Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis

Lewis, Gwyn N.; Rice, David A.; McNair, Peter; Kluger, M. T.

doi:10.1093/bja/aeu441

Cited by 449 publications

(461 citation statements)

References 64 publications

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“…These modest associations persisted when adjusted for sex, age, and number of medical comorbidities. Several psychologic factors, including anxiety or depression and catastrophizing, are associated with worse outcomes of surgical procedures including TKA [15,17,23,26,31,32]. Thus, the association we documented between painful body regions as determined using a body pain diagram and the MHI-5 and PCS scores suggests that the pain diagram may be useful in identifying patients at risk for a poor surgical outcome.…”

Section: Discussionmentioning

confidence: 66%

“…Studies have shown that pain catastrophizing, greater medical comorbidity, lower educational attainment, depression, fear avoidance, and other psychologic factors are associated with persistent pain and/ or enhanced functional limitations after TKA [9,10,17,26,29,35]. Pain catastrophizing has been defined as ''an exaggerated negative mental set brought to bear during actual or anticipated painful experience'' [31].…”

Section: Introductionmentioning

confidence: 99%

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Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Dave

Selzer

Losina

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Greater levels of self-reported pain, pain catastrophizing, and depression have been shown to be associated with persistent pain and functional limitation after surgeries such as TKA. It would be useful for clinicians to be able to measure these factors efficiently. Questions/purposes We asked: (1) What is the association of whole-body pain with osteoarthritis (OA)-related knee pain, function, pain catastrophizing, and mental health? (2) What is the sensitivity and specificity for different cutoffs for body pain diagram region categories in relation to pain catastrophizing? Methods Patients (n = 267) with knee OA undergoing elective TKA at one academic center and two community orthopaedic centers were enrolled before surgery in a prospective cohort study. Questionnaires included the WOMAC Pain and Function Scales, Pain Catastrophizing Scale (PCS), Mental Health Inventory-5 (MHI-5), and a pain body diagram. The diagram documents pain in 19 anatomic areas. Based on the distribution of the anatomic areas, we established six different body regions. Our analyses excluded the index (surgically treated) knee. Linear regression was used to evaluate the association between the total number of nonindex painful sites on the whole-body pain diagram and measures of OA-related pain and function, mental health, and pain catastrophizing. Generalized linear regression was used to evaluate the association between the number of painful nonindex body regions (categorized as 0; 1-2; or 3-6) with our measures of interest. All models were adjusted for age, sex, and number of comorbid conditions. The cohort included 63% females and the mean age was 66 years (SD, 9 years). With removal of the index knee, the median pain diagram score was 2 (25 th , 75 th percentiles, 1, 4) with a range of 0 to 15. The median number of painful body regions was 2 (25 th , 75 th percentiles, 1, 3). Results After adjusting for age, sex, and number of comorbid conditions, we found modest associations between painful body region categories and mean scores for WOMAC physical function (r = 0.22, p \ 0.001), WOMAC pain (r = 0.20, p = 0.001), MHI-5 (r = À0.31, p\ 0.001), and PCS (r = 0.27, p \ 0.001). A nonindex body pain region score greater than 0 had 100% (95% CI, 75%-100%) sensitivity for a pain catastrophizing score greater than 30 but a specificity of just 23% (95% CI, 18%-29%) . A score of 3 or greater had greater specificity (73%; 95% CI, 66%-79%) but lower sensitivity (53%; 95% CI, 27%-78%). Conclusions We found modest associations between the number of painful sites on a whole-body pain diagram and the number of painful body regions and measures of OArelated pain, function, pain catastrophizing, and mental health. Patients with higher self-reported body pain region scores might benefit from further evaluation for depression and pain catastrophizing. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Dave

Selzer

Losina

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Results TSK1 was correlated with WOMAC results at 12 months (p = 0.005, ρ = 0.197). STAI (p = 0.002, ρ = 0.222), BDI (p < 0.0005, ρ = 0.307), and sex Considering the exponential increase in TKA and potential revision procedures, this is becoming a major concern not only for patients, but also for health care providers and researchers [27].…”

Section: Introductionmentioning

confidence: 99%

Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients

Filardo

Merli

Roffi

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…Have we missed the point then? The majority of patients have good functional and pain outcomes following surgery, but a few patients, 6-15% 12 , go on to suffer significant persistent pain, disability and have associated high healthcare costs post-operatively 13 . A meta-analysis published this year in The British Journal of Anasthesia 13 has analysed the factors that predict persistent pain following TKA.…”

Section: S-0805mentioning

confidence: 99%

“…5 (range:[10][11][12][13][14][15][16][17][18][19][20][21][22]. Results: No failures and no complications were recorded at a mean follow-up of 8.1 years (range: 2.1-13.7 years).…”

mentioning

confidence: 99%

WFH Musculoskeletal Congress 2015 Abstracts

2015

Haemophilia

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Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis

Cited by 449 publications

References 64 publications

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Is There an Association Between Whole-body Pain With Osteoarthritis-related Knee Pain, Pain Catastrophizing, and Mental Health?

Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients

WFH Musculoskeletal Congress 2015 Abstracts

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