Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement.
Mechanical hyperalgesia and neuropathic pain qualities impart risk for chronic postoperative pain after total knee replacement.
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机械性痛觉过敏和神经性疼痛会增加全膝关节置换术后慢性术后疼痛的风险。
DOI：
10.1101/2024.01.16.24301372
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发表时间：
2024
期刊：
影响因子：
--
通讯作者：
Branco,Paulo
中科院分区：
文献类型：
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作者：
Vigotsky,AndrewD;Cong,Olivia;Pinto,CamilaB;Barroso,Joana;Perez,Jennifer;Petersen,KristianKjaer;Arendt-Nielsen,Lars;Hardt,Kevin;Manning,David;Apkarian,AVania;Branco,Paulo
全膝关节置换术（TKR）是治疗终末期慢性骨关节炎疼痛的金标准，但许多患者报告TKR后的慢性术后疼痛。TKR术后慢性疼痛的术前预测因素的研究结果不一致。本研究探讨定量感觉测试（QST）和PainDETECT对tkr术后3、6和12个月疼痛的预测价值。我们评估了77例膝关节OA （KOA）患者和41例健康对照者的基线和术后（3个月和6个月）QST测量，以及患者的神经性疼痛评分（PainDETECT）。QST参数包括压力-疼痛-压力阈值（PPT）、疼痛耐受阈值（PTT）、条理性疼痛调节（CPM）和时间累积（TS）（采用袖带测量法），以及机械性痛觉过敏和重复性针刺刺激的机械性时间累积)。与健康对照相比，KOA患者在基线时表现出对内侧受oa影响的膝关节的针刺刺激和对同侧小腿的袖带压力的痛感。下袖带测量PTT和机械针刺痛觉过敏与基线KOA疼痛强度相关。此外，基线针刺痛过敏解释了tkr后12个月疼痛强度变化的25%，术前神经性疼痛评分也分别占术后6个月和12个月疼痛变化的30%和20%。机械性针刺痛觉从术前到TKR后3个月的减少与TKR后12个月随访时的术后疼痛降低相关，反之亦然。我们的研究结果表明，术前针刺痛觉过敏和PainDETECT神经性疼痛症状对慢性tkr后疼痛的发展具有预测价值。
Total knee replacement (TKR) is the gold-standard treatment for end-stage chronic osteoarthritis pain, yet many patients report chronic postoperative pain after TKR. The search for preoperative predictors for chronic postoperative pain following TKR has been studied with inconsistent findings. This study investigates the predictive value of quantitative sensory testing (QST) and PainDETECT for postoperative pain 3, 6, and 12 months post-TKR. We assessed baseline and postoperative (3- and 6-months) QST measures in 77 patients with knee OA (KOA) and 41 healthy controls, along with neuropathic pain scores in patients (PainDETECT). QST parameters included pressure pain pressure threshold (PPT), pain tolerance threshold (PTT), conditioned pain modulation (CPM), and temporal summation (TS) using cuff algometry, alongside mechanical hyperalgesia, and mechanical temporal summation to repeated pinprick stimulation. Compared to healthy controls, KOA patients at baseline demonstrated hyperalgesia to pinprick stimulation at the medial OA-affected knee and cuff pressure on the ipsilateral calf. Lower cuff algometry PTT and mechanical pinprick hyperalgesia were associated with baseline KOA pain intensity. Moreover, baseline pinprick pain hyperalgesia explained 25% of variance in pain intensity 12 months post-TKR and preoperative neuropathic pain scores also captured 30% and 20% of the variance in postoperative pain at 6- and 12-months, respectively. A decrease in mechanical pinprick hyperalgesia from before surgery to 3 months after TKR was associated with lower postoperative pain at the 12 months post-TKR follow-up, and vice-versa. Our findings suggest that preoperative pinprick hyperalgesia and PainDETECT neuropathic-like pain symptoms show predictive value for the development of chronic post-TKR pain.