Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors

Rice, David A.; Kluger, M. T.; McNair, Peter; Lewis, Gwyn N.; Somogyi, Andrew A.; Borotkanics, Robert; Barratt, Daniel T.; Walker, McCall

doi:10.1016/j.bja.2018.05.070

Cited by 130 publications

(166 citation statements)

References 46 publications

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“…In rats with preoperative pain, IL-1β, IL6 and TNFα were more highly expressed in the hippocampus of rats (P<0.05). This suggests that preoperative pain can cause a significant inflammatory response in the hippocampus after operation, so we further determined that preoperative pain is an important risk factor for postoperative cognitive impairment [21].…”

Section: Discussionmentioning

confidence: 99%

Preoperative pain aggravates postoperative cognitive deficits and hippocampal neuroinflammation in rats

Gao¹,

Ding²,

Yi³

et al. 2019

Preprint

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Background Perioperative neurocognitive disorder (PND) is the progressive deterioration of cognitive function after surgery. The purpose of this study was to observe the effect of preoperative pain on inflammatory factors and neuronal apoptosis in the hippocampus of rats. Methods 36 adult male Sprague-Dawley rats were randomly divided into 4 groups: the control group, the pain group, the pain+operation group, and the operation group. 6 days before the surgery, the rats received cognitive training, and the cognitive evaluation was carried out on the1, 3 and 7th days after the surgery. The rats were killed on the first, third and seventh days after the surgery (n = 3 rats/day). The cognitive function of rats was evaluated by the Morris Water Maze (MWM), and the expression levels of the pro-inflammatory cytokines interleukin 6(IL-6), Interleukin 1β(IL-1β)and Tumor Necrosis Factor-α(TNF-α), Acetylcholine(Ach)and Cyclic Adenosine monophosphate(cAMP), protein kinase A(PKA)and gamma-aminobutyric acid type A receptors(GABAA) in the hippocampus were measured on the 1st, 3rd and 7th days after the operation. Results Our results showed that the pain model rats exhibited impaired behavior on the first day (P< 0.001), and this lasted until the 7th day after the operation (P≤0.002 and P≤0. 001, respectively). Preoperative pain model rats showed a higher level of apoptosis than that shown by the simple operation rats. On the 1st, 3rd and 7th days after the operation, the protein content of IL-1β, IL-6 and TNF-α in the pain operation group was increased compared to that in the simple operation group (P<0.001). ACh, cAMP, PKA and GABAA expression in the hippocampus was decreased after operation in the preoperative pain model rats. Conclusion Preoperative pain is a key risk factor for the development of PND. The ACh-PKA-GABAA signaling pathway plays a key role in the acetylcholine pathway.

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Section: Discussionmentioning

confidence: 99%

Preoperative pain aggravates postoperative cognitive deficits and hippocampal neuroinflammation in rats

Gao¹,

Ding²,

Yi³

et al. 2019

Preprint

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“…The in uencing factors of functional recovery after TKA mainly include the patient's age, sex, preoperative pain level, total duration after TKA and preoperative knee functional state [1,14,15]. There are few studies on the effect of skin temperature on knee joint function, and only a few studies have reported that an increase in the skin temperature can affect the prognosis of knee joint function [1].…”

Section: Skin Temperature and Functional Recoverymentioning

confidence: 99%

Rapid Skin Temperature Measurement is Valuable in Evaluating Inflammation and Functional Status After Total Knee Arthroplasty：A Case Control Study

Huang

Yin

et al. 2020

Preprint

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Abstract Background：The skin temperature of the knee joint changes after total knee arthroplasty (TKA), and these changes are easy to detect and can be measured simply and accurately, but its significance is not clear.Methods: A total of 205 patients who underwent unilateral primary TKA were selected; the bilateral knee skin temperature, inflammatory indicators, pain score, knee range of motion (ROM) and quadriceps muscle strength of the patients were measured from preoperatively to 6 months postoperatively; and the relationships between the differential skin temperature and inflammatory and functional prognosis were analyzed.Results: The differential skin temperature was significantly correlated with the inflammatory index, pain score, ROM and muscle strength. A difference in skin temperature between the two sides of >0.52°C at 2 weeks after the operation suggested that the level of c-reactive protein increased (sensitivity 81.4%, specificity 39.8%) and affected the ROM at 2 weeks and 6 weeks after the operation, as well as the muscle strength at 6 weeks and 3 months after the operation. A difference in skin temperature of >2.15°C at 2 weeks after the operation suggested that the level of c-reactive protein increased by more than three times (sensitivity 90.9%, specificity 95.2%) and affected the ROM at 3 months and 6 months after the operation and muscle strength at 6 weeks and 3 months after the operation.Conclusion: The difference in the knee skin temperature between the operated side and contralateral side is closely related to functional recovery and the magnitude of increase in inflammatory indicators in patients after TKA. Skin temperature measurements can be used as references for predicting functional recovery and inflammatory indicators.Trial registration：Medical Ethics Committee of Affiliated Hospital of Qingdao University,QYFYKYLL2327945,2015-03-01

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“…Insbesondere scheinen hier direkt schmerzbezogene negative Affekte wie Katastrophisieren, Angst oder Hypervigilanz gegenüber Schmerzen entscheidend zu sein [16,22]. Die Vorhersagekraft von Fragebögen, die diese psychologischen Faktoren messen, ist natürlich nicht absolut und nicht vergleichbar mit denen eines diagnostischen Tests -es gibt jedoch erste Belege, dass die Kombination von Fragebögen zu negativen Affekten mit QST-Parametern wie der TS ein prädiktives Potenzial besitzt, das auf klinischer Seite Präventionsmaßnahmen zur Vermeidung von prolongiertem postoperativem Schmerz rechtfertigen könnte [39].…”

Section: Veränderungen Im Gehirnunclassified

Der sensibilisierte Patient in der Schmerztherapie

Bäumler¹

2020

Zeitschrift für Komplementärmedizin

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SummaryEine Gruppe von Patienten mit chronischen schmerzhaften Erkrankungen zeigen besonders viele unterschiedliche Symptome und ausgeprägte sensorische Sensibilisierungzeichen. Dieses Phänomen wird auch als Hypersensitivitätssyndrom beschrieben.Aus neurophysiologischer lässt sich dies durch komplexe Sensibilisierungsmechanismen auf Ebene des Rückenmarks und des Gehrins erklären. Gleichsam entscheidend ist die seelische Sensibilisierung – psychische Erkrankungen und negative Affekte, wie eine katastrophisierende Haltung, Ängste und eine depressive Stimmungslage.Intensive Forschungsarbeit hat gezeigt, dass neurophysiologische und psychologische Faktoren eng verwoben und nicht nur Folgen sondern auch Risikofaktoren für chronische schmerzhafte Erkrankungen sind.In der Therapie sensibilisierter Patienten haben sich Verfahren bewährt, die den zugrunde liegenden neurophysiologischen Veränderungen entgegenwirken und sich gleichzeitig regulierend auf dysfunktionale Kognitionen, Emotionen und Verhaltensmuster auswirken. Dabei kommt der Komplementärmedizin eine große Bedeutung zu.

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Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors

Abstract: ACTRN12612001089820.

Cited by 130 publications

References 46 publications

Preoperative pain aggravates postoperative cognitive deficits and hippocampal neuroinflammation in rats

Preoperative pain aggravates postoperative cognitive deficits and hippocampal neuroinflammation in rats

Rapid Skin Temperature Measurement is Valuable in Evaluating Inflammation and Functional Status After Total Knee Arthroplasty：A Case Control Study

Der sensibilisierte Patient in der Schmerztherapie

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