Predictors of postoperative movement and resting pain following total knee replacement.
Predictors of postoperative movement and resting pain following total knee replacement.
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DOI：
10.1016/j.pain.2012.06.021
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发表时间：
2012-11
期刊：
影响因子：
7.4
通讯作者：
Sluka KA
中科院分区：
文献类型：
--
作者：
Rakel BA;Blodgett NP;Zimmerman BM;Logsden-Sackett N;Clark C;Noiseux N;Callaghan J;Herr K;Geasland K;Yang X;Sluka KA
本研究确定了全膝关节置换术（TKR）后运动和静息疼痛的术前预测因素。我们假设术前疼痛强度、疼痛敏感性、特质焦虑、疼痛灾难化和抑郁程度较高的年轻患者比术前这些变量得分较低的老年患者更有可能经历更高的术后运动疼痛，并且静息疼痛的预测因子相似。术前对215名单侧TKR患者进行人口统计学、镇痛药摄入、焦虑、抑郁、疼痛灾难化、静息疼痛、运动疼痛（即在膝关节活动范围内）和定量感觉测试。术后第2天（POD2），再次评估镇痛剂量、静息疼痛和运动疼痛。中度或重度运动痛的显著预测因子为术前较高的运动痛、von Frey疼痛强度（VFPI）和热痛阈值（HPT）。术前有严重运动疼痛的患者术后有严重运动疼痛的可能性是正常人的20倍。当移除术前运动疼痛的影响后，抑郁成为预测因子。中度至重度静息疼痛的显著预测因素是术前静息疼痛、抑郁和年龄较小。这些结果表明术前疼痛和抑郁程度较高的患者更有可能在TKR后出现更高的疼痛，年轻患者可能有更高的静息疼痛。皮肤疼痛敏感性预测运动痛，但不能预测静息痛，这表明运动痛的机制与静息痛不同。术前疼痛、疼痛敏感和术前抑郁的积极处理可能有助于术后恢复。
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 (i.e., during active knee range of motion), and quantitative sensory tests, were performed pre-operatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2 (POD2), 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 (VFPI) and heat pain threshold (HPT). 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.
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DOI：
10.1097/01.blo.0000092983.12414.e9
发表时间：
2003-11-01
影响因子：
4.2
作者：
Brander, VA;Stulberg, SD;Houle, T
通讯作者：
Houle, T
影响因子：
2.8
作者：
Gordon, D B;Stevenson, K K;Ford-Roberts, K
通讯作者：
Ford-Roberts, K
影响因子：
8.8
作者：
Capdevila, X;Barthelet, Y;d'Athis, F
通讯作者：
d'Athis, F
影响因子：
7.4
作者：
Bisgaard, T;Klarskov, B;Kehlet, H
通讯作者：
Kehlet, H
影响因子：
7.4
作者：
Gagliese, L;Weizblit, N;Chan, VWS
通讯作者：
Chan, VWS