title: The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty.
abstract: Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA.
  
  
  
  This prospective analysis included 241 patients with knee osteoarthritis (OA) undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID).
  
  
  
  Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18-1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16-1.86).). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73-7.31).
  
  
  
  Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome.
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Dave
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Selzer
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Losina
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Usiskin
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Collins
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Y C
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Band
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Dalury
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Kindsfater
authors.affiliation: Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jnkatz@partners.org.
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001900:Boston; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000503:physiopathology*; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D016012:Poisson Distribution; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Catastrophizing; Pain diagram; Total knee arthroplasty; Widespread pain