Pain and sensitisation after total knee replacement or non-surgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months

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Abstract

BACKGROUND: This study is a secondary analysis of 12-month follow-ups from two parallel, randomised controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by non-surgical treatment compared with non-surgical treatment. RCT2: Non-surgical treatment compared with usual care. The aims were to investigate 1) possible predictors of treatment outcome after TKR and non-surgical interventions at 12 months, 2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitisation) at baseline and after 12 months, and 3) possible gender differences.

METHOD: Each RCT included 100 patients. Pain intensities, PPTs, and number of painful sites were assessed at baseline and after 12 months.

RESULTS: In all groups pain improved and pain sensitisation decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the non-surgical group had the greatest improvement, with no between-group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitisation but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).

CONCLUSION: Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after non-surgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values. This article is protected by copyright. All rights reserved.

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Detaljer

BACKGROUND: This study is a secondary analysis of 12-month follow-ups from two parallel, randomised controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by non-surgical treatment compared with non-surgical treatment. RCT2: Non-surgical treatment compared with usual care. The aims were to investigate 1) possible predictors of treatment outcome after TKR and non-surgical interventions at 12 months, 2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitisation) at baseline and after 12 months, and 3) possible gender differences.

METHOD: Each RCT included 100 patients. Pain intensities, PPTs, and number of painful sites were assessed at baseline and after 12 months.

RESULTS: In all groups pain improved and pain sensitisation decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the non-surgical group had the greatest improvement, with no between-group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitisation but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).

CONCLUSION: Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after non-surgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Pain
ISSN1090-3801
DOI
StatusE-pub ahead of print - 25 jan. 2018
PublikationsartForskning
Peer reviewJa
ID: 268161181