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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2015

01-01-2015 | Clinical Research

Abnormal Quantitative Sensory Testing is Associated With Persistent Pain One Year After TKA

Authors: Anthony Wright, PhD, Penny Moss, PhD, Karen Sloan, MSc, Richard J. Beaver, FRACS, Jarle B. Pedersen, MClinPhysio, Gerard Vehof, MClinPhysio, Henrik Borge, MClinPhysio, Luca Maestroni, MClinPhysio, Philip Cheong, MManipTher

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2015

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Abstract

Background

Up to 15% of patients report at least moderate persistent pain after TKA. Such pain may be associated with the presence of widespread hyperalgesia and neuropathic-type pain.

Questions/purposes

We asked if there was a difference among patients who report moderate to severe pain or no pain at least 12 months after TKA regarding (1) pressure pain threshold, (2) thermal (cold/heat) pain and detection thresholds, and (3) self-reported neuropathic pain.

Patients and Method

Fifty-three volunteers were recruited from patients reporting no pain or moderate to severe pain, according to the Knee Society Score©. Differences between the moderate-to-severe and no-pain groups regarding pressure pain, heat and cold thresholds, and self-reported neuropathic-type pain were analyzed using independent t-tests.

Results

Patients in the moderate-to-severe pain group exhibited reduced pressure pain threshold in the knee with the TKA (p = 0.025) and at the elbow (p = 0.002). This group also showed greater pain sensitivity to cold at the knee (p = 0.008) and elbow (p = 0.010), and increased heat pain sensitivity at the elbow (p = 0.032). Cold and heat detection thresholds were impaired in this group at the elbow (cold, p = 0.034; heat, p = 0.010), although only heat detection was impaired at the knee (p = 0.009). The moderate-to-severe pain group also reported more neuropathic-type pain (p = 0.001).

Conclusion

Persistent pain after TKA was associated with widespread pressure, cold hyperalgesia, and greater neuropathic-type pain.

Level of Evidence

Level III, prognostic study.
Literature
1.
Altman RD, Zinsenheim JR, Temple AR, Schweinle JE. Three-month efficacy and safety of acetaminophen extended-release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage. 2007;15:454–461.PubMedCrossRef
2.
Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain. 2010;149:573–581.PubMedCrossRef
3.
Babul N, Noveck R, Chipman H, Roth SH, Gana T, Albert K. Efficacy and safety of extended-release, once-daily tramadol in chronic pain: a randomized 12-week clinical trial in osteoarthritis of the knee. J Pain Symptom Manage. 2004;28:59–71.PubMedCrossRef
4.
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ; National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement: data from the National Joint Registry for England and Wales. J Bone Joint Surg Br. 2007;89:893–900.PubMedCrossRef
5.
Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9:807–819.PubMedCrossRef
6.
Barthel HR, Haselwood D, Longley S 3rd, Gold MS, Altman RD. Randomized controlled trial of diclofenac sodium gel in knee osteoarthritis. Semin Arthritis Rheum. 2009;39:203–212.PubMedCrossRef
7.
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T. Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res. 2003;416:27–36.PubMedCrossRef
8.
Busschbach JJ, McDonnell J, Essink-Bot ML, van Hout BA. Estimating parametric relationships between health description and health valuation with an application to the EuroQol EQ-5D. J Health Econ. 1999;18:551–571.PubMedCrossRef
9.
Chan, MT, Wan, AC, Gin T, Leslie K, Myles PS. Chronic postsurgical pain after nitrous oxide anesthesia. Pain. 2011;152:2514–2520.PubMedCrossRef
10.
Duivenvoorden T, Vissers MM, Verhaar JA, Busschbach JJ, Gosens T, Bloem RM, Bierma-Zeinstra SM, Reijman M. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013; 21:1834–1840.PubMedCrossRef
11.
Freynhagen R, Baron R, Gockel U., Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22:1911–1920.PubMedCrossRef
12.
Geber C, Klein T, Azad S, Birklein F, Gierthmühlen J, Huge V, Lauchart M, Nitzsche D, Stengel M, Valet M, Baron R, Maier C, Tölle T, Treede RD. Test–retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study. Pain. 2011;152:548–556.PubMedCrossRef
13.
Goldsmith R, Wright C, Bell SF, Rushton A. Cold hyperalgesia as a prognostic factor in whiplash associated disorders: a systematic review. Man Ther. 2012;17:402–410.PubMedCrossRef
14.
Graven-Nielsen T, Wodehouse T, Langford RM, Arendt-Nielsen L, Kidd BL. Normalization of widespread hyperesthesia and facilitated spatial summation of deep-tissue pain in knee osteoarthritis patients after knee replacement. Arthritis Rheum. 2012;64:2907–2916.PubMedCrossRef
15.
Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain. 2013;154:95–102.PubMedCrossRef
16.
Hochman JR, Davis AM, Elkayam J, Gagliese L, Hawker GA. Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Osteoarthritis Cartilage. 2013; 21: 1236–1242.PubMedCrossRef
17.
Hochman JR, Gagliese L, Davis AM, Hawker GA. Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011;19:647–654.PubMedCrossRef
18.
Jinks C, Jordan K, Croft P. Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoathritis Index (WOMAC). Pain. 2002;100:55–64.PubMedCrossRef
19.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–1625.PubMedCrossRef
20.
King CD, Sibille KT, Goodin BR, Cruz-Almeida Y, Glover TL, Bartley E, Riley JL, Herbert MS, Sotolongo A, Schmidt J, Fessler BJ, Redden DT, Staud R, Bradley LA, Fillingim RB. Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis. Osteoarthritis Cartilage. 2013;21: 1243–1252.PubMedCrossRef
21.
Kivitz A, Fairfax M, Sheldon EA, Xiang Q, Jones BA, Gammaitoni AR, Gould EM. Comparison of the effectiveness and tolerability of lidocaine patch 5% versus celecoxib for osteoarthritis-related knee pain: post hoc analysis of a 12 week, prospective, randomized, active-controlled, open-label, parallel-group trial in adults. Clin Ther. 2008;30:2366–2377.PubMedCrossRef
22.
Lacourt TE, Houtveen JH, van Doornen LJ. Experimental pressure-pain assessments: test–retest reliability, convergence and dimensionality. Scand J Pain. 2012;3:31–37.CrossRef
23.
Liu SS, Buvanendran A, Rathmell JP, Sawhney M, Bae JJ, Moric M, Perros S, Pope AJ, Poultsides L, Della Valle CJ, Shin NS, McCartney CJ, Ma Y, Shah M, Wood MJ, Manion SC, Sculco TP. Predictors for moderate to severe acute postoperative pain after total hip and knee replacement. Int Orthop. 2012;36:2261–2267.PubMedCentralPubMedCrossRef
24.
Lundblad H, Kreicbergs A, Jansson KA. Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg Br. 2008; 90:166–171.PubMedCrossRef
25.
Macrae WA, Davies HTO. Chronic postsurgical pain. In: Crombie IK, Croft PR, Linton SJ, LeResche L, Von Korff M, eds. Epidemiology of Pain. Seattle, WA: IASP Press, International Association for the Study of Pain. 1999;125–142.
26.
Moss P, Sluka K, Wright A. The initial effects of knee joint mobilization on osteoarthritic hyperalgesia. Man Ther. 2007;12:109–118.PubMedCrossRef
27.
Ohtori S, Orita S, Yamashita M, Ishikawa T, Ito T, Shigemura T, Nishiyama H, Konno S, Ohta H, Takaso M, Inoue G, Eguchi Y, Ochiai N, Kishida S, Kuniyoshi K, Aoki Y, Arai G, Miyagi M, Kamoda H, Suzkuki M, Nakamura J, Furuya T, Kubota G, Sakuma Y, Oikawa Y, Suzuki M, Sasho T, Nakagawa K, Toyone T, Takahashi K. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012;53: 801–805.PubMedCentralPubMedCrossRef
28.
Persson AL, Brogårdh C, Sjölund BH. Tender or not tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. J Rehabil Med. 2004;36:17–27.PubMedCrossRef
29.
Puolakka PA, Rorarius MG, Roviola M, Puolakka TJ, Nordhausen K, Lindgren L. Persistent pain following knee arthroplasty. Eur J Anaesthesiol. 2010;27:455–460.PubMedCrossRef
30.
Rakel BA, Blodgett NP, Bridget Zimmerman M, Logsden-Sackett N, Clark C, Noiseux N, Callaghan J, Herr K, Geasland K, Yang X, Sluka, KA. Predictors of postoperative movement and resting pain following total knee replacement. Pain. 2012;153:2192–2203.PubMedCentralPubMedCrossRef
31.
Riek S, Carson RG, Wright A. A new technique for the selective recording of extensor carpi radialis longus and brevis EMG. J Electromyogr Kinesiol. 2000;10:249–253.PubMedCrossRef
32.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003;49:156–163.PubMedCrossRef
33.
Skou ST, Graven-Nielsen T, Lengsoe L, Simonsen O, Laursen MB, Arendt-Nielsen L. Relating clinical measures of pain with experimentally assessed pain mechanisms in patients with knee osteoarthritis. Scand J Pain. 2013;4:111–117.CrossRef
34.
Slater H, Arendt- Nielsen L, Wright A, Graven-Nielsen T. Experimental deep tissue pain in wrist extensors: a model of lateral epicondylalgia. Eur J Pain. 2003;7:277–288.PubMedCrossRef
35.
Slater H, Arendt-Nielsen L, Wright A, Graven-Nielsen T. Sensory and motor effects of experimental muscle pain in patients with lateral epicondylalgia and controls with delayed onset muscle soreness. Pain. 2005;114:118–130.PubMedCrossRef
36.
Suokas AK, Walsh DA, McWilliams DF, Condon L, Moreton B, Wylde V, Arendt-Nielsen L, Zhang W. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2012;20:1075–1085.PubMedCrossRef
37.
38.
Valdes AM, Suokas AK, Doherty SA, Jenkins W, Doherty M. History of knee surgery is associated with higher prevalence of neuropathic pain-like symptoms in patients with severe osteoarthritis of the knee. Semin Arthritis Rheum. 2014; 43:588–592.PubMedCrossRef
39.
Vilardo L, Shah M. Chronic pain after hip and knee replacement. Tech Reg Anesth Pain Manag. 2011;15:110–115.CrossRef
40.
41.
Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all? Knee. 2007;14:417–423.PubMedCrossRef
42.
Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566–572.PubMedCrossRef
43.
Wylde V, Palmer S, Learmonth ID, Dieppe P. Test–retest reliability of Quantitative Sensory Testing in knee osteoarthritis and healthy participants. Osteoarthritis Cartilage. 2011;19:655–658.PubMedCrossRef
44.
Wylde V, Palmer S, Learmonth ID, Dieppe P. Somatosensory abnormalities in knee OA. Rheumatology (Oxford). 2012;51:535–543.PubMedCrossRef
45.
Wylde V, Palmer S, Learmonth ID, Dieppe P. The association between pre-operative pain sensitisation and chronic pain after knee replacement: an exploratory study. Osteoarthritis Cartilage. 2013;21: 1253–1256.PubMedCrossRef
Metadata
Title
Abnormal Quantitative Sensory Testing is Associated With Persistent Pain One Year After TKA
Authors
Anthony Wright, PhD
Penny Moss, PhD
Karen Sloan, MSc
Richard J. Beaver, FRACS
Jarle B. Pedersen, MClinPhysio
Gerard Vehof, MClinPhysio
Henrik Borge, MClinPhysio
Luca Maestroni, MClinPhysio
Philip Cheong, MManipTher
Publication date
01-01-2015
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2015
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-014-3990-2

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