title: The design and methods of genetic studies on acute and chronic postoperative pain in patients after total knee replacement.
abstract: OBJECTIVE
  Total knee replacement (TKR) is the treatment option of choice for the millions of individuals whose osteoarthritis pain can no longer be managed through non-invasive methods. Over 500,000 TKRs are performed annually in the United States. Although most patients report improvement in pain and functioning following TKR, up to 30% report persistent pain that interferes with daily function. However, the reasons for poor outcomes are not clear. To best determine which patients are at risk for pain post TKR, a detailed and comprehensive approach is needed. In this article, we present the methodology of a study designed to identify a set of genetic, proteomic, clinical, demographic, psychosocial, and psychophysical risk factors for severe acute and chronic pain post TKR.
  
  
  METHODS
  Prospective longitudinal observational study.
  
  
  METHODS
  University Hospital System.
  
  
  METHODS
  Patients scheduled for unilateral TKR with a target number of 150.
  
  
  METHODS
  Prior to surgery, we collect demographic, psychosocial, and pain data. Biological data, including blood samples for genetic analyses, and serum, urine, and joint fluid for cytokine assessment are collected intraoperatively. Pain assessments as well as medication use are collected during each of the three days postsurgery. Additionally, pain and psychosocial information is collected 6 and 12 months following surgery.
  
  
  CONCLUSIONS
  This study, for the first time, captures the information on both genetic and "environmental" risk factors for acute and chronic pain post-TKR and has the potential to lead to the next step-multicenter large-scale studies on predictors and biomarkers of poor TKR outcomes as well as on tailored interventions and personalized medicine approaches for those at risk.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Inna
authors.initials: I
authors.lastname: Belfer
authors.forename: Carol M
authors.initials: CM
authors.lastname: Greco
authors.forename: Anna
authors.initials: A
authors.lastname: Lokshin
authors.forename: Katie
authors.initials: K
authors.lastname: Vulakovich
authors.forename: Douglas
authors.initials: D
authors.lastname: Landsittel
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.forename: Lawrence
authors.initials: L
authors.lastname: Crossett
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Chelly
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D001826:Body Fluids / Q000737:chemistry; D016207:Cytokines / Q000032:analysis; D005240:Feasibility Studies; D005260:Female; D059647:Gene-Environment Interaction; D005819:Genetic Markers; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology; D008297:Male; D009407:Nerve Block; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000235:genetics* / Q000523:psychology / Q000628:therapy; D011312:Pressure / Q000009:adverse effects; D011446:Prospective Studies; D011584:Psychology; D012307:Risk Factors; D018401:Sample Size; D057566:Self Report; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D016207:Cytokines; D005819:Genetic Markers
keywords: Cytokines; Genetic; Pain; Postsurgical; Psychosocial; Total Knee Replacement