Conditioned pain modulation predicts persistent pain after knee replacement surgery

Introduction: Persistent pain after total knee replacement is an underestimated outcome leading to significant health burden. Sensory testing has been explored to help surgeons in decision making and better patient selection. Patients with different chronic pain syndromes exhibit a poor descending p...

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Detalles Bibliográficos
Autores: Dürsteler, Christian, Salazar, Yusmely, Rodriguez, Uxia, Pelfort López, Javier, Puig Verdié, Luís
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/48847
Acceso en línea:http://hdl.handle.net/10230/48847
http://dx.doi.org/10.1097/PR9.0000000000000910
Access Level:acceso abierto
Palabra clave:Conditioned pain modulation
Hyperalgesia
Knee osteoarthritis
Persistent postsurgical pain
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spelling Conditioned pain modulation predicts persistent pain after knee replacement surgeryDürsteler, ChristianSalazar, YusmelyRodriguez, UxiaPelfort López, JavierPuig Verdié, LuísConditioned pain modulationHyperalgesiaKnee osteoarthritisPersistent postsurgical painIntroduction: Persistent pain after total knee replacement is an underestimated outcome leading to significant health burden. Sensory testing has been explored to help surgeons in decision making and better patient selection. Patients with different chronic pain syndromes exhibit a poor descending pain inhibition that can be quantified through experimental paradigms (conditioned pain modulation). A poor preoperative descending pain inhibition response predicted persistence of pain after surgery in previous studies. Methods: This study investigated the correlation between a preoperative inefficient endogenous analgesia and a bad postoperative pain outcome (painful prosthesis). One hundred forty-six patients were studied preoperatively by quantitative sensory testing. Conditioned pain modulation was calculated as the relative decrease in pain intensity (thermal stimulus) during heterotopic painful stimulation. Results: Approximately 21.2% of patients had a bad pain outcome (painful prosthesis), 6 months after surgery. Preoperatively, 47.9% of patients exhibited an insufficient endogenous analgesia. The probability to develop persistent pain after surgery in that group was higher than that in patients with a sufficient endogenous analgesia (31.4% [20.9-43.6, 95% CI] vs 11.8% [5.5-21.3, 95% CI], respectively; P < 0.004). Correlation between conditioned pain modulation values and postoperative intensity of pain was also established. Besides, a preoperative lower quality of life (mental component) predicted a worse pain outcome, too. Conclusions: This cohort study shows that preoperative sensory testing predicts a bad pain outcome after total knee replacement. This tool could help clinicians in a better indication of patients with advanced knee osteoarthritis for replacement surgery. Registration details: ClinicalTrials.gov: NCT01811888 (prospective).Wolters Kluwer (LWW)202120212021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/48847http://dx.doi.org/10.1097/PR9.0000000000000910reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésPain Rep. 2021;6(1):e910© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/488472026-05-29T05:05:01Z
dc.title.none.fl_str_mv Conditioned pain modulation predicts persistent pain after knee replacement surgery
title Conditioned pain modulation predicts persistent pain after knee replacement surgery
spellingShingle Conditioned pain modulation predicts persistent pain after knee replacement surgery
Dürsteler, Christian
Conditioned pain modulation
Hyperalgesia
Knee osteoarthritis
Persistent postsurgical pain
title_short Conditioned pain modulation predicts persistent pain after knee replacement surgery
title_full Conditioned pain modulation predicts persistent pain after knee replacement surgery
title_fullStr Conditioned pain modulation predicts persistent pain after knee replacement surgery
title_full_unstemmed Conditioned pain modulation predicts persistent pain after knee replacement surgery
title_sort Conditioned pain modulation predicts persistent pain after knee replacement surgery
dc.creator.none.fl_str_mv Dürsteler, Christian
Salazar, Yusmely
Rodriguez, Uxia
Pelfort López, Javier
Puig Verdié, Luís
author Dürsteler, Christian
author_facet Dürsteler, Christian
Salazar, Yusmely
Rodriguez, Uxia
Pelfort López, Javier
Puig Verdié, Luís
author_role author
author2 Salazar, Yusmely
Rodriguez, Uxia
Pelfort López, Javier
Puig Verdié, Luís
author2_role author
author
author
author
dc.subject.none.fl_str_mv Conditioned pain modulation
Hyperalgesia
Knee osteoarthritis
Persistent postsurgical pain
topic Conditioned pain modulation
Hyperalgesia
Knee osteoarthritis
Persistent postsurgical pain
description Introduction: Persistent pain after total knee replacement is an underestimated outcome leading to significant health burden. Sensory testing has been explored to help surgeons in decision making and better patient selection. Patients with different chronic pain syndromes exhibit a poor descending pain inhibition that can be quantified through experimental paradigms (conditioned pain modulation). A poor preoperative descending pain inhibition response predicted persistence of pain after surgery in previous studies. Methods: This study investigated the correlation between a preoperative inefficient endogenous analgesia and a bad postoperative pain outcome (painful prosthesis). One hundred forty-six patients were studied preoperatively by quantitative sensory testing. Conditioned pain modulation was calculated as the relative decrease in pain intensity (thermal stimulus) during heterotopic painful stimulation. Results: Approximately 21.2% of patients had a bad pain outcome (painful prosthesis), 6 months after surgery. Preoperatively, 47.9% of patients exhibited an insufficient endogenous analgesia. The probability to develop persistent pain after surgery in that group was higher than that in patients with a sufficient endogenous analgesia (31.4% [20.9-43.6, 95% CI] vs 11.8% [5.5-21.3, 95% CI], respectively; P < 0.004). Correlation between conditioned pain modulation values and postoperative intensity of pain was also established. Besides, a preoperative lower quality of life (mental component) predicted a worse pain outcome, too. Conclusions: This cohort study shows that preoperative sensory testing predicts a bad pain outcome after total knee replacement. This tool could help clinicians in a better indication of patients with advanced knee osteoarthritis for replacement surgery. Registration details: ClinicalTrials.gov: NCT01811888 (prospective).
publishDate 2021
dc.date.none.fl_str_mv 2021
2021
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/48847
http://dx.doi.org/10.1097/PR9.0000000000000910
url http://hdl.handle.net/10230/48847
http://dx.doi.org/10.1097/PR9.0000000000000910
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Pain Rep. 2021;6(1):e910
dc.rights.none.fl_str_mv https://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wolters Kluwer (LWW)
publisher.none.fl_str_mv Wolters Kluwer (LWW)
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
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