-analyses were performed to determine the effect size of each predictor on persistent pain. Outcomes from studies implementing uni- and multivariable statistical models were analysed separately.
Thirty-two studies involving almost 30 000 patients were included in the review. Preoperative pain was the predictor that most commonly demonstrated a significant relationship with persistent pain across uni- and multivariable analyses. In the meta-analyses of data from univariate models, the largest effect sizes were found for: other pain sites, catastrophizing, and depression. For data from multivariate models, significant effects were evident for: catastrophizing, preoperative pain, mental health, and comorbidities.
Catastrophizing, mental health, preoperative knee pain, and pain at other sites are the strongest independent predictors of persistent pain after TKA.
多项研究已经确定了与持续性手术后疼痛相关的临床、心理社会、患者特征和围手术期变量；然而，这些变量的相对影响尚未被量化。本研究的目的是对与全膝关节置换术（TKA）后持续性疼痛相关的预测变量进行系统评价和荟萃分析。
纳入的研究必须在手术前或手术时测量预测变量，在 TKA 后至少 3 个月测量疼痛结局指标，并对预测变量对结局指标的影响进行统计学分析。对每个预测变量进行分析的次数以及发现其与持续性疼痛存在显著关系的次数进行了计数。分别进行了荟萃分析，以确定每个预测变量对持续性疼痛的效应大小。分别分析了实施单变量和多变量统计模型的研究的结果。
本综述共纳入了 32 项研究，涉及近 3 万名患者。术前疼痛是最常见的预测因素，在单变量和多变量分析中均与持续性疼痛有显著关系。在单变量模型数据的荟萃分析中，发现其他疼痛部位、灾难化和抑郁的效应量最大。对于多变量模型的数据，灾难化、术前疼痛、心理健康和合并症有显著影响。
灾难化、心理健康、术前膝关节疼痛和其他部位疼痛是 TKA 后持续性疼痛的最强独立预测因素。
