Phillips Jonathan Ra, Hopwood Beverley, Stroud Rowenna, Dieppe Paul A, Toms Andrew D
Royal Devon and Exeter Hospital, Exeter, UK.
Br J Pain. 2017 Nov;11(4):203-209. doi: 10.1177/2049463717719774. Epub 2017 Jul 31.
The aims of this study were to characterise the pain experienced by patients with chronic pain after knee replacement (KR), in whom no apparent 'orthopaedic' problem could be identified, and to establish how many have pain sensitisation problems (including neuropathic pain).
A total of 44 patients were prospectively evaluated at a multidisciplinary tertiary referral clinic by an orthopaedic surgeon, pain specialist, rheumatologist and physiotherapist. These patients had been pre-screened by an orthopaedic surgeon to remove cases where there was an obvious cause of pain that could be treated with revision surgery. They were then followed up to find out whether any subsequent interventions had occurred.
The mean time since surgery was 29 months (range: 3-108 months), and 18% were revision KR. Patients were evaluated for symptoms of nociceptive pain, allodynia, pains elsewhere and psychosocial factors. The patients were categorised into nociceptive pain 43% (n = 19), pain sensitisation 25% (n = 11) and mixed pain 32% (n = 14). Mean Visual Analogue Score (VAS) pain scores were 6.7/10 with high scores for both constant (66%) and intermittent (70%) pain elements, and pain caused high levels of interference with life. Fifty percent suffered depression and 25% suffered widespread pains (more than three pains elsewhere in the body). Patients with widespread pains suffered more pain (p = 0.01) and higher rates of both pain sensitisation (p = 0.07) and thermal allodynia (p < 0.04).
Patients after KR can experience severe pain that interferes with their lives, depression and many have pain sensitisation problems rather than any local, nociceptive cause. We advocate screening patients with unexplained pain after KR for pain sensitisation problems, pains at other sites and depression. Appropriate further treatment and multidisciplinary interventions can then be arranged.
本研究旨在描述膝关节置换术（KR）后慢性疼痛患者所经历的疼痛特征，这些患者未发现明显的“骨科”问题，并确定有多少患者存在疼痛敏化问题（包括神经性疼痛）。
共有44例患者在一家多学科三级转诊诊所接受了骨科医生、疼痛专家、风湿病学家和物理治疗师的前瞻性评估。这些患者已由骨科医生进行了预筛查，以排除存在可通过翻修手术治疗的明显疼痛原因的病例。然后对他们进行随访，以了解是否有任何后续干预措施。
术后平均时间为29个月（范围：3 - 108个月），18%为翻修KR。对患者进行了伤害性疼痛、痛觉过敏、其他部位疼痛和心理社会因素症状的评估。患者被分为伤害性疼痛43%（n = 19）、疼痛敏化25%（n = 11）和混合性疼痛32%（n = 14）。平均视觉模拟评分（VAS）疼痛评分为6.7/10，持续性（66%）和间歇性（70%）疼痛因素得分均较高，且疼痛对生活造成了高度干扰。50%的患者患有抑郁症，25%的患者患有广泛性疼痛（身体其他部位有三处以上疼痛）。患有广泛性疼痛的患者疼痛更严重（p = 0.01），疼痛敏化（p = 0.07）和热痛觉过敏（p < 0.04）的发生率更高。
KR术后患者可能会经历严重疼痛，影响他们的生活，出现抑郁，且许多患者存在疼痛敏化问题，而非任何局部的伤害性原因。我们主张对KR术后不明原因疼痛的患者进行疼痛敏化问题、其他部位疼痛和抑郁的筛查。然后可以安排适当的进一步治疗和多学科干预。
