Wylde Vikki, Sayers Adrian, Lenguerrand Erik, Gooberman-Hill Rachael, Pyke Mark, Beswick Andrew D, Dieppe Paul, Blom Ashley W
Musculoskeletal Research Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, England North Bristol NHS Trust, Southmead Hospital, Bristol, England Medical School, University of Exeter, Exeter, England.
Pain. 2015 Jan;156(1):47-54. doi: 10.1016/j.pain.0000000000000002.
Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.
关节置换术后的慢性疼痛很常见，全髋关节置换术（THR）后约10%的患者以及全膝关节置换术（TKR）后20%的患者会受到影响。对伤害性输入的普遍敏感性增强可能是这种疼痛发生的一个风险因素。本研究的主要目的是调查术前广泛的疼痛敏感性是否与关节置换术后的慢性疼痛相关。对254例行THR的患者和239例行TKR的患者的数据进行了分析。术前和术后12个月使用西安大略和麦克马斯特大学骨关节炎疼痛量表评估疼痛。术前通过使用压力痛觉计测量前臂的压力痛阈（PPTs）来评估广泛的疼痛敏感性。使用线性回归和线性混合模型进行统计分析，并对混杂变量进行了调整。在THR和TKR队列中，较低的PPTs（增强的广泛疼痛敏感性）均与术前较高的疼痛严重程度显著相关。在THR队列中，较低的PPTs也与术后12个月时较高的疼痛严重程度显著相关。然而，在TKR或THR队列中，PPTs与术前至术后12个月疼痛严重程度的变化均无关。这些发现表明，尽管术前广泛的压力痛觉敏感性与关节置换术前和术后的疼痛严重程度相关，但它并不是患者从关节置换手术中获得的疼痛缓解量的预测指标，与术前疼痛严重程度无关。
