Risk factors for moderate and severe persistent pain in patients undergoing total knee and hip arthroplasty: a prospective predictive study

Patrícia R Pinto, Teresa McIntyre, Ramón Ferrero, Armando Almeida, Vera Araújo-Soares, Patrícia R Pinto, Teresa McIntyre, Ramón Ferrero, Armando Almeida, Vera Araújo-Soares

Abstract

Persistent post-surgical pain (PPSP) is a major clinical problem with significant individual, social and health care costs. The aim of this study was to examine the joint role of demographic, clinical and psychological risk factors in the development of moderate and severe PPSP after Total Knee and Hip Arthroplasty (TKA and THA, respectively). This was a prospective study wherein a consecutive sample of 92 patients were assessed 24 hours before (T1), 48 hours after (T2) and 4-6 months (T3) after surgery. Hierarchical logistic regression analyses were performed to identify predictors of moderate and severe levels of PPSP. Four to six months after TKA and THA, 54 patients (58.7%) reported none or mild pain (Numerical Rating Scale: NRS ≤ 3), whereas 38 (41.3%) reported moderate to severe pain (NRS >3). In the final multivariate hierarchical logistic regression analyses, illness representations concerning the condition leading to surgery (osteoarthritis), such as a chronic timeline perception of the disease, emerged as a significant predictor of PPSP. Additionally, post-surgical anxiety also showed a predictive role in the development of PPSP. Pre-surgical pain was the most significant clinical predictive factor and, as expected, undergoing TKA was associated with greater odds of PPSP development than THA. The findings on PPSP predictors after major joint arthroplasties can guide clinical practice in terms of considering cognitive and emotional factors, together with clinical factors, in planning acute pain management before and after surgery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flowchart of TKA and THA…
Figure 1. Flowchart of TKA and THA patients (screening, inclusion and assessment at all data points).

References

    1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 89(4): 780–785.
    1. Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370: 1508–1519.
    1. Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, et al. (2009) Cost-effectiveness of Total Knee Arthroplasty in the United States - Patient Risk and Hospital Volume. Arch Intern Med 169(12): 1113–1121.
    1. Bachmeier CJM, March LM, Cross MJ, Lapsley HM, Tribe K, et al. (2001) A comparison of outcomes in osteoarthritis patients undergoing total hip and knee replacement surgery. Osteoarthritis and Cartilage 9: 137–146.
    1. Hamel MB, Toth M, Legedza A, Rosen MP (2008) Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee. Arch Intern Med 168: 1430–1440.
    1. Lingard EA, Katz JN, Wright EA, Sledge CB (2004) Kinemax Outcomes Group (2004) Predicting the Outcome of Total Knee Arthroplasty. J Bone Joint Surg Am 86: 2179–2186.
    1. Wylde V, Hewlett S, Learmonth ID, Dieppe P (2011) Persistent pain after joint replacement: Prevalence, sensory qualities, and postoperative determinants. Pain 152: 566–572.
    1. Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, et al. (2003) Predicting total knee replacement pain – a prospective, observational study. Clin Orthop Relat Res 416: 27–36.
    1. Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME (2000) Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 27: 1745–1752.
    1. Wylde V, Dieppe P, Hewlett S, Learmonth ID (2007) Total knee replacement: Is it really an effective procedure for all? The Knee 14: 417–423.
    1. Kehlet H, Jensen TS, Woolf C (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367: 1618–1625.
    1. Macrae WA (2008) Chronic post-surgical pain: 10 years on. Br J Anaesth 101: 77.
    1. Perkins F, Gopal A (2003) Postsurgical chronic pain: a model for investigating the origins of chronic pain. Tech Reg Anesth Pain Manag 7: 122–126.
    1. Ebrahimpour PB, Do HT, Bornstein LJ, Westrich GH (2011) Relationship Between Demographic Variables and Preoperative Pain and Disability in 5945 Total Joint Arthroplasties at a Single Institution. J Arthroplasty 26(6): 133–137.
    1. Nikolajsen L, Brandsborg B, Lucht U, Jensen TS, Kehlet H (2006) Chronic pain following total hip arthroplasty: a nationwide questionnaire study. Acta Anaesthesiol Scand 50: 495–500.
    1. Nilsdotter A, Aurell Y, Siösteen A, Lohmander L, Roos H (2001) Radiographic stage of osteoarthritis or sex of the patient does not predict one year outcome after total hip arthroplasty. Ann Rheum Dis 60: 228–232.
    1. Nilsdotter A, Petersson IF, Roos EM, Lohmander LS (2003) Predictors of patient relevant outcome after total hip replacement for osteoarthritis: a prospective study Ann Rheum Dis. 62: 923–930.
    1. Vissers MM, Bussmann JB, Verhaar JAN, Busschbach JJ, Bierma-Zeinstra S, et al. (2012) Psychological Factors Affecting the Outcome of Total Hip and Knee Arthroplasty: A Systematic Review. Semin Arthritis Rheum 41: 576–588.
    1. Faller H, Kirschner S, Konig A (2003) Psychological distress predicts functional outcomes at three and twelve months after total knee arthroplasty [Letter to the editor]. Gen Hosp Psychiatry 25: 372–373.
    1. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJ, Gross M (2008) Prospective relation between catastrophizing and residual pain following knee arthroplasty; two-year follow-up. Pain Res Manage 13: 335–341.
    1. Sullivan M, Tanzer M, Reardon G, Amirault D, Dunbar M, et al. (2011) The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain 152: 2287–2293.
    1. Leventhal H, Diefenbach M (1991) The active side of illness cognition. In: Skelton JA, Croyle RT, editors. Mental Representation in Health and Illness. New York: Springer Verlag. Pp. 247–272.
    1. Leventhal H, Nerenz DR, Steele DJ (1984) Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of Psychology and Health, Volume IV: Social Psychological Aspects of Health. Hillsdale: NJ: Erlbaum. 219–252.
    1. Hermele S, Olivo EL, Namerow P, Oz MC (2007) Illness representations and psychological distress in patients undergoing coronary artery bypass graft surgery. Psychology, Health & Medicine 12: 580–591.
    1. Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal E, et al... (1997) Illness representations: theoretical foundations. In: Petrie KJ, Weinman J, editors. Perceptions of health and illness: Current research and applications. Amsterdam: Harwood Academic. 19–45.
    1. Petrie KJ, Weinman J (2006) Why illness perceptions matter. Clinical Medicine 6: 536–539.
    1. Orbell S, Johnston M, Rowley D, Espley A, Davey P (1998) Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. Soc Sci Med 47: 93–102.
    1. Hagger MS, Orbell S (2003) A meta-analytic review of the common-sense model of illness representations. Psychol Health 18: 141–184.
    1. Moss-Morris R, Humphrey K, Johnson MH, Petrie KJ (2007) Patients’ Perceptions of Their Pain Condition Across a Multidisciplinary Pain Management Program: Do They Change and if So Does It Matter? Clin J Pain 23: 558–564.
    1. Petrie KJ, Weinman J, Sharpe N, Buckley J (1996) Role of patients’ view of their illness in predicting return to work and functioning after myocardial infarction: longitudinal study. BMJ 312: 1191–1194.
    1. Llewellyn CD, McGurk M, Weinman J (2007) Illness and treatment beliefs in head and neck cancer: Is Leventhal’s common sense model a useful framework for determining changes in outcomes over time? J Psychosom Res 63: 17–26.
    1. Mccarthy SC, Lyons AC, Weinman J, Talbot R, Purnell D (2003) Do expectations influence recovery from oral surgery? An illness representation approach. Psychol Health 18: 109–126.
    1. Pinto PR, McIntyre T, Nogueira-SIlva C, Almeida A, Araujo-Soares V (2012) Risk Factors for Persistent Post-surgical Pain in Women undergoing Hysterectomy due to Benign Causes: a Prospective predictive Study. J Pain 13(11): 1045–1057.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: 373–383.
    1. Jones CA, Voaklander DC, Suarez-Almazor ME (2003) Determinants of Function After Total Knee Arthroplasty. Physical Therapy 83(8): 696–706.
    1. Pinto PR, McIntyre T, Ferrero R, Almeida A, Araújo-Soares V (2013) Predictors of acute post-surgical pain and anxiety following primary total hip and knee arthroplasty. J Pain 14(5): 502–515.
    1. Cleeland C, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23: 129–138.
    1. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16: 297–334.
    1. Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1: 277–299.
    1. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67: 361–370.
    1. Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, et al. (2002) The Revised Illness Perception Questionnaire (IPQ-R). Psychol Health 17: 1–16.
    1. Sniehotta FF, Gorski C, Araujo-Soares V (2010) Adoption of community-based cardiac rehabilitation programs and physical activity following phase III cardiac rehabilitation in Scotland: A prospective and predictive study. Psychol Health 25: 839–854.
    1. Riley JL, Robinson ME (1997) CSQ: five factors or fiction? Clin J Pain 13: 156–162.
    1. Watson-Jones R, Robinson WC (1956) Arthrodesis of the osteoarthritic hip joint. J Bone Joint Surg Br. 38-B(1): 353–377.
    1. Dihle A, Helseth S, Paul SM, Miaskowski C (2006) The exploration of the establishment of cutpoints to categorize the severity of acute postoperative pain. Clin J Pain 22: 617–624.
    1. Hartrick CT, Kovan JP, Shapiro S (2003) The Numeric Rating Scale for Clinical Pain Measurement: A Ratio Measure? Pain Pract 3: 310–316.
    1. Singh JA, Lewallen D (2010) Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskeletal Disorders 11: 90–98.
    1. Vuorenmaa M, Ylinen J, Kiviranta I, Intke A, Kautiainen HJ, et al. (2008) Changes in pain and physical function during waiting time and 3 months after knee joint arthroplasty. J Rehabil Med 40: 570–575.
    1. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y (2001) The Visual Analog Scale for Pain. Clinical Significance in Postoperative Patients. Anesthesiology 95: 1356–1361.
    1. Dolin SJ, Cashman JN, Bland JM (2002) Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 89(3): 409–423.
    1. Kehlet H, Rathmell JP (2010) Persistent Postsurgical Pain - The Path Forward through Better Design of Clinical Studies. Anesthesiology 112: 514–515.
    1. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) 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 2 (1): e000435. Available: . Accessed 2012 Jan 18.
    1. Brander VA, Gondek S, Martin E, Stulberg SD (2007) Pain and Depression Influence Outcome 5 Years after Knee Replacement Surgery. Clin Orthop Relat Res 464: 21–26.
    1. Lundblad H, Kreicbergs A, Jansson KA (2008) Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg [Br] 90-B: 166–171.
    1. Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS (2007) Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 106(5): 1003–1012.
    1. Gerbershagen H, Özgür E, Dagtekin O, Straub K, Hahn M, et al. (2009) Preoperative pain as a risk factor for chronic post-surgical pain – Six month follow-up after radical prostatectomy. Eur J Pain 13: 1054–1061.
    1. Hanley MA, Jensen MP, Smith DG, Ehde DM, Edwards WT, et al. (2007) Preamputation pain and acute pain predict chronic pain after lower extremity amputation. J Pain 8: 102–109.
    1. Nikolajsen L, Jensen TS (2001) Phantom limb pain. Br J Anaesth 87: 107–116.
    1. Rolfson O, Dahlberg LE, Nilsson JA, Malchau H, Garellick G (2009) Variables determining outcome in total hip replacement surgery. J Bone Joint Surg [Br] 91-B: 157–161.
    1. Latremoliere A, Woolf CJ (2009) Central Sensitization: A Generator of Pain Hypersensitivity by Central Neural Plasticity. J Pain 10: 895–926.
    1. Gonçalves L, Silva R, Pinto-Ribeiro F, Pego JM, Bessa JM, et al. (2008) Neuropathic pain is associated with depressive behaviour and induces neuroplasticity in the amygdala of the rat. Exp Neurol 213: 48–56.
    1. Neugebauer V, Galhardo V, Maione S, Mackey SC (2010) Forebrain pain mechanisms. Brain Res Rev 60: 226–242.
    1. Pinto-Ribeiro F, Ansah OB, Almeida A, Pertovaara A (2008) Influence of arthritis on descending modulation of nociception from the paraventricular nucleus of the hypothalamus. Brain Res 1197: 63–75.
    1. Bisgaard T, Rosenberg J, Kehlet H (2005) From acute to chronic pain after laparoscopic cholecystectomy. A prospective follow-up analysis. Scand J Gastroenterol 40: 1358–1364.
    1. Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, et al. (2008) Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 140: 87–94.
    1. Peters ML, Sommer M, Rijke JM, Kessels F, Heineman E, et al. (2007) Somatic and psychologic predictors of long-term unfavourable outcome after surgical intervention. Ann Surg 245: 487–494.
    1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, et al. (2006) Risk Factors for Chronic Pain Following Breast Cancer Surgery: A Prospective Study. J Pain 7: 626–634.
    1. Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, et al. (2010) Persistent pain following knee arthroplasty. Eur J Anaesthesiol 27(5): 455–460.
    1. Kosek E, Ordeberg G (2000) Abnormalities of somatosensory perception in patients with painful osteoarthritis normalize following successful treatment. Eur J Pain 4: 229–238.
    1. O’Driscoll SL, Jayson MI (1974) Pain threshold analysis in patients with osteoarthrosis of hip. Br Med J 3: 714–715.
    1. Schaible HG, Ebersberger A, Von Banchet GS (2006) Mechanisms of pain in arthritis. Ann N Y Acad Sci 966: 343–354.
    1. Buvanendran A, Kroin JS, Valle CJ, Kari M, Moric M, et al. (2010) Perioperative Oral Pregabalin Reduces Chronic Pain After Total Knee Arthroplasty: A Prospective, Randomized, Controlled Trial. Anesth Analg 110: 199–207.
    1. Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, et al. (2004) Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum 51(1): 100–109.
    1. Linsell L, Dawson J, Zondervan K, Rose P, Carr A, et al. (2006) Pain and overall health status in older people with hip and knee replacement: a population perspective. J Public Health 28(3): 267–273.
    1. Salmon P, Hall G, Peerbhoy D, Shenkin A, Parker C (2001) Recovery From Hip and Knee Arthroplasty: Patients’ Perspective on Pain, Function, Quality of Life, and Well-Being Up to 6 Months Postoperatively. Arch Phys Med Rehabil 82(3): 360–366.
    1. Scharloo M, de Jong RJ, Langeveld TP, Velzen-Verkaik E, Akker MM, et al. (2005) Quality of life and illness perceptions in patients with recently diagnosed head and neck cancer. Head & Neck 27: 857–863.
    1. Groarke AM, Curtis R, Coughlan R, Gsel A (2005) The impact of illness representations and disease activity on adjustment in women with rheumatoid arthritis. A longitudinal study. Psychol Health 20(5): 597–613.
    1. Botha-Scheepers S, Riyazi N, Kroon HM, Scharloo M, Houwing-Duistermaat JJ, et al. (2008) Activity limitations in the lower extremities in patients with osteoarthritis: the modifying effects of illness perceptions and mental health. Osteoarthritis Cartilage 14: 1104–1110.
    1. Foster N, Bishop A, Thomas E, Main C, Horne R, et al. (2008) Illness perceptions of low back pain patients in primary care: What are they, do they change and are they associated with outcome? Pain 136(1–2): 177–187.
    1. Frostholm L, Oernboel E, Christensen KS, Toft T, Olesen F, et al. (2007) Do illness perceptions predict health outcomes in primary care patients? A 2-year follow-up study. J Psychosomatic Res 62: 129–138.
    1. Rozema H, Völlink T, Lechner L (2009) The role of illness representations in coping and health of patients treated for breast cancer. Psycho-Oncology 18(8): 849–857.
    1. Vaughan R, Morrison L, Miller E (2003) The illness representations of multiple sclerosis and their relations to outcome. Br J Health Psychol 8: 287–301.
    1. Hudak PL, Jocalyn PC, Gillian AH, Peter CC, Nizar NM, et al. (2002) “You’re Perfect for the Procedure! Why Don’t You Want It?” Elderly Arthritis Patients’ Unwillingness to Consider Total Joint Arthroplasty Surgery: A Qualitative Study. Med Decis Making 22: 272–278.
    1. Gerbershagen HJ, Dagtekin O, Rothe T, Heidenreich A, Gerbershagen K, et al. (2009) Risk factors for acute and chronic postoperative pain in patients with benign and malignant renal disease after nephrectomy. Eur J Pain 13: 853–860.
    1. Graver V, Ljunggren AE, Malt UF, Loeb M, Haaland AK, et al. (1995) Can psychological traits predict the outcome of lumbar disc surgery when anamnestic and physiological risk factors are controlled for? Results of a prospective cohort study. J Psychosom Res 39: 465–476.
    1. Haythornthwaite JA, Raja SN, Fisher B, Frank SM, Brendler CB, et al. (1998) Pain and quality of life following radical retropubic prostatectomy. J Urol 160: 1761–1764.
    1. Bruehl S, Chung OY (2004) Psychological Interventions for Acute Pain. In: Hadjistavropoulos T, Craig KD, editors. Pain: Psychological Perspectives. Mahwah, New Jersey: Lawrence Erlbaum Associates. 245–269.
    1. Johnston M, Vogele C (1993) Benefits of psychological preparation for surgery: a meta-analysis. Ann Behav Med 15(4): 245–256.
    1. Sjoling M, Nordahl G, Olofsson N, Asplund K (2003) The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. Patient Educ Couns 51: 169–176.
    1. Stoddard JA, White KS, Covino NA, Strauss L (2005) Impact of a Brief Intervention on Patient Anxiety Prior to Day Surgery. J Clin Psychol Med Settings 12(2): 99–110.

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