Association of preoperative pain in knee and external to knee with postoperative pain outcome after total knee arthroplasty

다국어 초록 (Multilingual Abstract)

Background: Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee.
Methods: We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0–3 was assessed using a multivariable generalized linear model.
Results: In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0–3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0–3 were not significantly different between the two groups (P > 0.05).
Conclusions: This study showed that there was an increase of morphine equivalent consumption during POD 0–3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.

참고문헌 (Reference)

1 Julien N, "Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition" 114 : 295-302, 2005

2 Beswick AD, "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" 2 : e000435-, 2012

3 Schaible HG, "Spinal mechanisms contributing to joint pain" 260 : 4-22, 2004

4 Staud R, "Spatial summation of mechanically evoked muscle pain and painful aftersensations in normal subjects and fibromyalgia patients" 130 : 177-187, 2007

5 Nie H, "Spatial and temporal summation of pain evoked by mechanical pressure stimulation" 13 : 592-599, 2009

6 D’Hoore W, "Risk adjustment in outcome assessment : the Charlson comorbidity index" 32 : 382-387, 1993

7 Brander V, "Rehabilitation after hip- and knee-joint replacement. An experience- and evidence-based approach to care" 85 (85): S98-S118, 2006

8 Maradit Kremers H, "Prevalence of total hip and knee replacement in the United States" 97 : 1386-1397, 2015

9 Wylde V, "Preoperative widespread pain sensitization and chronic pain after hip and knee replacement : a cohort analysis" 156 : 47-54, 2015

10 Armaghani SJ, "Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery" 39 : E1524-E1530, 2014

11 Kim KY, "Preoperative chronic opioid users in total knee arthroplasty-which patients persistently abuse opiates following surgery" 33 : 107-112, 2018

12 Rakel BA, "Predictors of postoperative movement and resting pain following total knee replacement" 153 : 2192-2203, 2012

13 Puolakka PA, "Persistent pain following knee arthroplasty" 27 : 455-460, 2010

14 Fingleton C, "Pain sensitization in people with knee osteoarthritis : a systematic review and meta-analysis" 23 : 1043-1056, 2015

15 Lee YC, "Pain sensitivity and pain reactivity in osteoarthritis" 63 : 320-327, 2011

16 Han T, "Opioids in cancer and non-cancer pain management in Korea: the past, present and future" 5 (5): 73-78, 2001

17 Derby SA, "Opioid conversion guidelines for managing adult cancer pain" 99 : 62-65, 1999

18 Teichtahl AJ, "Obesity and the female sex, risk factors for knee osteoarthritis that may be attributable to systemic or local leptin biosynthesis and its cellular effects" 65 : 312-315, 2005

19 Graven-Nielsen T, "Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement" 64 : 2907-2916, 2012

20 Imamura M, "Impact of nervous system hyperalgesia on pain, disability, and quality of life in patients with knee osteoarthritis : a controlled analysis" 59 : 1424-1431, 2008

21 Lluch Girbés E, "Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis" 96 : 1196-1207, 2016

22 Lluch E, "Evidence for central sensitization in patients with osteoarthritis pain : a systematic literature review" 18 : 1367-1375, 2014

23 Kim MH, "Comparison of postoperative pain in the first and second knee in staged bilateral total knee arthroplasty : clinical evidence of enhanced pain sensitivity after surgical injury" 155 : 22-27, 2014

24 Wylde V, "Central sensitization as a determinant of patients’benefit from total hip and knee replacement" 21 : 357-365, 2017

25 Ossipov MH, "Central modulation of pain" 120 : 3779-3787, 2010

26 Staud R, "Abnormal sensitization and temporal summation of second pain(wind-up)in patients with fibromyalgia syndrome" 91 : 165-175, 2001

27 Staud R, "Abnormal endogenous pain modulation is a shared characteristic of many chronic pain conditions" 12 : 577-585, 2012