Wall Amanda J W, Leyland Kirsten M, Kiran Amit, Arden Nigel K, Cooper Cyrus, Wanigasekera Vishvarani, Javaid M Kassim, Price Andrew J, Tracey Irene M C, Irani Anushka
Oxford University Centre for Integrative Neuroimaging, Nuffield Department Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, UK.
Mayo Clin Proc Innov Qual Outcomes. 2025 Aug 4;9(5):100649. doi: 10.1016/j.mayocpiqo.2025.100649. eCollection 2025 Oct.
To investigate whether neuropathic-like pain, identified using the PainDETECT questionnaire, predicts postoperative symptoms, using data from 2 independent, prospective cohort studies.
Data were collected from patients undergoing primary knee arthroplasty for primary osteoarthritis recruited to the Evaluation of perioperative Pain in Osteoarthritis of the kNEe (EPIONE) Study n=120, from October 1, 2011, to May 30, 2014, and the Clinical Outcomes in Arthroplasty Study (COASt) n=404, from January 1, 2010, to December 31, 2018). The PainDETECT questionnaire score was used to divide patients into nociceptive (<13), unclear (13-18), and neuropathic pain (>18) groups preoperatively using validated cutoffs. As the neuropathic group also captures nociplastic pain, we used neuropathic-like to represent this combination. Surgical outcome was compared between groups using the Oxford Knee Score (OKS) and the presence of moderate to severe pain 12 months after arthroplasty.
Total of 296 (56%) reported nociceptive, 144 (27%) unclear, and 84 (16%) neuropathic-like pain preoperatively. Patients in the neuropathic-like pain group had significantly worse OKS postoperatively, compared with the nociceptive group (34 [12] vs 40 [8], <.05), independent of baseline OKS, age, sex, and body mass index. Moderate to severe pain 12 months after arthroplasty was statistically significantly higher in the unclear (OR 2.19 [95% CI, 1.36-3.53]) and neuropathic-like (OR, 2.83 [95% CI, 1.58-5.09]) pain groups when compared with the nociceptive group.
Patients classified presurgery as having unclear and neuropathic pain by the modified PainDETECT have considerably worse outcomes after surgery. Neuropathic pain categorized by this tool commonly has centralized pain features and is a potential predictor of ongoing postsurgical pain. Knowledge of this may aid informed decision-making with respect to surgical intervention for those with knee osteoarthritis.
利用两项独立的前瞻性队列研究的数据，调查使用疼痛检测问卷识别出的神经性疼痛样疼痛是否能预测术后症状。
数据收集自因原发性骨关节炎接受初次膝关节置换术的患者，这些患者来自膝关节骨关节炎围手术期疼痛评估（EPIONE）研究（n = 120，2011年10月1日至2014年5月30日）和关节置换术临床结果研究（COASt）（n = 404，2010年1月1日至2018年12月31日）。术前使用经过验证的临界值，根据疼痛检测问卷评分将患者分为伤害性疼痛组（<13分）、不明疼痛组（13 - 18分）和神经性疼痛组（>18分）。由于神经性疼痛组也包含了伤害感受性疼痛，我们使用神经性疼痛样来表示这种组合。使用牛津膝关节评分（OKS）以及关节置换术后12个月时中重度疼痛的情况比较两组的手术结果。
共有296例（56%）患者术前报告有伤害性疼痛，144例（27%）为不明疼痛，84例（16%）为神经性疼痛样疼痛。与伤害性疼痛组相比，神经性疼痛样疼痛组患者术后的OKS明显更差（34 [12] 对40 [8]，P <.05），且与基线OKS、年龄、性别和体重指数无关。与伤害性疼痛组相比，不明疼痛组（比值比2.19 [95%可信区间，1.36 - 3.53]）和神经性疼痛样疼痛组（比值比2.83 [95%可信区间，1.58 - 5.09]）在关节置换术后12个月时中重度疼痛的发生率在统计学上显著更高。
术前经改良疼痛检测问卷分类为不明疼痛和神经性疼痛的患者术后结局明显更差。该工具分类的神经性疼痛通常具有疼痛集中的特征，是术后持续疼痛的潜在预测指标。了解这一点可能有助于为膝关节骨关节炎患者的手术干预做出明智的决策。
