Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
J Pain. 2022 Oct;23(10):1712-1723. doi: 10.1016/j.jpain.2022.04.005. Epub 2022 Apr 22.
This prospective observational study evaluated preoperative predictors of complex regional pain syndrome (CRPS) outcomes in the 6 months following total knee arthroplasty (TKA). Participants were n = 110 osteoarthritis patients (64.5% female) undergoing unilateral TKA with no prior CRPS history. Domains of negative affect (depression, anxiety, catastrophizing), pain (intensity, widespread pain, temporal summation of pain [TSP]), pain interference, sleep disturbance, and pro-inflammatory status (tumor necrosis factor-alpha [TNF-a]) were assessed preoperatively. CRPS outcomes at 6-week and 6-month follow-up included the continuous CRPS Severity Score (CSS) and dichotomous CRPS diagnoses (2012 IASP criteria). At 6 months, 12.7% of participants met CRPS criteria, exhibiting a "warm CRPS" phenotype. Six-week CSS scores were predicted by greater preoperative depression, anxiety, catastrophizing, TSP, pain intensity, sleep disturbance, and TNF-a (P's < .05). Provisional CRPS diagnosis at 6 weeks was predicted by higher preoperative TSP, sleep disturbance, and TNF-a (P's < .05). CSS scores at 6 months were predicted by more widespread and intense preoperative pain, and higher preoperative TSP, pain interference, and TNF-a (P's < .01). CRPS diagnosis at 6 months was predicted only by more widespread and intense pain preoperatively (P's < .05). Risk for CRPS following TKA appears to involve preoperative central sensitization and inflammatory mechanisms. Preoperative negative affect is unlikely to directly influence long-term CRPS risk. PERSPECTIVE: This article identifies preoperative predictors of CRPS features at 6 months following total knee arthroplasty, including more widespread pain and higher pain intensity, temporal summation of pain, pain interference, and tumor necrosis factor-alpha levels. Findings suggest the importance of central sensitization and inflammatory mechanisms in CRPS risk following tissue trauma.
本前瞻性观察研究评估了全膝关节置换术（TKA）后 6 个月内复杂区域疼痛综合征（CRPS）结局的术前预测因素。参与者为 110 名接受单侧 TKA 的骨关节炎患者（64.5%为女性），且无 CRPS 病史。术前评估了负性情绪（抑郁、焦虑、灾难化思维）、疼痛（强度、广泛性疼痛、疼痛时间总和[TSP]）、疼痛干扰、睡眠障碍和促炎状态（肿瘤坏死因子-α[TNF-a]）等领域。6 周和 6 个月随访时的 CRPS 结局包括连续 CRPS 严重程度评分（CSS）和 CRPS 诊断（2012 IASP 标准）。在 6 个月时，12.7%的参与者符合 CRPS 标准，表现出“温热型 CRPS”表型。6 周 CSS 评分由术前更高的抑郁、焦虑、灾难化思维、TSP、疼痛强度、睡眠障碍和 TNF-a 预测（P <.05）。6 周时的暂定 CRPS 诊断由更高的术前 TSP、睡眠障碍和 TNF-a 预测（P <.05）。6 个月时的 CSS 评分由术前更广泛和强烈的疼痛以及更高的术前 TSP、疼痛干扰和 TNF-a 预测（P <.01）。6 个月时的 CRPS 诊断仅由术前更广泛和强烈的疼痛预测（P <.05）。TKA 后发生 CRPS 的风险似乎涉及术前中枢敏化和炎症机制。术前负性情绪不太可能直接影响长期 CRPS 风险。观点：本文确定了 TKA 后 6 个月内 CRPS 特征的术前预测因素，包括更广泛的疼痛和更高的疼痛强度、TSP、疼痛干扰和肿瘤坏死因子-α水平。研究结果表明，中枢敏化和炎症机制在组织创伤后 CRPS 风险中具有重要意义。
