The association between pre-operative pain sensitisation and chronic pain after knee replacement: An exploratory study

Dieppe, P.; Wylde, V.; Palmer, S.; Learmonth, I. D.; Wylde, Vikki; Palmer, Shea; Learmonth, Ian; Dieppe, Paul

Abstract

Objective: Chronic pain after total knee replacement (TKR) is a prevalent condition, affecting about 20% of patients. The aim of this study was to explore the relationship between pre-operative pain thresholds and chronic pain after TKR. Design: Patients listed for a TKR because of osteoarthritis participated in a Quantitative Sensory Testing (QST) session prior to surgery. Pressure pain thresholds (PPTs) and hot pain thresholds were assessed at the osteoarthritic knee and the forearm. Patients were followed-up at 1-year after TKR, and the severity of pain in the replaced knee was assessed using the WOMAC Pain score. Pre-operative median QST thresholds were compared to thresholds from a normative database collected from 50 people with no knee pain. The relationship between pre-operative pain thresholds and pain severity post TKR were tested using correlations. Results: Fifty-one patients participated in a pre-operative QST session and completed a 1-year WOMAC Pain score. Pre-operatively, patients demonstrated evidence of localised (knee) and widespread (forearm) pain sensitisation in response to pressure stimuli compared to healthy participants. Pre-operative PPTs at the forearm were found to be significantly correlated with 1-year WOMAC Pain scores (r=0.37, P=0.008). Conclusions: This study provides preliminary evidence that pre-operative widespread pain sensitisation, measured using pressure algometry, may be associated with chronic pain after TKR. Further research is needed to explore the predictive value of an assessment of pre-operative widespread pain sensitisation in identifying who is likely to develop chronic pain after TKR. © 2013 Osteoarthritis Research Society International.

• Journal Article Type: Article
• Publication Date: Sep 1, 2013
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Electronic ISSN: 1522-9653
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 9
• Pages: 1253-1256
• DOI: https://doi.org/10.1016/j.joca.2013.05.008
• Keywords: pain, knee replacement
• Public URL: https://uwe-repository.worktribe.com/output/927936
• Publisher URL: http://dx.doi.org/http://dx.doi.org/10.1016/j.joca.2013.05.008