title: Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis.
abstract: Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity.
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, England North Bristol NHS Trust, Southmead Hospital, Bristol, England Medical School, University of Exeter, Exeter, England.
authors.forename: Vikki
authors.initials: V
authors.lastname: Wylde
authors.forename: Adrian
authors.initials: A
authors.lastname: Sayers
authors.forename: Erik
authors.initials: E
authors.lastname: Lenguerrand
authors.forename: Rachael
authors.initials: R
authors.lastname: Gooberman-Hill
authors.forename: Mark
authors.initials: M
authors.lastname: Pyke
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Beswick
authors.forename: Paul
authors.initials: P
authors.lastname: Dieppe
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Blom
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000592:standards*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies