Bossmann Tanja, Brauner Torsten, Wearing Scott, Horstmann Thomas
Department of Conservative & Rehabilitative Orthopedics, Faculty of Sports & Health Sciences, Technical University Munich, Germany.
Institute of Health & Biomedical Innovation, Queensland University of Technology, Kelvin Grove campus, Australia.
Pain Manag. 2017 Sep;7(5):391-403. doi: 10.2217/pmt-2017-0023. Epub 2017 Sep 22.
This study explored whether nociceptive (NS) and autonomic nervous system (ANS) dysregulation and psychological distress were predictive of pain 6 months after primary total knee replacement.
PATIENTS & METHODS: ANS and NS regulation, psychological distress and self-reported pain, stiffness and function were evaluated preoperatively in 56 patients. Pain severity measured 6 months after surgery was used as the primary outcome in an analysis of covariance model.
The data of 47 patients (85.5%) could be analyzed. Postoperative pain severity 6 months after surgery was significantly associated with reduced heart rate variability and tended to be related to a lower conditioned pain modulation effect, but the latter only in females.
Due to the small sample size the results must be interpreted with caution. A dysregulation of ANS and NS may be predictive of pain severity 6 months after total knee replacement. The impact of the conditioned pain modulation effect could be sex specific.
本研究探讨伤害性神经系统（NS）和自主神经系统（ANS）功能失调以及心理困扰是否可预测初次全膝关节置换术后6个月的疼痛情况。
对56例患者术前评估了ANS和NS功能、心理困扰以及自我报告的疼痛、僵硬和功能情况。手术6个月后测量的疼痛严重程度用作协方差分析模型的主要结局指标。
47例患者（85.5%）的数据可进行分析。术后6个月的术后疼痛严重程度与心率变异性降低显著相关，并且倾向于与较低的条件性疼痛调制效应有关，但后者仅在女性中存在。
由于样本量较小，结果必须谨慎解读。ANS和NS功能失调可能可预测全膝关节置换术后6个月的疼痛严重程度。条件性疼痛调制效应的影响可能具有性别特异性。
