title: Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty.
abstract: OBJECTIVE
  Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA.
  
  
  METHODS
  Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records.
  
  
  RESULTS
  Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery.
  
  
  CONCLUSIONS
  Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients' perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes.
authors: Department of Surgery, Lovisenberg Diakonale Hospital, Oslo, Norway.|Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors: Maren Falch
authors: MF
authors: Lindberg
authors: School of Nursing, University of California San Francisco, San Francisco, California, United States of America.
authors: Christine
authors: C
authors: Miaskowski
authors: Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
authors: Tone
authors: T
authors: Rustøen
authors: Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors: Leiv Arne
authors: LA
authors: Rosseland
authors: School of Nursing, University of California San Francisco, San Francisco, California, United States of America.
authors: Steven M
authors: SM
authors: Paul
authors: Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.|Department of Patient Safety and Research, Lovisenberg Diakonale Hospital, Oslo, Norway.
authors: Anners
authors: http://orcid.org/0000-0002-7144-5096
authors: A
authors: Lerdal
mesh_terms: D059787:Acute Pain / Q000209:etiology* / Q000523:psychology*; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010149:Postoperative Pain / Q000209:etiology* / Q000523:psychology*; D059035:Perioperative Period; D057234:Preoperative Period