Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty.
Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty.
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DOI：
10.1002/art.39051
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发表时间：
2015-05
影响因子：
13.3
通讯作者：
Clauw, Daniel J.
中科院分区：
文献类型：
--
作者：
Brummett, Chad M.;Urquhart, Andrew G.;Hassett, Afton L.;Tsodikov, Alex;Hallstrom, Brian R.;Wood, Nathan I.;Williams, David A.;Clauw, Daniel J.
虽然社会心理因素与膝关节和髋关节置换术后较差的预后有关，但我们假设，在纤维肌痛等疾病中发生的疼痛感知增强可能导致对原发性膝关节和髋关节置换术的反应性降低。进行了一项前瞻性、观察性队列研究。术前表型分析采用有效的问卷来评估疼痛、功能、抑郁、焦虑和灾难。参与者还完成了2011年纤维肌痛调查问卷，该问卷涉及与纤维肌痛特征相关的广泛的身体疼痛和共病症状。在665名参与者中，464名在手术后6个月被保留。由于符合纤维肌痛分类标准的个体预期反应较差，所有的初步分析都排除了这些个体（占队列的6%）。在预测膝关节/髋关节疼痛变化（主要结局）的多元线性回归模型中，较高的纤维肌痛调查评分独立预测疼痛改善较少（估计值- 0.25,SE 0.044; P < 0.00001）。较低的基线关节疼痛评分和膝关节（相对于髋关节）置换术也预示着较低的改善（R2 = 0.58）。相同的协变量在多变量logistic回归模型中预测了膝关节/髋关节疼痛的变化，纤维肌痛调查评分每增加1分，未能达到50%改善阈值的几率增加17.8% （P = 0.00032）。纤维肌痛调查评分也能独立预测总体疼痛的变化和患者对变化的总体印象。我们的研究结果表明，纤维肌痛调查评分是较差的关节置换术结果的可靠预测指标，即使是在评分远低于纤维肌痛分类诊断阈值的个体中也是如此。
While psychosocial factors have been associated with poorer outcomes after knee and hip arthroplasty, we hypothesized that augmented pain perception, as occurs in conditions such as fibromyalgia, may account for decreased responsiveness to primary knee and hip arthroplasty. A prospective, observational cohort study was conducted. Preoperative phenotyping was conducted using validated questionnaires to assess pain, function, depression, anxiety, and catastrophizing. Participants also completed the 2011 fibromyalgia survey questionnaire, which addresses the widespread body pain and comorbid symptoms associated with characteristics of fibromyalgia. Of the 665 participants, 464 were retained 6 months after surgery. Since individuals who met criteria for being classified as having fibromyalgia were expected to respond less favorably, all primary analyses excluded these individuals (6% of the cohort). In the multivariate linear regression model predicting change in knee/hip pain (primary outcome), a higher fibromyalgia survey score was independently predictive of less improvement in pain (estimate −0.25, SE 0.044; P < 0.00001). Lower baseline joint pain scores and knee (versus hip) arthroplasty were also predictive of less improvement (R2 = 0.58). The same covariates were predictive in the multivariate logistic regression model for change in knee/hip pain, with a 17.8% increase in the odds of failure to meet the threshold of 50% improvement for every 1‐point increase in fibromyalgia survey score (P = 0.00032). The fibromyalgia survey score was also independently predictive of change in overall pain and patient global impression of change. Our findings indicate that the fibromyalgia survey score is a robust predictor of poorer arthroplasty outcomes, even among individuals whose score falls well below the threshold for the categorical diagnosis of fibromyalgia.
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