Skip to main content
SpringerLink
Log in

Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study

  • Symposium: Perioperative Pain Management in Orthopaedic Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Persistent postsurgical pain is a major source of dissatisfaction after knee arthroplasty. Postoperative pain trajectories allow a dynamic view of pain resolution after surgery and might help to identify patients at risk for persistent pain.

Questions/purposes

In this prospective observational study, we examined the relationship between postoperative pain trajectories and persistent pain, specifically neuropathic pain, at 3 months after knee arthroplasty.

Methods

Over a 1-year period, all patients undergoing elective unilateral knee arthroplasty for osteoarthritis by one surgeon were invited to participate in the study, provided they had not had prior knee surgery and their American Society of Anesthesiologists grade was 3 or lower; 128 patients fulfilled these criteria. Patients filled in a diary questioning postoperative pain at rest and during mobilization and maximal pain from Day 1 until Day 8 after surgery. At 3 months, the patients were questioned concerning the presence of persistent pain and its nature and intensity using the Douleur Neuropathique 4 [Neuropathic Pain 4] and Brief Pain Inventory questionnaires. At 3 months, 112 of the 128 patients (87%) were successfully contacted.

Results

At 3 months, 47 of the 112 (42%) patients were totally pain free and 65 (58%) reported persistent pain at the surgical site. Among the latter, 12 patients (11%) presented with a neuropathic component and more severe persistent pain. Pain trajectories highlighted higher acute pain scores for maximal pain (from Day 1 until Day 8) and for pain at mobilization (from Day 3 until Day 8) in patients with neuropathic persistent pain (p < 0.05 at all time points compared with the no persistent pain group).

Conclusions

Postoperative pain trajectories constructed from patient’s pain diary suggest that a subgroup of patients who will present with higher pain at 3 months after knee arthroplasty might be identified early in the postoperative period and might benefit from preventative treatment.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Beswick A, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open. 2012;2:e000435.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Bonnet A, Lavand’homme P, France MN, Reding R, De Kock M. [Postoperative pain trajectories to identify risk of chronic postsurgical pain in living donors for liver transplantation] [in French]. Ann Fr Anesth Reanim. 2012;31:945–949.

    Article  PubMed  CAS  Google Scholar 

  3. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29–36.

    Article  PubMed  Google Scholar 

  4. Buvanendran A, Kroin J, Della Valle C, Kari M, Moric M, Tuman K. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg. 2010;110:199–207.

    Article  PubMed  CAS  Google Scholar 

  5. Chapman C, Donaldson G, Davis J, Bradshaw D. Improving individual measurement of postoperative pain: the pain trajectory. J Pain. 2011;12:257–262.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cleeland C, Ryan K. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore. 1994;23:129–138.

    PubMed  CAS  Google Scholar 

  7. Erdemoglu AK, Koc R. Brief Pain Inventory score identifying and discriminating neuropathic and nociceptive pain. Acta Neurol Scand. 2013 April 18 [Epub ahead of print].

  8. Haroutiunian S, Nikolajsen L, Finnerup N, Jensen T. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain. 2013;154:95–102.

    Article  PubMed  Google Scholar 

  9. Hayes C, Browne S, Lantry G, Burstal R. Neuropathic pain in the acute pain service: a prospective study. Acute Pain. 2002;4:45–48.

    Article  Google Scholar 

  10. Johansen A, Romundstad L, Nielsen C, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153:1390–1396.

    Article  PubMed  Google Scholar 

  11. Kehlet H, Jensen T, Woolf C. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–1625.

    Article  PubMed  Google Scholar 

  12. Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol. 2011;24:545–550.

    Article  PubMed  Google Scholar 

  13. Liu S, Buvanendran A, Rathmell J, Sawhney M, Bae J, Moric M, Perros S, Pope A, Poultsides L, Della Valle C, Shin N, McCartney C, Ma Y, Shah M, Wood M, Manion S, Sculco TP. A cross-sectional survey on prevalence and risk factors for persistent postsurgical pain 1 year after total hip and knee replacement. Reg Anesth Pain Med. 2012;37:415–422.

    Article  PubMed  Google Scholar 

  14. Macrae WA, Davies HT. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, eds. Epidemiology of Pain. Seattle, WA: IASP Press; 1999:125–142.

    Google Scholar 

  15. Martinez V, Ben Ammar S, Judet T, Bouhassira D, Chauvin M, Fletcher D. Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model. Pain. 2012;153:1478–1483.

    Google Scholar 

  16. Morze C, Johnson N, Williams G, Moroney M, Lamberton T, McAuliffe M. Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study. J Arthroplasty. 2013;28:1565–1570.

    Article  PubMed  Google Scholar 

  17. Puolakka P, Rorarius M, Roviola M, Puolakka T, Nordhausen K, Lindgren L. Persistent pain following knee arthroplasty. Eur J Anaesthesiol. 2010;27:455–460.

    Article  PubMed  Google Scholar 

  18. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.

    Google Scholar 

  19. Sullivan M, Lynch M, Clark A. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain. 2005;113:310–315.

    Article  PubMed  Google Scholar 

  20. Thienpont E. Faster quadriceps recovery with the far medial subvastus approach in minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013;21:2370–2374.

    Article  PubMed  Google Scholar 

  21. Torrance N, Smith B, Bennett M, Lee A. The epidemiology of chronic pain of predominantly neuropathic origin: results from a general population survey. J Pain. 2006;7:281–289.

    Article  PubMed  Google Scholar 

  22. Wylde V, Hewlett S, Learmonth I, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants. Pain. 2011;152:566–572.

    Article  PubMed  Google Scholar 

  23. Wylde V, Rooker J, Halliday L, Blom A. Acute postoperative pain at rest after hip and knee arthroplasty: severity, sensory qualities and impact on sleep. Orthop Traumatol Surg Res. 2011;97:139–144.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, St Luc Hospital University, Catholic University of Louvain, Av Hippocrate 10, 1200, Brussels, Belgium

    Patricia M. Lavand’homme MD, PhD, Irina Grosu MD & Marie-Noëlle France RN

  2. Department of Orthopaedic surgery, St Luc Hospital University, Catholic University of Louvain, Brussels, Belgium

    Emmanuel Thienpont MD, MBA

Authors
  1. Patricia M. Lavand’homme MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irina Grosu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marie-Noëlle France RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emmanuel Thienpont MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Patricia M. Lavand’homme MD, PhD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Lavand’homme, P.M., Grosu, I., France, MN. et al. Pain Trajectories Identify Patients at Risk of Persistent Pain After Knee Arthroplasty: An Observational Study. Clin Orthop Relat Res 472, 1409–1415 (2014). https://doi.org/10.1007/s11999-013-3389-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-3389-5

Keywords

Search

Navigation