Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review

Abstract

Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.

Evolution of somatosensory processing signs after nociceptive targeted surgery in patients with musculoskeletal disorders: a systematic review

“…28,37 Findings of previous systematic reviews are also in line with this theory because they also mainly focused on preoperative SPS signs and the link with postoperative pain and found as such no fully consistent conclusions. 12,44,47,50,51,61 A recent review indicates the importance of performing more studies focusing on the evolution of SPS signs in combination with or without pain improvement, 4 and also our review reveals that the improvement of pain-related variables over time is a predictor (according to correlation analyses) for an improvement of PPT, CPM, and EIH over time and vice versa, which also strengthens this theory. It is possible that disturbed SPS signs are present preoperatively, but if they normalize after surgery in combination with pain relief, it is postulated that the driving factor for the disturbed SPS sign was the nociceptive source itself (chronic secondary MSK pain).…”

Transition from acute to chronic pain: a misleading concept?

“…24 Similarly, studies addressing clinical signs of central sensitization before surgery show some evidence for a link to chronic pain only for total joint arthroplasty, and with conflicting results. 52,54 Nevertheless, the association between severe acute and persistent postsurgical pain (PPSP) found in many studies 21,35,53 has been used to argue for the hypothesis that PPSP may be prevented by preemptive treatment or aggressive treatment of acute postsurgical pain. However, there is so far no proof of a causative link between acute postsurgical pain and PPSP 21,34,36,43 and no evidence that preemptive 48 or early treatment can prevent PPSP 11,31,40,44 despite evidence from preclinical research, 56 albeit only few clinical studies have been performed.…”

“…24 Similarly, studies addressing clinical signs of central sensitization before surgery show some evidence for a link to chronic pain only for total joint arthroplasty, and with conflicting results. 52,54 Nevertheless, the association between severe acute and persistent postsurgical…”

Quantitative sensory testing as an assessment tool to predict the response to standard pain treatment in knee osteoarthritis: a systematic review and meta-analysis

“…49 Studies indicate that some patients are more pain sensitive than others, 3,23,31 and the new pain descriptor "nociplastic" may apply to these pain sensitive patients. 33 Parades et al 42 reviewed the literature on the predictive role of QST on acute and chronic pain after TKA and identified 9 studies in which preoperative QST predicted chronic postoperative pain, but the field has grown since the Parades et al 42 review, and it is currently unknown if these predictions can be applied to other standard pain therapies for OA as recommended by the OARSI. 9 The current paper aims to provide an up-to-date systematic review and meta-analysis on the possible role of specific QST parameters to predict outcome after surgical, pharmacological, and exercise-based therapies in OA.…”