Evidence of generalised mechanical hyperalgesia in patients with advanced knee osteoarthritis undergoing total knee arthroplasty
Evidence of generalised mechanical hyperalgesia in patients with advanced knee osteoarthritis undergoing total knee arthroplasty
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DOI：
10.1016/j.knee.2018.03.002
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发表时间：
2018-06-01
期刊：
影响因子：
1.9
通讯作者：
McAuliffe, Michael
中科院分区：
文献类型：
--
作者：
Jaber, Khalid;O'Leary, Shaun;McAuliffe, Michael
背景和目的：据报告，在全膝关节置换术（TKA）治疗膝关节骨关节炎（KOA）后，高达34%的患者出现持续性疼痛。该组中的持续性疼痛被认为至少部分反映了痛觉超敏反应。本研究的目的是评估感觉超敏反应，使用机械和热定量感觉测试，在即将接受TKA的患者。设计和方法：压力疼痛阈值（PPT）和冷痛阈值（CPT）记录从30名参与者之前，他们的TKA，并与记录从30名健康对照组参与者的年龄和性别相似。在手术膝关节的本地和远程（另一个膝关节，三角肌）记录了关节把持。使用一般线性混合模型方法进行组间比较（KOA、对照组、组），将年龄、性别和体重指数（BMI）作为协变量。结果：与对照组相比，KOA组所有测量部位的PPT均显著降低（除三角肌P = 0.004外，其他部位P <0.001）。与女性相比，男性表现出更高的疼痛阈值，所有部位的平均值，P = 0.02。有没有观察到组间差异CPT（P = 0.122）。结论：这项研究表明，一些人即将接受TKA的先进KOA表现出广泛的机械感觉超敏反应。这些发现对这些患者的围手术期和长期疼痛管理具有潜在的重要临床意义。(C)2018爱思唯尔B.V.保留所有权利。
Background and objective: Persistent pain is reported in up to 34% of patients following total knee arthroplasty (TKA) for management of knee osteoarthritis (KOA). Persistent pain in this group is thought to be at least partly reflective of pain sensory hypersensitivity. The objective of this study was to evaluate sensory hypersensitivity, using mechanical and thermal quantitative sensory testing, in patients about to undergo TKA.Design and methods: Pressure pain thresholds (PPT) and cold pain thresholds (CPT) were recorded from 30 participants prior to their TKA, and compared with recordings taken from 30 healthy control participants of similar age and gender. Thresholds were recorded locally and remotely (other knee, deltoid) to the operative knee. Group comparisons (KOA, control, groups) were made using a general linear mixed models approach with age, gender, and body mass index (BMI) included as covariates. Pairwise comparisons were conducted with Bonferonni correction for multiple comparisons.Results: Significantly lower PPTs were at all measured sites in the KOA group compared to the control group (P < 0.001 at all sites, except the deltoid P = 0.004). Males demonstrated higher pain threshold compared to females, averaged over all sites, P = 0.02. There were no observed between-group differences in CPT (P = 0.122).Conclusions: This study suggested that some individuals about to undergo TKA for their advanced KOA demonstrated widespread mechanical sensory hypersensitivity. These findings have potentially important clinical implications regarding perioperative and longer-term pain management in these patients. (C) 2018 Elsevier B.V. All rights reserved.