Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia.
Osteoarthritis Cartilage. 2020 Nov;28(11):1403-1411. doi: 10.1016/j.joca.2020.07.010. Epub 2020 Aug 11.
Almost a third of those undergoing knee replacement for osteoarthritis have poor outcomes despite technically successful surgery. Preoperative neuropathic-like pain and/or pain sensitisation may increase the risk of pain following joint replacement.
To examine whether preoperative neuropathic-like pain and pain sensitisation predicts pain, function and satisfaction following joint replacement for knee osteoarthritis.
Systematic review with meta-analysis.
Medline, EMBASE and CINAHL were systematically searched until March 2020. Studies detecting neuropathic-like pain and/or sensitisation using self-report questionnaires prior to knee replacement for osteoarthritis, and relating this to post-operative outcomes were identified. Data extraction, risk of bias assessment and meta-analysis were performed, where appropriate.
Five manuscripts, including one preprint, examining six cohorts were included: four used painDETECT or modified painDETECT, one the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, and another the Central Sensitisation Inventory to identify preoperative characteristics. Three studies showed preoperative neuropathic-like pain or sensitisation was associated with more intense post-operative pain. All four studies examining the risk of significant pain after knee replacement suggested it was increased after >3 months. The only study examining patient satisfaction and function found reduced satisfaction, but no difference in function in those with preoperative sensitisation. Meta-analysis found the relative risk of increased pain following knee replacement in those with neuropathic-like pain (painDETECT ≥13) to be 2.05 (95% confidence intervals 1.51, 2.79).
These results provide consistent but limited evidence that self-report tools detecting neuropathic-like pain and/or pain sensitisation, predict patients at higher risk of pain following knee replacement.
尽管膝关节置换术在技术上是成功的，但仍有近三分之一的骨关节炎患者术后效果不佳。术前神经病理性疼痛和/或疼痛敏感可能会增加关节置换术后疼痛的风险。
研究术前神经病理性疼痛和疼痛敏感是否能预测膝关节骨关节炎关节置换术后的疼痛、功能和满意度。
系统评价和荟萃分析。
系统检索了 Medline、EMBASE 和 CINAHL，检索时间截至 2020 年 3 月。研究使用术前膝关节骨关节炎自我报告问卷检测神经病理性样疼痛和/或敏感，并将其与术后结果相关联。对数据进行提取、风险评估和荟萃分析。
共纳入五篇文献，包括一篇预印本，共涉及六个队列：四项研究使用疼痛 DETECT 或改良疼痛 DETECT，一项研究使用 Leeds 评估周围神经病理性疼痛症状和体征自评量表，另一项研究使用中枢敏化量表来确定术前特征。三项研究表明术前神经病理性样疼痛或敏感与术后更剧烈的疼痛相关。四项研究均表明膝关节置换术后 3 个月后出现显著疼痛的风险增加。唯一一项研究检测术前敏感对患者满意度和功能的影响，发现术前敏感与患者满意度降低相关，但与功能无差异。荟萃分析发现，术前存在神经病理性样疼痛（疼痛 DETECT≥13）的患者，膝关节置换术后疼痛增加的相对风险为 2.05（95%置信区间 1.51，2.79）。
这些结果提供了一致但有限的证据，表明自我报告工具检测神经病理性样疼痛和/或疼痛敏感可预测患者膝关节置换术后疼痛风险较高。
