术前疼痛、条件性疼痛调制和疼痛灾难化预测全膝关节置换术后 12 个月的术后疼痛。

The Combination of Preoperative Pain, Conditioned Pain Modulation, and Pain Catastrophizing Predicts Postoperative Pain 12 Months After Total Knee Arthroplasty.

机构信息

SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark.

Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

出版信息

Pain Med. 2021 Jul 25;22(7):1583-1590. doi: 10.1093/pm/pnaa402.

DOI:10.1093/pm/pnaa402

PMID:33411890

Abstract

OBJECTIVES

Approximately 20% of knee osteoarthritis patients undergoing total knee arthroplasty (TKA) report chronic postoperative pain. Studies suggest that preoperative variables such as impaired descending pain control, catastrophizing, function, and neuropathic pain-like symptoms may predict postoperative pain 12 months after TKA, but the combined prediction value of these factors has not been tested. The current prospective cohort study aimed to combine preoperative risk factors to investigate the predictive value for postoperative pain 12 months after TKA.

DESIGN

Prospective cohort with follow-up 12 months after surgery.

PATIENTS

A consecutive sample of 131 knee osteoarthritis patients undergoing TKA.

METHODS

Pain intensity, Pain Catastrophizing Scale (PCS) scores, PainDETECT Questionnaire scores, conditioned pain modulation (CPM), and Oxford Knee Score (OKS) were obtained before and 12 months after TKA.

RESULTS

TKA improved pain (P < 0.001), PCS scores (P < 0.001), PainDETECT Questionnaire scores (P < 0.001), and OKSs (P < 0.001). Preoperative pain correlated with preoperative PCS scores (r = 0.38, P < 0.001), PainDETECT scores (r = 0.53, P < 0.001), and OKSs (r = -0.25, P = 0.001). Preoperative PainDETECT scores were associated with preoperative PCS scores (r = 0.53, P < 0.001) and OKSs (r = -0.25, P = 0.002). Higher postoperative pain was correlated with high preoperative pain (r = 0.424, P < 0.001), PCS scores (r = 0.33, P < 0.001), PainDETECT scores (r = 0.298, P = 0.001), and lower CPM (r = -0.18, P = 0.04). The combination of preoperative pain, PCS score, and CPM explained 20.5% of variance in follow-up pain. PCS scores had a significant effect on pain trajectory when accounting for patient variance (t = 14.41, P < 0.0005).

CONCLUSION

The combination of high preoperative clinical pain intensity, high levels of pain catastrophizing thoughts, and impaired CPM may predict long-term postoperative pain 12 months after surgery.

摘要

目的

大约 20%接受全膝关节置换术（TKA）的膝关节骨关节炎患者报告有慢性术后疼痛。研究表明，术前变量，如下降的疼痛控制受损、灾难化、功能和神经病理性疼痛样症状，可能预测 TKA 后 12 个月的术后疼痛，但这些因素的综合预测价值尚未得到检验。本前瞻性队列研究旨在结合术前危险因素，探讨 TKA 后 12 个月术后疼痛的预测价值。

设计

前瞻性队列研究，术后随访 12 个月。

患者

131 例膝关节骨关节炎患者连续接受 TKA。

方法

术前和 TKA 后 12 个月分别测定疼痛强度、疼痛灾难化量表（PCS）评分、疼痛检测问卷评分、条件性疼痛调制（CPM）和牛津膝关节评分（OKS）。

结果

TKA 改善了疼痛（P < 0.001）、PCS 评分（P < 0.001）、疼痛检测问卷评分（P < 0.001）和 OKS（P < 0.001）。术前疼痛与术前 PCS 评分（r = 0.38，P < 0.001）、疼痛检测评分（r = 0.53，P < 0.001）和 OKS（r = -0.25，P = 0.001）相关。术前疼痛检测评分与术前 PCS 评分（r = 0.53，P < 0.001）和 OKS（r = -0.25，P = 0.002）相关。较高的术后疼痛与较高的术前疼痛（r = 0.424，P < 0.001）、PCS 评分（r = 0.33，P < 0.001）、疼痛检测评分（r = 0.298，P = 0.001）和较低的 CPM（r = -0.18，P = 0.04）相关。术前疼痛、PCS 评分和 CPM 的组合解释了随访疼痛的 20.5%的变异性。当考虑到患者变异性时，PCS 评分对疼痛轨迹有显著影响（t = 14.41，P < 0.0005）。