Biobehavioral Risk Factors for Persistent Pain following Total Knee Arthroplasty

描述（由申请人提供）：退行性关节疾病，特别是膝关节骨关节炎（OA），是最普遍和致残的慢性疼痛疾病之一，预计将随着美国人口老龄化而急剧增加。预测还表明，全膝关节置换术（终末期膝关节OA的首选治疗）的年度数量在未来几十年内将在美国增加5至10倍。虽然全膝关节置换术后的结局通常良好，但仍有相当一部分患者在手术后继续经历显著的长期疼痛和残疾。膝关节置换术后疼痛和功能轨迹的这些个体差异与体格检查和影像学检查结果的相关性极小。我们的小组已经确定了几个潜在的重要变量，这些变量可能在塑造长期疼痛结局方面发挥作用，尽管在膝关节OA患者中发表的研究很少。拟定的2中心前瞻性队列项目将仔细评价并随访接受全膝关节置换术的患者样本。膝关节OA患者将在术前进行评估，包括一系列心理物理疼痛测试程序，睡眠质量、连续性和结构的多模式评价，关于心理功能的问卷调查和生理采样（例如，血液和唾液样本）。将通过12个月随访评价疼痛、功能和镇痛剂使用等结局。这些数据将使我们能够对这些类别的“风险因素”变量的独特和综合影响进行建模。总的来说，识别与关节置换术后持续性疼痛和疼痛相关残疾的发展和维持相关的因素，对手术患者的选择和术后疼痛的管理具有重要的实际意义，以及在理解疼痛相关结局的个体差异来源方面的理论重要性。

DESCRIPTION (provided by applicant): Degenerative joint disease, particularly knee osteoarthritis (OA), is one of the most prevalent and disabling chronic pain conditions and is projected to increase sharply as the U.S. population ages. Projections also indicate that the annual number of total knee replacements, the treatment of choice for end-stage knee OA, will increase five- to ten-fold in the U.S. over the next several decades. While the outcomes following total knee arthroplasty are generally good, a substantial minority of patients continue to experience significant long-term pain and disability after surgery. These individual differences in the trajectory of pain and function after knee replacement are minimally related to findings from physical examination and imaging procedures. Our group has identified several potentially important variables that are likely to play a role in shaping long-term pain outcomes, though there are few published studies in patients with knee OA. The proposed 2-site prospective cohort project will carefully evaluate and follow a sample of patients undergoing total knee replacement. Knee OA patients will be assessed pre-surgically with a battery of psychophysical pain testing procedures, multimodal evaluation of sleep quality, continuity, and architecture, questionnaires regarding psychological function, and physiological sampling (e.g., blood and saliva samples). Outcomes such as pain, functioning, and analgesic usage will be evaluated through 12-month follow-up. These data will allow us to model the unique and combined impact of these classes of "risk factor" variables. Collectively, the identification of factors associated with the development and maintenance of persistent pain and pain-related disability following joint replacement has important practical implications for selection of surgical patients and for management of post-operative pain, as well as theoretical importance in understanding the sources of individual differences in pain-related outcomes.