The Combination of Preoperative Pain, Conditioned Pain Modulation, and Pain Catastrophizing Predicts Postoperative Pain 12 Months After Total Knee Arthroplasty

Abstract

Objectives Approximately 20% of knee osteoarthritis patients undergoing total knee arthroplasty (TKA) report chronic postoperative pain. Studies suggest that preoperative variables such as impaired descending pain control, catastrophizing, function, and neuropathic pain–like symptoms may predict postoperative pain 12 months after TKA, but the combined prediction value of these factors has not been tested. The current prospective cohort study aimed to combine preoperative risk factors to investigate the predictive value for postoperative pain 12 months after TKA. Design Prospective cohort with follow-up 12 months after surgery. Patients A consecutive sample of 131 knee osteoarthritis patients undergoing TKA. Methods Pain intensity, Pain Catastrophizing Scale (PCS) scores, PainDETECT Questionnaire scores, conditioned pain modulation (CPM), and Oxford Knee Score (OKS) were obtained before and 12 months after TKA. Results TKA improved pain (P < 0.001), PCS scores (P < 0.001), PainDETECT Questionnaire scores (P < 0.001), and OKSs (P < 0.001). Preoperative pain correlated with preoperative PCS scores (r = 0.38, P < 0.001), PainDETECT scores (r = 0.53, P < 0.001), and OKSs (r = –0.25, P = 0.001). Preoperative PainDETECT scores were associated with preoperative PCS scores (r = 0.53, P < 0.001) and OKSs (r = –0.25, P = 0.002). Higher postoperative pain was correlated with high preoperative pain (r = 0.424, P < 0.001), PCS scores (r = 0.33, P < 0.001), PainDETECT scores (r = 0.298, P = 0.001), and lower CPM (r = –0.18, P = 0.04). The combination of preoperative pain, PCS score, and CPM explained 20.5% of variance in follow-up pain. PCS scores had a significant effect on pain trajectory when accounting for patient variance (t = 14.41, P < 0.0005). Conclusion The combination of high preoperative clinical pain intensity, high levels of pain catastrophizing thoughts, and impaired CPM may predict long-term postoperative pain 12 months after surgery.

Pain catastrophizing and related influencing factors in pro-operative total knee arthroplasty in Lanzhou, China : a cross-sectional study

“…Similar to previous studies [42,43], our study found that patients with stronger pain intensity during activity were more likely to experience pain catastrophizing. The result was consistent with a recent study by Larsen et al [44], and authors also pointed out preoperative clinical pain intensity, high levels of pain catastrophizing thoughts, and impaired conditioned pain modulation may predict long-term postoperative pain 12 months after TKA. A review by Quartana et al indicated [45] a relationship of catastrophizing and pain intensity.…”

Central sensitisation in chronic pain conditions: latest discoveries and their potential for precision medicine

“…It is also important to highlight that there are other factors, such as pain catastrophising, that interact with central sensiti sation to determine whether a postoperative outcome is positive or not. 80 Also, the presence of central sensitisation should not prevent healthcare providers from searching for and possibly treating peripheral dysfunctions, in the context of a multifactorial disease model that considers both peripheral and central components. Unfortunately, many clinicians globally continue to focus on treating only peripheral drivers of central sensitisation, rather than adhering to a multifactorial disease model.…”

A mechanism-based proof of concept study on the effects of duloxetine in patients with painful knee osteoarthritis

“…TSP has also been found to be a predictor of limited analgesic effect of non-steroidal anti-inflammatory drugs (NSAIDs) [ 46 ] in OA. CPM is a proxy for descending pain inhibitory control [ 60 ], is impaired in severe patients with OA [ 6 ] and impaired CPM has been associated with higher levels chronic postoperative pain [ 34 , 57 ] and poor analgesic effects to NSAIDs effects in patients with OA [ 21 , 48 ].…”