Petersen Kristian Kjær, Arendt-Nielsen Lars, Simonsen Ole, Wilder-Smith Oliver, Laursen Mogens Berg
Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
Pain. 2015 Jan;156(1):55-61. doi: 10.1016/j.pain.0000000000000022.
Patients with knee osteoarthritis demonstrate decreased pressure pain thresholds (PPTs), facilitated temporal summation (TS) of pain, and decreased conditioned pain modulation (CPM) compared with healthy controls. This study aimed to correlate preoperative PPTs, TS, and CPM with the development of chronic postoperative pain after total knee replacement (TKR) surgery. Knee pain intensity (visual analog scale [VAS]: 0-10), PPTs, TS, and CPM were collected before, 2 months, and 12 months after TKR. Patients were divided into a low-pain (VAS < 3) and a high-pain (VAS ≥ 3) group based on their VAS 12 months after TKR. The high-pain group (N = 17) had higher pain intensities compared with the low-pain group (N = 61) before surgery (P = 0.009) and 12 months after surgery (P < 0.001). The PPTs of the low-pain groups were normalized for all measurement sites comparing presurgery with 12 months postsurgery (P < 0.05, contralateral arm: P = 0.059), which was not the case for the high-pain group. The low-pain group showed a functional inhibitory CPM preoperatively and 12 months postoperatively (P < 0.05), which was not found in the high-pain group. The high-pain group had higher facilitated TS preoperatively and 12 months postoperatively compared with the low-pain group (P < 0.05). Preoperative TS level correlated to 12-month postoperative VAS (R = 0.240, P = 0.037). Patients who developed moderate-to-severe pain had pronociceptive changes compared with patients who developed mild pain postsurgery. Preoperative TS level correlated with the postoperative pain intensity and may be a preoperative mechanistic predictor for the development of chronic postoperative pain in patients with osteoarthritis after TKR.
与健康对照组相比，膝关节骨关节炎患者表现出压力疼痛阈值（PPTs）降低、疼痛的时间总和（TS）增强以及条件性疼痛调制（CPM）降低。本研究旨在探讨全膝关节置换术（TKR）术前PPTs、TS和CPM与术后慢性疼痛发生之间的相关性。在TKR术前、术后2个月和12个月收集膝关节疼痛强度（视觉模拟评分法[VAS]：0-10）、PPTs、TS和CPM。根据TKR术后12个月的VAS，将患者分为低疼痛组（VAS<3）和高疼痛组（VAS≥3）。高疼痛组（N = 17）与低疼痛组（N = 61）相比，术前（P = 0.009）和术后12个月（P<0.001）疼痛强度更高。低疼痛组所有测量部位的PPTs在术前与术后12个月比较均恢复正常（P<0.05，对侧手臂：P = 0.059），高疼痛组则不然。低疼痛组术前和术后12个月表现出功能性抑制性CPM（P<0.05），高疼痛组未发现此现象。与低疼痛组相比，高疼痛组术前和术后12个月TS增强更明显（P<0.05）。术前TS水平与术后12个月的VAS相关（R = 0.240，P = 0.037）。与术后发生轻度疼痛的患者相比，发生中重度疼痛的患者具有伤害性感受变化。术前TS水平与术后疼痛强度相关，可能是TKR术后骨关节炎患者慢性术后疼痛发生的术前机制预测指标。
