Prognostic value of preoperative mechanical hyperalgesia and neuropathic pain qualities for postoperative pain after total knee replacement.

Autor: Vigotsky AD; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Biomedical Engineering and Statistics, Northwestern University, Evanston, Illinois, USA., Cong O; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Pinto CB; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Barroso J; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Perez J; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Petersen KK; Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark.; Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark., Arendt-Nielsen L; Department of Health Science and Technology, Center for Neuroplasticity and Pain (CNAP), SMI, Faculty of Medicine, Aalborg University, Aalborg, Denmark.; Department of Material and Production, Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Faculty of Engineering and Science, Aalborg University, Aalborg, Denmark.; Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.; Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark., Hardt KD; Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Manning D; Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Apkarian AV; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Branco P; Center for Translational Pain Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Neuroscience, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.; Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: European journal of pain (London, England) [Eur J Pain] 2024 Sep; Vol. 28 (8), pp. 1387-1401. Date of Electronic Publication: 2024 Jun 08.
DOI: 10.1002/ejp.2295
Abstrakt: Background: Total knee replacement (TKR) is the gold standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings.
Methods: This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6 and 12 months post-TKR. We assessed preoperative and postoperative (3 and 6 months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM) and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia and temporal summation to repeated pinprick stimulation.
Results: Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial knee undergoing TKR, and cuff pressure at the calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with preoperative KOA pain intensity. Moreover, preoperative pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6 and 12 months respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up.
Conclusion: Our findings suggest that preoperative pinprick hyperalgesia and neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.
Significance Statement: This study's findings hold significant implications for chronic pain management in knee osteoarthritis patients, particularly those undergoing total knee replacement surgery (TKR). Mechanical hyperalgesia and neuropathic pain-like characteristics predict postoperative pain 1 year after TKR, emphasizing the importance of understanding pain phenotypes in OA for selecting appropriate pain management strategies. The normalization of hyperalgesia after surgery correlates with better long-term outcomes, further highlighting the therapeutic potential of addressing abnormal pain processing mechanisms pre- and post-TKR.
(© 2024 The Author(s). European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.)
Databáze: MEDLINE
Externí odkaz: