Adverse Effects of Higher Preoperative Pain at Rest, a Central Sensitization-Related Symptom, on Outcomes After Total Hip Arthroplasty in Patients with Osteoarthritis

Ohashi, Y; Fukushima, Kazuhiko; Uchida, Kentaro; Koyama, Tomohisa; Tsuchiya, Maho; Saito, Hiroki; Uchiyama, Katsufumi; Takahira, Naonobu; Inoue, Gen; Takaso, Masashi

doi:10.2147/jpr.s322314

Cited by 12 publications

(7 citation statements)

References 31 publications

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“…While preliminary data suggest that some features of altered brain morphology associated with pain in osteoarthritis are potentially reversible within the first year after surgery,45 the nature and timing of any potential resolution of central sensitisation after surgery requires further investigation. Studies which have used questionnaire-based screening methods to identify features of central sensitisation in the preoperative and postoperative periods suggest it is likely to persist at least up to 2 years after surgery 46–49…”

Section: Discussionmentioning

confidence: 99%

Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

et al. 2022

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ObjectiveAs part of the STAR Programme, a comprehensive study exploring long-term pain after surgery, we investigated how pain and function, health-related quality of life (HRQL), and healthcare resource use evolved over 5 years after total knee replacement (TKR) for those with and without chronic pain 1 year after their primary surgery.MethodsWe used data from the Clinical Outcomes in Arthroplasty Study prospective cohort study, which followed patients undergoing TKR from two English hospitals for 5 years. Chronic pain was defined using the Oxford Knee Score Pain Subscale (OKS-PS) where participants reporting a score of 14 or lower were classified as having chronic pain 1-year postsurgery. Pain and function were measured with the OKS, HRQL using the EuroQoL-5 Dimension, resource use from yearly questionnaires, and costs estimated from a healthcare system perspective. We analysed the changes in OKS-PS, HRQL and resource use over a 5-year follow-up period. Multiple imputation accounted for missing data.ResultsChronic pain was reported in 70/552 operated knees (12.7%) 1 year after surgery. The chronic pain group had worse pain, function and HRQL presurgery and postsurgery than the non-chronic pain group. Those without chronic pain markedly improved right after surgery, then plateaued. Those with chronic pain improved slowly but steadily. Participants with chronic pain reported greater healthcare resource use and costs than those without, especially 1 year after surgery, and mostly from hospital readmissions. 64.7% of those in chronic pain recovered during the following 4 years, while 30.9% fluctuated in and out of chronic pain.ConclusionAlthough TKR is often highly beneficial, some patients experienced chronic pain postsurgery. Although many fluctuated in their pain levels and most recovered over time, identifying people most likely to have chronic pain and supporting their recovery would benefit patients and healthcare systems.

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Section: Discussionmentioning

confidence: 99%

Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

et al. 2022

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“…We also investigated the correlations between pre-operative CSI scores and post-operative clinical outcomes in HOA patients with and without CSSs. Several studies indicated the associations between pre-operative CSI scores and poor post-operative outcomes in patients with HOA and KOA 10 , 23 , 24 . As in previous studies, the CSI score correlated with pain, function, mental, and total scores on the JHEQ in patients with HOA without CSSs in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between poor post-operative outcomes and the number of CSSs is still controversial. Several studies have reported a correlation between the pre-operative degree of CS and poor outcomes, including persistent pain after THA 10 , 31 . However, to our best knowledge, no study has previously indicated differences in post-operative outcomes according to the number of CSSs morbidities.…”

Section: Discussionmentioning

confidence: 99%

“…In the past decade, central sensitization (CS), defined as increased responsiveness of nociceptive neurons in the central nervous system to normal or subthreshold afferent input, has been suggested to contribute to the persistence and extent of pain in HOA and knee osteoarthritis (KOA) 8 , 9 . A high degree of pre-operative CS has been reported as a risk factor for residual pain at 1-year post-operatively in patients who undergo THA for HOA 10 . Furthermore, both pre-operatively and post-operatively, CS is resistant to treatment, including traditional physiotherapy and pain medication; however, specific treatments have been found to be effective 11 , 12 .…”

Section: Introductionmentioning

confidence: 99%

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Differences in outcomes after total hip arthroplasty for osteoarthritis between patients with and without central sensitivity syndromes other than fibromyalgia

Ohashi

Fukushima

Uchida

et al. 2022

Sci Rep

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We investigated the differences in outcomes after total hip arthroplasty (THA) for hip osteoarthritis (HOA) between patients with and without central sensitivity syndromes (CSSs) other than fibromyalgia (FM). After excluding two patients with FM, we compared the clinical data of 41 patients with CSSs and 132 patients without CSSs. Clinical data included scores on the central sensitization inventory, visual analog scale for pain (VAS pain), and Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). VAS pain was significantly higher at 3 and 6 months after THA in patients with CSSs than in those without CSSs (3 and 6 months, P < 0.001). Satisfaction, pain, and mental JHEQ scores were lower in patients with CSSs than in those without CSSs (satisfaction, P < 0.001; pain, P = 0.011; mental, P = 0.032). Multiple regression analyses indicated that one and ≥ 2 CSS diagnoses significantly impacted the satisfaction score (one CSS, β = − 0.181, P = 0.019; ≥ 2 CSSs, β = − 0.175, P = 0.023). Two or more CSSs were the only factor influencing the pain score (β = − 0.175, P = 0.027). Pain in patients with CSSs reflects central sensitization, which may adversely affect post-operative outcomes. Surgeons should pay attention to patients with a history of CSSs diagnoses who undergo THA for HOA.

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“…According to a 5-point Likert scale, each of the items was graded on a scale of 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = always. There has been a significant impact on postoperative pain residuals as well as a decrease in satisfaction with CS in studies evaluated by CSI [70][71][72]. Our previous study suggested that the pre-operative CSI score was negatively correlated with pain and satisfaction scores at 12 months after surgery in patients undergoing total hip arthroplasty (THA) for HOA [70].…”

Section: Clinical Characteristics Of Sensitized Pain In Oamentioning

confidence: 99%

Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain

Ohashi¹,

Uchida²,

Fukushima³

et al. 2023

Cureus

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Pain, the primary symptom of osteoarthritis (OA), reduces both the quality and quantity of life for patients. The pathophysiology of OA pain is complex and often difficult to explain solely by radiological structural changes. One reason for this discrepancy is pain sensitization (peripheral sensitization [PS] and central sensitization [CS]) in OA. Thus, an understanding of pain sensitization is important when considering treatment strategies and development for OA pain. In recent years, pro-inflammatory cytokines, nerve growth factors (NGFs), and serotonin have been identified as causative agents that induce peripheral and central sensitization and are becoming therapeutic targets for OA pain. However, the characteristics of the clinical manifestations of pain sensitization elicited by these molecules remain unclear, and it is not well understood who among OA patients should receive the therapeutic intervention. Thus, this review summarizes evidence on the pathophysiology of peripheral and central sensitization in OA pain and the clinical features and treatment options for this condition. While the majority of the literature supports the existence of pain sensitization in chronic OA pain, clinical identification and treatment of pain sensitization in OA are still in their infancy, and future studies with good methodological quality are needed.

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Adverse Effects of Higher Preoperative Pain at Rest, a Central Sensitization-Related Symptom, on Outcomes After Total Hip Arthroplasty in Patients with Osteoarthritis

Cited by 12 publications

References 31 publications

Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

Differences in outcomes after total hip arthroplasty for osteoarthritis between patients with and without central sensitivity syndromes other than fibromyalgia

Mechanisms of Peripheral and Central Sensitization in Osteoarthritis Pain

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