title: Predictors of postoperative movement and resting pain following total knee replacement.
abstract: This study determined preoperative predictors of movement and resting pain following total knee replacement (TKR). We hypothesized that younger patients with higher preoperative pain intensity, pain sensitivity, trait anxiety, pain catastrophizing, and depression would be more likely to experience higher postoperative movement pain than older patients with lower scores on these variables prior to surgery, and that predictors would be similar for resting pain. Demographics, analgesic intake, anxiety, depression, pain catastrophizing, resting pain, movement pain (ie, during active knee range of motion), and quantitative sensory tests were performed preoperatively on 215 participants scheduled for a unilateral TKR. On postoperative day 2, analgesic intake, resting pain, and movement pain were again assessed. Significant predictors of moderate or severe movement pain were higher preoperative movement pain, von Frey pain intensity, and heat pain threshold. People with severe movement pain preoperatively were 20 times more likely to have severe movement pain postoperatively. When the influence of preoperative movement pain was removed, depression became a predictor. Significant predictors of moderate to severe resting pain were higher preoperative resting pain, depression, and younger age. These results suggest that patients with higher preoperative pain and depression are more likely to have higher pain following TKR, and younger patients may have higher resting pain. Cutaneous pain sensitivity predicted movement pain but not resting pain, suggesting that mechanisms underlying movement pain are different from resting pain. Aggressive management of preoperative pain, pain sensitivity, and depression prior to surgery may facilitate postoperative recovery.
authors: The University of Iowa College of Nursing, Iowa City, IA 52242, USA Department of Biostatistics, The University of Iowa College of Public Health, Iowa City, IA 52242, USA Department of Orthopedics and Rehabilitation, The University of Iowa College of Medicine, Iowa City, IA 52242, USA Department of Physical Therapy and Rehabilitation Science, The University of Iowa College of Medicine, Iowa City, IA 52242, USA.
authors: Barbara A
authors: BA
authors: Rakel
authors: Nicole Petsas
authors: NP
authors: Blodgett
authors: Bridget M
authors: BM
authors: Zimmerman
authors: Nyla
authors: N
authors: Logsden-Sackett
authors: Charles
authors: C
authors: Clark
authors: Nicolas
authors: N
authors: Noiseux
authors: John
authors: J
authors: Callaghan
authors: Keela
authors: K
authors: Herr
authors: Katharine
authors: K
authors: Geasland
authors: Xiaoyan
authors: X
authors: Yang
authors: Kathleen A
authors: KA
authors: Sluka
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000502:physiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold / Q000502:physiology* / Q000523:psychology; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D011237:Predictive Value of Tests; D011446:Prospective Studies