Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

Vikki Wylde, Adrian Sayers, Erik Lenguerrand, Rachael Gooberman-Hill, Mark Pyke, Andrew D Beswick, Paul Dieppe, Ashley W Blom, Vikki Wylde, Adrian Sayers, Erik Lenguerrand, Rachael Gooberman-Hill, Mark Pyke, Andrew D Beswick, Paul Dieppe, Ashley W Blom

Abstract

Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.

Conflict of interest statement

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

References

    1. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, Bittner R, Kehlet H. Predictive risk factors for persistent postherniotomy pain. Anesthesiology 2010;112:957–69.
    1. Althaus A, Arranz Becker O, Neugebauer E. Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain. Eur J PAIN 2014;18:513–21.
    1. Aranda-Villalobos P, Fernandez-de-Las-Penas C, Navarro-Espigares JL, Hernandez-Torres E, Villalobos M, Arendt-Nielsen L, Arroyo-Morales M. Normalization of widespread pressure pain hypersensitivity after total hip replacement in patients with hip osteoarthritis is associated with clinical and functional improvements. Arthritis Rheum 2013;65:1262–70.
    1. Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. PAIN 2010;149:573–81.
    1. Barrack RL, Ruh EL, Chen J, Lombardi AV, Jr, Berend KR, Parvizi J, Della Valle CJ, Hamilton WG, Nunley RM. Impact of socioeconomic factors on outcome of total knee arthroplasty. Clin Orthop Relat Res 2014;472:86–97.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988;15:1833–40.
    1. Bellamy N, Campbell J, Hill J, Band P. A comparative study of telephone versus onsite completion of the WOMAC 3.0 osteoarthritis index. J Rheumatol 2002;29:783–6.
    1. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012;2:e000435.
    1. Bisgaard T, Rosenberg J, Kehlet H. From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol 2005;40:1358–64.
    1. Black JA, Sharp SJ, Wareham NJ, Sandbaek A, Rutten GE, Lauritzen T, Khunti K, Davies MJ, Borch-Johnsen K, Griffin SJ, Simmons RK. Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial. Br J Gen Pract 2014;64:e208–16.
    1. Brandsborg B, Dueholm M, Kehlet H, Jensen TS, Nikolajsen L. Mechanosensitivity before and after hysterectomy: a prospective study on the prediction of acute and chronic postoperative pain. Br J Anaesth 2011;107:940–7.
    1. Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, Thompson AM, Cairns Smith W, Chambers WA, Scott NW; Recovery Study Group. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. PAIN 2014;155:232–43.
    1. Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 2013;7:CD008307.
    1. Clarke H, Bonin RP, Orser BA, Englesakis M, Wijeysundera DN, Katz J. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anesth Analg 2012;115:428–42.
    1. Clement ND, Jenkins PJ, MacDonald D, Nie YX, Patton JT, Breusch SJ, Howie CR, Biant LC. Socioeconomic status affects the Oxford knee score and short-form 12 score following total knee replacement. Bone Joint J 2013;95-B:52–8.
    1. Finan PH, Buenaver LF, Bounds SC, Hussain S, Park RJ, Haque UJ, Campbell CM, Haythornthwaite JA, Edwards RR, Smith MT. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum 2013;65:363–72.
    1. Granot M. Can we predict persistent postoperative pain by testing preoperative experimental pain? Curr Opin Anaesthesiol 2009;22:425–30.
    1. Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum 2012;64:2907–16.
    1. Gwilym SE, Oag HC, Tracey I, Carr AJ. Evidence that central sensitisation is present in patients with shoulder impingement syndrome and influences the outcome after surgery. J Bone Joint Surg Br 2011;93:498–502.
    1. Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP): a systematic review. Eur J PAIN 2009;13:719–30.
    1. Jeffery AE, Wylde V, Blom AW, Horwood JP. “It's there and I'm stuck with it”: patients' experiences of chronic pain following total knee replacement surgery. Arthritis Care Res (Hoboken) 2011;63:286–92.
    1. Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE, Dieppe PA. Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford) 2012;51:1804–13.
    1. Judge A, Batra RN, Thomas GE, Beard D, Javaid MK, Murray DW, Dieppe PA, Dreinhoefer KE, Peter-Guenther K, Field R, Cooper C, Arden NK. Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. Osteoarthritis Cartilage 2014;22:431–9.
    1. Kassam A, Dieppe P, Toms AD. An analysis of time and money spent on investigating painful total knee replacements. Br J Med Pract 2012;5:a526.
    1. King CD, Sibille KT, Goodin BR, Cruz-Almeida Y, Glover TL, Bartley E, Riley JL, Herbert MS, Sotolongo A, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis. Osteoarthritis Cartilage 2013;21:1243–52.
    1. Kosek E, Ordeberg G. Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment. Eur J PAIN 2000;4:229–38.
    1. Kosek E, Ordeberg G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. PAIN 2000;88:69–78.
    1. Leckie G, Charlton C. Runmlwin: a program to run the MLwiN multilevel modelling software from within Stata. J Stat Softw 2013;52:1–40.
    1. Lee YC, Lu B, Bathon JM, Haythornthwaite JA, Smith MT, Page GG, Edwards RR. Pain sensitivity and pain reactivity in osteoarthritis. Arthritis Care Res (Hoboken) 2011;63:320–7.
    1. Lluch E, Torres R, Nijs J, Van Oosterwijck J. Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review. Eur J PAIN 2014;18:1367–75.
    1. Lundblad H, Kreicbergs A, Jansson KA. Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg Br 2008;90-B:166–71.
    1. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008;101:77–86.
    1. Martin RM, Kramer MS, Dahhou M, Platt RW, Patel R, Bogdanovich N, Matush L, Davey Smith G; Promotion of Breastfeeding Intervention Trial Study Group. Do gastrointestinal tract infections in infancy increase blood pressure in childhood? A cohort study. J Epidemiol Community Health 2010;64:1068–73.
    1. Martinez V, Fletcher D, Bouhassira D, Sessler DI, Chauvin M. The evolution of primary hyperalgesia in orthopedic surgery: quantitative sensory testing and clinical evaluation before and after total knee arthroplasty. Anesth Analg 2007;105:815–21.
    1. Masselin-Dubois A, Attal N, Fletcher D, Jayr C, Albi A, Fermanian J, Bouhassira D, Baudic S. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain 2013;14:854–64.
    1. National Joint Registry. 10th annual report. Hemel Hempstead: NJR Centre, 2013.
    1. Neogi T, Frey-Law L, Scholz J, Niu J, Arendt-Nielsen L, Woolf C, Nevitt M, Bradley L, Felson DT; for the Multicenter Osteoarthritis Study. Sensitivity and sensitisation in relation to pain severity in knee osteoarthritis: trait or state? Ann Rheum Dis Published Online Ahead of Print [18 December 2013] doi: .
    1. Nikolajsen L, Kristensen AD, Thillemann TM, Jurik AG, Rasmussen T, Kehlet H, Jensen TS. Pain and somatosensory findings in patients 3 years after total hip arthroplasty. Eur J Pain 2008;13:576–81.
    1. Nunez M, Lozano L, Nunez E, Segur JM, Sastre S, Macule F, Ortega R, Suso S. Total knee replacement and health-related quality of life: factors influencing long-term outcomes. Arthritis Rheum 2009;61:1062–9.
    1. Palmer ST, Martin DJ, Steedman WM, Ravey J. C- and Adelta-fibre mediated thermal perception: response to rate of temperature change using method of limits. Somatosens Mot Res 2000;17:325–33.
    1. Pavlakovic G, Petzke F. The role of quantitative sensory testing in the evaluation of musculoskeletal pain conditions. Curr Rheumatol Rep 2010;12:455–61.
    1. Rajgopal V, Bourne RB, Chesworth BM, MacDonald SJ, McCalden RW, Rorabeck CH. The impact of morbid obesity on patient outcomes after total knee arthroplasty. J Arthroplasty 2008;23:795–800.
    1. Rakel BA, Blodgett NP, Bridget Zimmerman M, Logsden-Sackett N, Clark C, Noiseux N, Callaghan J, Herr K, Geasland K, Yang X, Sluka KA. Predictors of postoperative movement and resting pain following total knee replacement. PAIN 2012;153:2192–203.
    1. Rasbash J, Charlton C, Browne W, Healey M, Cameron B. MLwiN version 2.24. Centre for Multilevel Modelling, University of Bristol, Bristol, 2009.
    1. Santaguida PL, Hawker GA, Hudak PL, Glazier R, Mahomed NN, Kreder HJ, Coyte PC, Wright JG. Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 2008;51:428–36.
    1. Singh JA. Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J 2011;5:80–5.
    1. Skou ST, Graven-Nielsen T, Rasmussen S, Simonsen OH, Laursen MB, Arendt-Nielsen L. Widespread sensitization in patients with chronic pain after revision total knee arthroplasty. PAIN 2013;154:1588–94.
    1. Srikandarajah S, Gilron I. Systematic review of movement-evoked pain versus pain at rest in postsurgical clinical trials and meta-analyses: a fundamental distinction requiring standardized measurement. PAIN 2011;152:1734–9.
    1. Stratford PW, Kennedy DM, Woodhouse LJ, Spadoni GF. Measurement properties of the WOMAC LK 3.1 pain scale. Osteoarthritis Cartilage 2007;15:266–72.
    1. Suokas AK, Walsh DA, McWilliams DF, Condon L, Moreton B, Wylde V, Arendt-Nielsen L, Zhang W. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2012;20:1075–85.
    1. VanDenKerkhof E, Peters ML, Bruce J. Chronic pain after surgery: time for standardization? A framework to establish core risk factor and outcome domains for epidemiological studies. Clin J Pain 2013;29:2–8.
    1. Werner MU, Duun P, Kehlet H. Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation. Anesthesiology 2004;100:115–9; discussion 115A.
    1. Wilder-Smith OH, Schreyer T, Scheffer GJ, Arendt-Nielsen L. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study. J Pain Palliat Care Pharmacother 2010;24:119–28.
    1. Wylde V, Gooberman-Hill R, Horwood J, Beswick A, Noble S, Brookes S, Smith AJ, Pyke M, Dieppe P, Blom AW. The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: a protocol for a double-blind randomised controlled trial. BMC Musculoskelet Disord 2011;12:53.
    1. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. PAIN 2011;152:566–72.
    1. Wylde V, Palmer S, Learmonth ID, Dieppe P. Test-retest reliability of quantitative sensory testing in knee osteoarthritis and healthy participants. Osteoarthritis Cartilage 2011;19:655–8.
    1. Wylde V, Palmer S, Learmonth ID, Dieppe P. Somatosensory abnormalities in knee OA. Rheumatology (Oxford) 2012;51:535–43.
    1. Wylde V, Palmer S, Learmonth ID, Dieppe P. The association between pre-operative pain sensitisation and chronic pain after knee replacement: an exploratory study. Osteoarthritis Cartilage 2013;21:1253–6.
    1. Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, Ben-Nun A, Sprecher E, Best LA, Granot M. Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk. PAIN 2008;138:22–8.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir