Pre-surgical predictors of TKR post surgical pain.
Knee osteoarthritis (OA) is mostly characterized by loss of function, disability and pain. A total knee replacement (TKR) is the most common treatment for knee OA, however literature shows that 20% of the patients aren’t satisfied post-surgery. Various factors can account for this, such as structural or anatomical causes, but these can be resolved in surgical procedures and they are not the most common cause for post-surgical pain.
It has been thought that central sensitization may very well be the major cause for post-surgical pain. An overactivation of the descending and ascending pain facilitatory pathways can cause nociceptive pain. The aim of this systematic review was to search the literature on this topic and determine whether the presence of altered central pain modulation pre-surgically influences outcome after TKR in patients with knee OA.
This article describes pre surgical depression as one of the factors that can cause post surgical pain 6 months to 1 year. Another predictor is pain catastrophizing, which can cause post surgical pain varying from 6 weeks to 2 years. Other predictors, which were mentioned in various studies, were anxiety, fear of movement and coping strategies. Most of these predictors were measured using questionnaires.
Based on the outcome of this review, it can be concluded that psychological disorders are the most common cause for post surgical pain. It can cause altered central pain modulation. This study implies that a pre surgical screening can be helpful in predicting the post surgical pain outcome in patients with a TKR.
> From: Baert et al., Osteoarthritis Cartilage 24 (2017) 213-223(Epub ahead of print). All rights reserved to Elsevier Ltd. Click here for the online summary.