Sex differences in negative affect and postoperative pain in patients undergoing total knee arthroplasty

Abstract

Background Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence in the developed world, and affects women to a greater degree than men. In the USA, the growth of knee OA has been paralleled by an increase in rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, postoperative trajectories of pain vary widely, with some patients reporting a complete absence of pain, but with a significant minority reporting worsening pain. Biopsychosocial factors, including anxiety and depression, are known to contribute importantly to the experience of joint pain, with women reporting a higher degree of negative affective symptoms. Methods This study investigated sex differences in TKA outcomes in age-matched groups of men and women at two academic medical centers. Pain and physical function were assessed in 100 patients (50 men and 50 women) during the perioperative period (preoperative visit—6 weeks postsurgical). The association of preoperative negative affect (anxiety and depression scores) to postoperative pain and function was evaluated, with specific attention to sex differences in this relationship. Results Overall, women reported more baseline pain-related physical dysfunction (although not higher baseline pain scores), as well as higher acute postoperative pain scores during the 2 weeks following TKA than their male counterparts. By 6 weeks postoperatively, sex differences in reported pain were no longer evident. Interestingly, although women reported higher preoperative levels of emotional distress than men, preoperative anxiety and depression scores were better predictors of severe postoperative pain among men than women, throughout the postoperative test period. Conclusions This study underlines the importance of considering sex and psychosocial factors, as well as their interaction, in understanding postsurgical pain trajectories.

<p>Preoperative Factors Associated with Remote Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: Post Hoc Analysis of a Perioperative Gabapentin Trial</p>

“…Although higher acute postoperative pain scores are reported among women in the first 2 weeks after total knee arthroplasty, sex differences were no longer evident at 6 weeks. 48 This may explain why we did not find an association of gender with time to remote pain or opioid cessation. The majority of patients receiving lumpectomy and mastectomy were female.…”

Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic

“…Although chronic pain is common, some individuals are at higher risk. 62 Pain susceptibility seems to be influenced by sociodemographic factors, including sex, 26 , 47 , 50 , 52 race and ethnicity, 11 , 37 , 55 education, 29 , 51 , 56 and employment, 22 making individuals with these characteristics more vulnerable. 4 , 8 , 21 , 33 , 34 In addition, the impact of social context in which an individual experiences pain has been understudied compared with biological and psychological constructs.…”

Sex Differences in Interleukin-6 Responses Over Time Following Laboratory Pain Testing Among Patients With Knee Osteoarthritis

“…The parent study collected data including psychophysical pain testing, self-report questionnaires, daily diaries, and prescription opioid use during hospitalization. A number of papers were published using the parent study, 2,35,44 and the main outcome paper is currently in progress. One paper examined sex differences in negative affect and postoperative pain using the parent study data, 44 however, none of these previously published studies overlap with the present study.…”