Fitzsimmons Matthew, Carr Eloise, Woodhouse Linda, Bostick Geoff P
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada(∗).
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada(†).
PM R. 2018 Sep;10(9):903-909. doi: 10.1016/j.pmrj.2018.01.010. Epub 2018 Feb 13.
Despite the effectiveness of total knee arthroplasty (TKA) for osteoarthritis (OA), up to 20% will report knee pain 1 year after surgery. One possible reason is the development of neuropathic pain before or after TKA.
To longitudinally describe suspected neuropathic pain in patients pre- and post-TKA and to explore relations between pre-TKA suspected neuropathic pain and post-TKA outcomes.
Prospective observational study.
Participants were recruited from orthopedic surgery clinics prior to inpatient elective primary TKA.
Convenience sample of 135 patients were assessed for eligibility; 99 were enrolled and 74 completed the 6-month follow-up.
Participants completed the Self-Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and outcome measures at baseline (pre-TKA) and 1 and 6 months post-TKA by postal survey. Demographic variables included age, gender, and comorbidities. Descriptive statistics were calculated for the presence of suspected neuropathic pain at each assessment and course of outcomes for various suspected neuropathic pain trajectories. Further, t-tests were used to compare outcomes between those with and without suspected neuropathic pain at each assessment. Multiple linear regressions assessed the relationship between baseline suspected neuropathic pain and 6-month outcomes.
Intermittent and Constant Osteoarthritis Pain (ICOAP), Pain Catastrophizing Scale (PCS), and the Patient Health Questionnaire (PHQ-9) for depression.
Suspected neuropathic pain was present in 35.5% of pre-TKA patients, 39.0% at 1 month, and 23.6% at 6 months post-TKA. Those with suspected neuropathic pain had higher scores for ICOAP total pain (P = .05), pain catastrophizing (P < .01), and depression (P < .01) at each assessment. After adjusting for potential confounding, pre-TKA suspected neuropathic pain did not predict ICOAP total pain or PHQ-9 depression scores at 6 months.
Although 14% of individuals with knee OA had suspected neuropathic pain that persisted 6 months post-TKA and those with suspected neuropathic pain had higher levels of pain, catastrophizing, and depression, the clinical identification of neuropathic pain remains enigmatic. Preoperative suspected neuropathic pain, as measured by S-LANSS, may have limited prognostic value for post-TKA outcomes.
II.
尽管全膝关节置换术（TKA）对骨关节炎（OA）有效，但高达20%的患者在术后1年仍会报告膝关节疼痛。一个可能的原因是TKA术前或术后发生神经性疼痛。
纵向描述TKA术前和术后患者疑似神经性疼痛的情况，并探讨TKA术前疑似神经性疼痛与术后结果之间的关系。
前瞻性观察研究。
参与者在住院择期初次TKA手术前从骨科门诊招募。
对135例患者的便利样本进行资格评估；99例入选，74例完成了6个月的随访。
参与者通过邮寄调查问卷在基线（TKA术前）、TKA术后1个月和6个月完成自我利兹神经性症状和体征评估（S-LANSS）及结果测量。人口统计学变量包括年龄、性别和合并症。计算每次评估时疑似神经性疼痛的存在情况以及各种疑似神经性疼痛轨迹的结果病程的描述性统计数据。此外，使用t检验比较每次评估时有和没有疑似神经性疼痛的患者之间的结果。多元线性回归评估基线疑似神经性疼痛与6个月结果之间的关系。
间歇性和持续性骨关节炎疼痛（ICOAP）、疼痛灾难化量表（PCS）以及用于评估抑郁的患者健康问卷（PHQ-9）。
TKA术前35.5%的患者存在疑似神经性疼痛，术后1个月为39.0%，术后6个月为23.6%。在每次评估中，有疑似神经性疼痛的患者在ICOAP总疼痛（P = 0.05）、疼痛灾难化（P < 0.01）和抑郁（P < 0.01）方面得分更高。在调整潜在混杂因素后，TKA术前疑似神经性疼痛不能预测6个月时的ICOAP总疼痛或PHQ-9抑郁评分。
尽管14%的膝骨关节炎患者在TKA术后6个月仍存在疑似神经性疼痛，且有疑似神经性疼痛的患者疼痛、灾难化和抑郁水平更高，但神经性疼痛的临床识别仍然难以捉摸。通过S-LANSS测量的术前疑似神经性疼痛对TKA术后结果的预后价值可能有限。
II级。
