Does pre-surgical central modulation of pain influence outcome after total knee replacement? A systematic review

Abstract

The aim of this study is to systematically review whether the presence of altered central pain modulation pre-surgical influences outcome after total knee replacement (TKR) in patients with knee osteoarthritis (OA), and if so which indices of central pain modulation predict poor outcome after TKR. To identify relevant articles, PubMed and Web of Science were searched. The search strategy was a combination of key words related to "Knee Osteoarthritis and Total Knee Replacement", "Central Pain Modulation" and "Post-Surgical Outcome Measures". Articles fulfilling the inclusion criteria were screened for methodological quality and results were analyzed and summarized. Sixteen prospective cohort studies were included. Strong evidence is available that presence of catastrophic thinking and poor coping strategies predict more pain after TKR and that there is no association between fear of movement and post-surgical pain or function. Evidence on other psychosocial influences is limited or conflicting. Literature on the influence of other signs of altered central pain modulation on post-surgical outcome is scarce. It is plausible that pre-surgical signs of altered central pain modulation, such as joint pain at rest or widespread pain sensitization, predict more post-surgical pain. Surgeons should be attentive for patients with signs of altered central pain modulation before surgery as they might be at risk for unfavorable outcome. A broader therapeutic approach aiming to desensitize the central nervous system can be adapted in these patients. Further research is however needed to identify the influence of central pain modulation pre-surgical in predicting outcome after TKR.

Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis

“…The association between duration of symptoms and CPM has particular clinical implications. CPM can be assessed easily in a clinical setting and can predict treatment outcomes including that of TKA . Moreover CPM may respond to rehabilitation, such as the joint mobilization intervention evaluated in our previous study .…”

“…Clinical trials in knee OA have demonstrated that longer pain duration has been associated with poorer outcomes . In addition, abnormal descending pain inhibition may predict poor pain outcomes after total knee arthroplasty, and women may be at increased risk for have poorer total knee arthroplasty outcomes . There are currently no validated appropriateness criterial for knee arthroplasty—moreover, women tend to delay surgery until their symptoms are more severe than their male counterparts .…”

Toward a Mechanism-Based Approach to Pain Diagnosis

“…A predisposition to develop neuropathic pain may be present in FBSS patients due to genetic or epigenetic factors, independent of surgical technique or patient management, but at present we cannot identify these factors pre-operatively, though genetic polymorphisms may eventually help. Patients with more and wider spread secondary hyperalgesia as well as with psychological dysfunction have a higher risk of poor surgical outcome 14, 17, 25 Whether this reflects higher susceptibility to establishment of an autonomous centralized state is intriguing to consider, but requires evidence to support it.…”

Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review

“…Nonetheless, further investigation is needed to better understand the neurobiological underpinnings of these centrally mediated comorbid symptoms and how they interact with psychological variables. A recent systematic review adopted a broader approach and interpreted self‐report measures of catastrophic thinking and pain coping strategies as indices of altered central pain modulation, based on the capacity of the forebrain to modulate pain processing through powerful descending pathways . This review found strong evidence that pain coping skills and catastrophic thinking were predictors of more pain at various time points after TKA .…”

“…A recent systematic review adopted a broader approach and interpreted self‐report measures of catastrophic thinking and pain coping strategies as indices of altered central pain modulation, based on the capacity of the forebrain to modulate pain processing through powerful descending pathways . This review found strong evidence that pain coping skills and catastrophic thinking were predictors of more pain at various time points after TKA . Meanwhile, Brummett et al .…”