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Clinical, nociceptive and psychological profiling to predict acute pain after total knee arthroplasty
Author(s) -
Luna I. E.,
Kehlet H.,
Petersen M. A.,
Aasvang E. K.
Publication year - 2017
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12899
Subject(s) - medicine , logistic regression , physical therapy , anxiety , analgesic , hospital anxiety and depression scale , prospective cohort study , anesthesia , odds ratio , population , arthroplasty , surgery , environmental health , psychiatry
Background Pre‐operative identification of high‐pain responders for acute pain after total knee arthroplasty ( TKA ) could lead to targeted analgesic trials and individualized analgesic strategies to improve recovery and potentially reduce the risk of persistent post‐surgical pain. The aim of this study was to use simple clinical tests and questionnaires to identify predictive nociceptive and psychological factors for acute post‐ TKA pain. Methods Sixty consecutive TKA patients were included in a prospective descriptive study of pain during a 5‐m walk‐test 24 h post‐operatively as the primary outcome. Predictive variables collected prior to surgery included demographics, nociceptive testing (pressure pain threshold ( PPT ), cold pressor tolerance, electrical pain threshold and tolerance) and psychological profile (pain catastrophizing scale ( PCS ) and hospital anxiety and depression scale). The prediction of acute post‐ TKA pain was assessed by univariate analysis, logistic regressions and ROC curves. Results Reduced PPT on the arm and increased PCS were predictive variables for moderate/severe post‐ TKA pain 24 h after surgery ( P = 0.007 and P = 0.026, respectively, R‐squared 0.21) in the logistic regression model. Odds ratios were 0.67 for a 50 kP a increased PPT and 1.36 for a 5 point increase in PCS . A predictive model with cut‐off values of PPT ≤ 245 kP a and PCS ≥ 8 point had a sensitivity of 71.4 and a specificity of 62.5. Conclusion Pre‐operative widespread pressure pain hypersensitivity and pain catastrophizing are predictive of moderate severe post‐ TKA pain. If validated in a larger population, the clinically applicable tests should be considered in future interventions aiming to minimize post‐operative pain in high‐risk patients.