Predictors of postoperative movement and resting pain following total knee replacement

Abstract

This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery, and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (ie, during active knee range of motion), and quantitative sensory tests were performed preoperatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2, analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity, and heat pain threshold. People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR, and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery.

Conflict of interest statement

Conflict of Interest

The authors have no conflicts of interest to disclose.

Published by Elsevier B.V.

Figures

Figure 1

Percent of Participants with Mild or Severe Postoperative Movement Pain Based On Preoperative Movement Pain Levels* *=A larger percentage of participants with mild postoperative movement pain rated their preoperative movement pain low (0–7) while a larger percentage of participants with severe postoperative movement pain rated their preoperative movement pain high (15–20).

Figure 2

Percent of Participants with Mild or Severe Postoperative Movement Pain Based On Preoperative Von Frey Pain Intensity Levels* *=A larger percentage of participants with mild postoperative movement pain rated the pain intensity to a standard von frey stimulus low (0–1) while a larger percentage of participants with severe postoperative movement pain rated the pain intensity to a standard von frey stimulus high (9–10). Von Frey pain intensities were grouped, based on data quartiles, and mean scores for each quartile were plotted.

Figure 3

Percent of Participants with Mild or Severe Postoperative Movement Pain Based On Preoperative Heat Pain Threshold Levels* *=A larger percentage of participants with mild postoperative movement pain had high preoperative heat pain thresholds (45–48) while a larger percentage of participants with severe postoperative movement pain had low heat pain thresholds (38–43). Heat pain thresholds were grouped, based on data quartiles, and mean scores for each quartile were plotted.