Predictors of postoperative movement and resting pain following total knee replacement

Abstract

This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (i.e., during active knee range of motion), and quantitative sensory tests, were performed pre-operatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2 (POD2), analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity (VFPI) and heat pain threshold (HPT). People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery.

Abnormal Quantitative Sensory Testing is Associated With Persistent Pain One Year After TKA

“…A future, more comprehensive, study should take into consideration the large number of covariates that may influence the presence of persistent postoperative pain. These might include perioperative factors such as surgical approach and perioperative anesthesia [9,19,39], psychological factors such depression or catastrophizing [10,30,39], and intrinsic factors such as gender, BMI, or high preoperative pain levels [31,39].…”

Rest Pain and Movement‐Evoked Pain as Unique Constructs in Hip and Knee Replacements

“…Furthermore, within the surgical literature, there is a growing recognition of the importance of distinguishing between pain‐at‐rest and pain‐on‐movement due to differing mechanistic pathways and clinical implications, such as differential effectiveness of pharmacologic therapies and impact on functional recovery 8, 9. It has therefore been argued that the assessment of acute postoperative pain‐on‐movement is more important than assessing pain‐at‐rest because of the potential for interference with postoperative mobilization 10.…”

Editorial: Synovitis and Pain Sensitization

“…Findings might therefore be influenced by OA stage (early versus late) or pain characteristics. Whereas the importance of central sensitization to OA pain remains controversial, increasing evidence indicates that its presence might be a barrier to treatment response, and widespread sensitization predicts poor outcomes to arthroplasty (19)(20)(21). The findings presented by Neogi and colleagues provide insights into what drives differences in pain processing between individuals with OA, and open novel therapeutic possibilities that might improve pain progression in this common, incurable, and disabling condition.…”