Conditioned pain modulation predicts persistent pain after knee replacement surgery
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- dc.contributor.author Dürsteler, Christian
- dc.contributor.author Salazar, Yusmely
- dc.contributor.author Rodriguez, Uxia
- dc.contributor.author Pelfort López, Javier
- dc.contributor.author Puig Verdié, Luís
- dc.date.accessioned 2021-10-29T06:08:26Z
- dc.date.available 2021-10-29T06:08:26Z
- dc.date.issued 2021
- dc.description.abstract 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).
- dc.format.mimetype application/pdf
- dc.identifier.citation Dürsteler C, Salazar Y, Rodriguez U, Pelfort X, Verdié LP. Conditioned pain modulation predicts persistent pain after knee replacement surgery. Pain Rep. 2021;6(1):e910. DOI: 10.1097/PR9.0000000000000910
- dc.identifier.doi http://dx.doi.org/10.1097/PR9.0000000000000910
- dc.identifier.issn 2471-2531
- dc.identifier.uri http://hdl.handle.net/10230/48847
- dc.language.iso eng
- dc.publisher Wolters Kluwer (LWW)
- dc.relation.ispartof Pain Rep. 2021;6(1):e910
- dc.rights © 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.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri https://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Conditioned pain modulation
- dc.subject.keyword Hyperalgesia
- dc.subject.keyword Knee osteoarthritis
- dc.subject.keyword Persistent postsurgical pain
- dc.title Conditioned pain modulation predicts persistent pain after knee replacement surgery
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion