Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty

Abstract

It has been estimated that up to 54% of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli, with suprathreshold heat pain as the most consistent test modality. This study aimed to explore whether 2 heat test paradigms could predict postoperative pain after total knee arthroplasty (TKA). Patients scheduled for elective, unilateral, primary TKA under spinal anesthesia were consecutively included in this prospective, observational study. Perioperative analgesia was standardized for all patients. Outcomes were postoperative pain during walk: from 6 to 24 hours (primary), from postoperative day (POD) 1 to 7 (secondary), and from POD 14 to 30 (tertiary). Two preoperative tonic heat stimuli with 47°C were used; short (5 seconds) and long (7 minutes) stimulation upon which patients rated their pain response on an electronic visual analog scale. Multivariate stepwise linear and logistic regressions analyses were carried out, including 8 potential preoperative explanatory variables (among these anxiety, depression, preoperative pain, and pain catastrophizing) to assess pain response to preoperative heat pain stimulation as an independent predictor for postoperative pain. A total of 100 patients were included, and 3 were later excluded. A weak correlation [rho (95% confidence interval); P value] was observed between pain from POD 1 to 7 and pain response to short [rho=0.25(0.04 to 0.44); P=.02] and to long [rho=0.27 (0.07 to 0.46); P=.01] heat pain stimulation. However, these positive correlations were not supported by the linear and logistic regression analyses, in which only anxiety, preoperative pain, and pain catastrophizing were significant explanatory variables (but with low R-squares; 0.05 to 0.08). Pain responses to 2 types of preoperative heat stimuli were not independent clinically relevant predictors for postoperative pain after TKA.

The Cold Pressor Test as a Predictor of Prolonged Postoperative Pain, a Prospective Cohort Study

“…Supra-threshold heat pain has been found to be the most consistent test modality [14]. The cold pressor test provides a valid and low-risk test for evaluating pain in preoperative patients and has been routinely used in pain research [7].…”

Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

“…While average dose of opioids and average preoperative pain intensity only made significant contributions to parts of the change in average pain intensity over time, they improved the overall model fit, and findings from previous studies suggest that they are important predictors of postoperative pain [13, 14, 48]. Average preoperative pain was a variable of particular interest in this study.…”

“…In addition, consistent with a previous report [50], lower average preoperative pain intensity was associated with slower decrease in worst pain from prior to surgery until the DOS (Fig 4B). However, in recent studies on acute pain after TKA that used regression analysis, higher preoperative pain was associated with higher postoperative pain with rest and movement [13, 14]. In the current study, for both average and worst postoperative pain, the PW1 slope represents the transition from preoperative to acute postoperative pain as well as the transition to a multimodal pain management plan that was initiated on the DOS.…”

“…Higher preoperative pain [13, 14] and preoperative opioid consumption [15] have been identified as risk factors for increased acute pain at rest and with movement after TKA. While preoperative pain, anxiety, and younger age predicted postoperative pain in a variety of surgeries, [12] only one longitudinal study was found that evaluated predictors of acute average and worst pain during hospitalization in patients who underwent TKA [16].…”

Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review

“…Knee joint pain was the most frequent condition studied (knee OA: n = 6, nonspecific knee pain awaiting arthroplasty: n = 1). A further two studies included mixed cohorts of participants scheduled for either total hip arthroplasty (THA) or total knee arthroplasty (TKA); the primary diagnosis was OA in one study and unspecified in the other .…”