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Johnson B, Bonamer J, Thomson C, Figueras J, Shah N, Sabbagh RS, Kuechly H, Newyear B, Narendran N, Grawe B. Negative Pain Thoughts Questionnaire Short Form (NPTQ-SF) Scores and Outcomes After Arthroscopic Meniscectomy. Am J Sports Med 2024:3635465241265321. [PMID: 39175395 DOI: 10.1177/03635465241265321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Pain is multifactorial, and pain intensity has been shown to be influenced by patients' thoughts. The Negative Pain Thoughts Questionnaire Short Form (NPTQ-SF) can be used to quantify unhelpful negative cognitive biases about pain, but the relationship between negative pain thoughts and orthopaedic surgery outcomes is not known. PURPOSE To evaluate the prevalence of negative pain thoughts in patients undergoing arthroscopic meniscectomy using the NPTQ-SF survey and assess the relationship these thoughts have to knee function, general health, pain, and satisfaction before and after surgery. STUDY DESIGN Case series; Level of evidence, 4. METHODS In total, 146 patients undergoing arthroscopic meniscectomy were administered the 4-item NPTQ-SF, 12-item Short Form Survey (SF-12), International Knee Documentation Committee (IKDC) questionnaire, and visual analog scale pain survey preoperatively between July 2021 and August 2022. The same surveys were completed at a minimum of 3 months and no later than 1 year postoperatively by 92 patients confirmed to have undergone meniscectomy. RESULTS NPTQ-SF scores were correlated with IKDC, SF-12, and satisfaction score preoperatively and at least 3 months postoperatively (mean, 108.5 ± 43.7 days). Preoperative NPTQ-SF scores were significantly negatively correlated with postoperative IKDC (R = -0.284), SF-12 (R = -0.266 and -0.328), and visual analog scale pain (R = 0.294) scores, while a relationship with postoperative satisfaction did not reach statistical significance (P = .067). Patients with a preoperative NPTQ-SF score >8 were less likely to achieve a Patient Acceptable Symptom State on the postoperative IKDC questionnaire (39% vs 63%; P = .03). Patients with a history of a psychiatric or chronic pain diagnoses have worse NPTQ-SF, SF-12, and IKDC scores pre- and postoperatively. CONCLUSION The level of negative pain thoughts in patients undergoing meniscectomy is related to knee function, general health, and pain. Patients with a high level of negative pain thoughts are less likely to achieve a favorable outcome from meniscectomy, with a score ≥8 representing a clinically significant threshold for preoperative screening.
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Affiliation(s)
- Brian Johnson
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - John Bonamer
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cameron Thomson
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jorge Figueras
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nihar Shah
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ramsey Samir Sabbagh
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Henry Kuechly
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian Newyear
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nakul Narendran
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian Grawe
- Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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Askari A, Mohammadpour M, Jabalameli M, Naeimipoor N, Goodarzy B, Jafari B, Rashidi H, Mousazadeh F, Rajei M, Khazanchin A, Bahardoust M, Hassanzadeh M. Predictors of health-related quality of life after total knee arthroplasty: a case-control study. Sci Rep 2024; 14:14176. [PMID: 38898136 PMCID: PMC11187171 DOI: 10.1038/s41598-024-65042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
Total knee arthroplasty (TKA) improves patients' Health-related quality of life (HRQoL) compared to before surgery. However, based on our knowledge, the improvement in HRQoL after TKA, which depends on various factors, has yet to be investigated compared to healthy people. This study aimed to evaluate the HRQoL of patients compared to healthy people and the factors affecting the HRQoL after TKA. In this matched case-control study (1002 participants), HRQoL in 501 patients who underwent TKA between 2015 and 2022 at Shafa Yahyainan Hospital affiliated with Iran University of Medical Sciences were compared with 501 healthy controls. HRQoL was evaluated in two parts (before compared to 12 months after TKA and 12 months after TKA compared to the healthy population). The 36-item short-form health survey (SF-36) was used to evaluate HRQoL 12 months after surgery. The influencing factors on HRQoL were evaluated by multivariate logistic regression analysis. No significant difference was observed in the demographic characteristics of the participants in the two groups. The mean overall SF-36 score, 12 months after surgery, significantly improved compared to before surgery (64.21 ± 22.2 vs. 37.55 ± 15.13, p:0.001). The mean total score of SF-36 was statistically similar between the case and control groups (64.21 ± 22.2 VS 72.53 ± 25.3). The multivariate analysis showed that sex, BMI, number of comorbidities, postoperative compliance, and complications were significantly related to the decrease in patients' HRQoL (P < 0.001).TKA can improve the HRQoL except for two subscales of happiness/vitality and physical performance, similar to the healthy population. Female gender, obesity and overweight, comorbidity, bilateral TKA, non-adherence to postoperative physiotherapy, and complications were associated with decreased HRQoL.
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Affiliation(s)
- Alireza Askari
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadpour
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran
| | - Mahmoud Jabalameli
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Naeimipoor
- Department of Psychology, Neyshabur Branch, Azad University, Neyshabur, Iran
| | - Babak Goodarzy
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Jafari
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Heeva Rashidi
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mousazadeh
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Rajei
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khazanchin
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hassanzadeh
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Lin A, Liu ZQ, Yao JP, Liu YH, Wan H. A Review of the Extent of Pain Catastrophizing in Patients Who Have Undergone Total Knee Replacement. Pain Manag Nurs 2024; 25:e192-e200. [PMID: 38461044 DOI: 10.1016/j.pmn.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 03/11/2024]
Abstract
OBJECTIVES This study aimed to analyze the current status and influencing factors of pain catastrophizing in patients undergoing total knee replacement (TKR) and to provide a basis and reference for the clinical improvement of pain catastrophizing in these patients. DESIGN This study was designed in accordance with PRISMA guidelines. DATA SOURCES PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu and Chinese Biomedical Literature Databases. REVIEW/ANALYSIS METHODS A scoping review was performed using PubMed, the Web of Science, the Elton B. Stephens Company, the Cochrane Library, Embase, Chinese National Knowledge Infrastructure, the WanFang, Weipu, and Chinese Biomedical Literature Databases, and after literature screening and data extraction, the results were summarized. RESULTS A total of 23 articles were included in the study. Pain catastrophizing is mostly assessed using the Pain Catastrophizing Scale and the Coping Strategies Questionnaire. The level of pain catastrophizing is an independent predictor of pain in patients undergoing TKR and is influenced by demographic, psychological, co-morbid, and prognostic factors. Pain catastrophizing interventions mainly consist of surgery, physiotherapy, medication, and psychological therapy. CONCLUSIONS Pain catastrophizing involves multiple factors, and it is necessary to explore the predictors affecting pain catastrophizing, improve the systematic evaluation of pain catastrophizing and adopt the appropriate intervention methods.
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Affiliation(s)
- Ai Lin
- The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, China
| | - Zhi Qun Liu
- Department of Emergency Medicine, Clinical Research Center For Emergency and Critical Care In Hunan Province, Hunan Provincial Institute of Emergency Medicine, Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Jia Pei Yao
- Department of Nursing, The Second People's Hospital of Changzhou, Changzhou, China
| | - Yan Hui Liu
- The First Affiliated Hospital of Hunan Normal University (Hunan Provincial People's Hospital), Changsha, China
| | - Huan Wan
- Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, China.
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Martin JR, Coronado R, Wilson JM, Polkowski GG, Shinar AA, Bruehl S. Central Sensitization: The Missing Link Between Psychological Distress and Poor Outcome Following Primary Total Knee Arthroplasty. J Arthroplasty 2024; 39:1201-1206. [PMID: 38128626 PMCID: PMC11032226 DOI: 10.1016/j.arth.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND While preoperative psychological distress is known to predict risk for worse total knee arthroplasty (TKA) outcomes, distress may be too broad and nonspecific a predictor in isolation. We tested whether there are distinct preoperative TKA patient types based jointly on psychological status and measures of altered pain processing that predict adverse clinical outcomes. METHODS In 112 TKA patients, we preoperatively assessed psychological status (depression, anxiety, and catastrophizing) and altered pain processing via a simple quantitative sensory testing protocol capturing peripheral and central pain sensitization. Outcomes (pain, function, opioid use) were prospectively evaluated at 6 weeks and 6 months after TKA. Cluster analyses were used to empirically identify TKA patient subgroups. RESULTS There were 3 distinct preoperative TKA patient subgroups identified from the cluster analysis. A low-risk (LR) group was characterized by low psychological distress and low peripheral and central sensitization. In addition, 2 subgroups with similarly elevated preoperative psychological distress were identified, differing by pain processing alterations observed: high-risk centralized pain and high-risk peripheral pain. Relative to LR patients, high-risk centralized pain patients displayed significantly worse function and greater opioid use at 6 months after TKA (P values <.05). The LR and high-risk peripheral pain patient subgroups had similar 6-month outcomes (P values >.05). CONCLUSIONS Among patients who have psychological comorbidity, only patients who have central sensitization were at elevated risk for poor functional outcomes and increased opioid use. Central sensitization may be the missing link between psychological comorbidity and poor TKA clinical outcomes. Preoperative testing for central sensitization may have clinical utility for improving risk stratification in TKA patients who have psychosocial risk factors.
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Affiliation(s)
- J. Ryan Martin
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Rogelio Coronado
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Jacob M. Wilson
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Gregory G. Polkowski
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Andrew A. Shinar
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Stephen Bruehl
- Vanderbilt University Medical Center, Department of Anesthesia, 1211 Medical Center Dr, Nashville, TN 37232
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5
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Zhou Y, Gao W, Gao S, Guo X, Liu M, Cao C. Pain Catastrophizing, Kinesiophobia and Exercise Adherence in Patients After Total Knee Arthroplasty: The Mediating Role of Exercise Self-Efficacy. J Pain Res 2023; 16:3993-4004. [PMID: 38026453 PMCID: PMC10676101 DOI: 10.2147/jpr.s432106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To examine whether exercise self-efficacy mediates the contributions of pain catastrophizing and kinesiophobia to exercise adherence in patients after total knee arthroplasty. Patients and Methods A cross-sectional study design was conducted. A total 211 post-total knee arthroplasty patients were recruited from three orthopedics units of a tertiary hospital in China. Participants were invited to complete questionnaires on pain catastrophizing, kinesiophobia, exercise self-efficacy, and exercise adherence. Mplus 8.3 software was used to construct mediation models. Results Pain catastrophizing and kinesiophobia were negatively correlated with exercise adherence (r = -0.509, r = -0.605, p < 0.001 respectively), while exercise self-efficacy were positively associated with exercise adherence (r = 0.799, p < 0.001). The results found exercise self-efficacy mediated the correlations of pain catastrophizing and kinesiophobia with exercise adherence after adjusting for demographic and clinical covariates. Pain catastrophizing indirectly affected patients' exercise adherence through its effect on exercise efficacy (indirect effect: -0.412), while Kinesiophobia is directly associated with exercise adherence and also indirectly through exercise self-efficacy (direct effect: -0.184, indirect effect: -0.415). Conclusion Patients after total knee arthroplasty who have high levels of psychological distress (pain catastrophizing and kinesiophobia) are vulnerable to be non-adherent to exercise behaviors. Exercise self-efficacy explains the effects of pain catastrophizing and kinesiophobia on exercise adherence and may be a key target for measures to improve exercise behaviors in patients after total knee arthroplasty.
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Affiliation(s)
- Yi Zhou
- School of Nursing, Langfang Health Vocational College, Langfang, Hebei, People’s Republic of China
| | - Weina Gao
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, People’s Republic of China
| | - Shumin Gao
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, People’s Republic of China
| | - Xutong Guo
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, People’s Republic of China
| | - Meng Liu
- Department of Orthopedics, Baoding No.1 Central Hospital, Baoding, Hebei, People’s Republic of China
| | - Congjie Cao
- School of Nursing, Langfang Health Vocational College, Langfang, Hebei, People’s Republic of China
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Jones IA, Talehakimi A, Murphy LS, Wang JC, Piple AS, Christ AB, Heckmann ND. Duloxetine for Postoperative Pain Control Following Knee or Hip Replacement: A Systematic Review and Meta-Analysis. Arthroplast Today 2023; 20:101097. [PMID: 36852213 PMCID: PMC9957748 DOI: 10.1016/j.artd.2023.101097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/08/2022] [Accepted: 01/02/2023] [Indexed: 03/01/2023] Open
Abstract
Background Duloxetine is a Food and Drug Administration-approved selective norepinephrine reuptake inhibitor for treating depression, anxiety, fibromyalgia, and neuropathic and chronic musculoskeletal pain. This meta-analysis aims to evaluate the efficacy of duloxetine in reducing pain and postoperative opioid use following lower extremity total joint arthroplasty. Methods A literature search was performed, identifying randomized controlled trials investigating duloxetine for pain management after total hip and total knee arthroplasty. Data from the visual analog scale (VAS) for pain during movement and at rest were extracted for postoperative days (PODs) 1, 3, 7, and 14, as well as postoperative week 6 and postoperative month 3. Opioid use data were obtained at 24, 48 and 72 hours. All data were analyzed using inverse variance with random effects and presented as weighted mean difference. Results Eight unique studies were identified and included, 7 of which were analyzed quantitatively. Duloxetine decreased postoperative opioid consumption at 48 and 72 hours. For VAS for pain at rest, significantly reduced pain was reported by duloxetine-treated patients at POD 3, POD 7, and postoperative week 6. For VAS for pain at movement, significantly reduced pain was reported by duloxetine-treated patients at POD1, POD 3, POD 7, POD 14, postoperative week 6, and postoperative month 3. Conclusions Duloxetine appears to decrease postoperative pain and opioid consumption following total joint arthroplasty. However, definitive conclusions are limited by small sample size and study heterogeneity. While there is a need for follow-up studies to determine the optimal dose, duration, and patient population, strong preliminary data provide robust support for future large-scale efficacy studies.
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Affiliation(s)
- Ian A. Jones
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Arad Talehakimi
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | - Linda S. Murphy
- Irvine Libraries Reference Department, University of California, Irvine, CA, USA
| | - Jennifer C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Amit S. Piple
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander B. Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Nathanael D. Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
- Corresponding author. Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo Street, Ste 2000, Los Angeles, CA 90333. Tel.: +1 323 704 6363.
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Arasegawa Y, Muramatsu K, Inoue K, Ueda T, Jyouichi K, Kinoshita D. The Relationship of Patient Characteristics and Prolonged Pain after Treatment of Carpometacarpal Joint Arthritis of the Thumb. J Hand Surg Asian Pac Vol 2023; 28:53-60. [PMID: 36803472 DOI: 10.1142/s242483552350008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: The carpometacarpal (CMC) joint of the thumb is the second most common site of osteoarthritis in the hand. Clinical severity stage of CMC joint arthritis has not been correlated with the pain level of the patient. Recently, the association of joint pain with patient psychological factor, such as depression or case-specific personality, has been investigated. This study was designed to determine the impact of psychological factors to residual pain after treatment of CMC joint arthritis, using pain catastrophizing scale (PCS) and the Yatabe-Guilford (YG) personality test. Methods: Twenty-six patients (7 males and 19 females) with 26 hands were included. Thirteen patients classified as Eaton stage 3 underwent suspension arthroplasty and 13 patients as Eaton stage 2 underwent conservative treatment using a custom fitted orthosis. Clinical evaluation was assessed using Visual Analogue Scale (VAS) and the quick Disabilities of the Arm, Shoulder and Hand Questionnaire Score (QuickDASH) at initial evaluation, at 1 month and at 3 months after treatment. We compared both groups using the PCS and YG test. Results: The PCS showed significant difference in the VAS scores only at initial evaluation in both surgical and conservative treatment. There was a significant difference in VAS at 3 months between the two groups in both surgical and conservative treatment and in QuickDASH at 3 months in conservative treatment. Conclusions: The YG test has been used mainly in psychiatry. Although this test has not yet been used worldwide, its usefulness has been recognised and applied clinically, especially in Asia. Patient characteristics are strongly associated with residual pain of the CMC joint arthritis of the thumb. The YG test is a useful tool to analyse pain-related patient characteristics and can be utilised to determine the therapeutic modalities and most effective rehabilitation programme for pain control. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Yoshito Arasegawa
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Keiichi Muramatsu
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kiyotaka Inoue
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Takeshi Ueda
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kouhei Jyouichi
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Daisuke Kinoshita
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
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Overton M, Swain N, Falling C, Gwynne-Jones D, Fillingim R, Mani R. Activity-related pain predicts pain and functional outcomes in people with knee osteoarthritis: A longitudinal study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1082252. [PMID: 36713644 PMCID: PMC9880771 DOI: 10.3389/fpain.2022.1082252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023]
Abstract
Knee Osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly resulting in pain and disability. However, pain and disability in this population are poorly related with the degree of structural joint damage. Underlying pain mechanisms, including activity-related pain and sensitization assessed via Quantitative Sensory Testing (QST), may better predict pain and functional outcomes of those with knee OA. Therefore, the aim of this study was to explore whether activity-related pain and sensitization assessed via QST predict future pain, function, fatigue, physical performance and quality of life outcomes in those living in the community with knee OA. Eighty-six participants with knee OA were recruited in Dunedin, New Zealand. Those eligible to participate underwent baseline testing including QST as well as measures of activity-related pain including Movement-evoked Pain (MEP) and Sensitivity to Physical Activity (SPA). Outcome measures exploring pain, function, fatigue and quality of life outcomes were collected at baseline, and two follow-up periods (two and nine weeks). Univariable linear regression models were developed followed by multivariable linear regression models for each prognostic marker adjusting for age, gender, BMI, OA duration, baseline pain intensity and socioeconomic status. Activity-related measures of pain, including MEP and SPA, demonstrated predictive associations with pain and functional outcomes prospectively in those with knee OA. Therefore, those demonstrating activity-related pain are at future risk of greater pain, disability and reduced quality of life. Larger, externally validated longitudinal studies are required which include individuals with more severe knee OA.
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Affiliation(s)
- Mark Overton
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand,Correspondence: Mark Overton
| | - Nicola Swain
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Carrie Falling
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Otago School of Medicine, University of Otago, Dunedin, New Zealand
| | - Roger Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Department of Community Dentistry and Behavioural Science, University of Florida, Gainesville, FL, United States
| | - Ramakrishnan Mani
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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The Effect of Reiki on Anxiety, Fear, Pain, and Oxygen Saturation in Abdominal Surgery Patients; A Randomized Controlled Trial. Explore (NY) 2022:S1550-8307(22)00210-5. [DOI: 10.1016/j.explore.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
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10
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Kuwakado S, Kawaguchi K, Otsuka H, Fujita A, Kusaba R, Tokieda M, Fujiyoshi D, Kamishima T, Fujino E, Motomura G, Hamai S, Nakashima Y. Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA. Geriatr Orthop Surg Rehabil 2022; 13:21514593221126019. [PMID: 36177368 PMCID: PMC9513576 DOI: 10.1177/21514593221126019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty. Materials and Methods This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months. Results Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P < .01), pain (P < .01), FAI scores (P < .01), and EQ5D (P < .01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR: .93, 95% CI: .86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty. Conclusions Total arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.
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Affiliation(s)
- So Kuwakado
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Kawaguchi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Otsuka
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Akio Fujita
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ryuichi Kusaba
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Miki Tokieda
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Daisuke Fujiyoshi
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takahide Kamishima
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Eijiro Fujino
- Department of Rehabilitation Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Koh HS, Choi YH, Park D, Jeong MG. Association Between Pain Catastrophizing and Central Sensitization Among Patients With Severe Knee Osteoarthritis Awaiting Primary Total Knee Arthroplasty. Orthopedics 2022; 45:197-202. [PMID: 35394381 DOI: 10.3928/01477447-20220401-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total knee arthroplasty (TKA) is among the most successful types of surgery for the treatment of knee osteoarthritis (OA). However, nearly 20% of patients report unexpected pain after surgery. Recently, some studies have proposed that pain after TKA is related to pain catastrophizing (PC) and central sensitization (CS). However, there is no study comparing PC and CS for the same patient with knee OA requiring TKA. Thus, the goal of this study was to confirm the association between PC and CS among patients with knee OA awaiting primary TKA. This study was conducted with the clinical data of 153 patients collected between July 2019 and February 2021. Both PC and CS were evaluated with the Pain Catastrophizing Scale (PCS) and the Central Sensitizing Inventory (CSI). Patients with PCS scores higher than 30 were classified as high-level catastrophizing. Patients with CSI scores higher than 40 were classified as central sensitized. The distribution of PC and CS levels was confirmed, and the correlation between PC and CS was analyzed. A significant correlation was found between PCS and CSI scores, with Pearson's correlation coefficient of 0.606. Participants with high-level catastrophizing were 2.07 times more likely to belong to the central sensitized group compared with those who did not show high-level catastrophizing. Participants in the central sensitized group were 3.02 times more likely to belong to the high-level catastrophizing group than those who were not central sensitized. In conclusion, many patients with knee OA awaiting primary TKA had high-level catastrophizing, and a significant association was found between PC and CS. [Orthopedics. 2022;45(4):197-202.].
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Veljkovic A, Gagne O, Abuhantash M, Younger ASE, Symes M, Penner MJ, Wing KJ, Syed KA, Lau J. High Pain Catastrophizing Scale Predicts Lower Patient-Reported Outcome Measures in the Foot and Ankle Patient. Foot Ankle Spec 2022:19386400221093865. [PMID: 35607813 DOI: 10.1177/19386400221093865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative outcomes may be affected by the patient's preoperative morbidity. It is hypothesized that patient's pain catastrophization prior to foot and ankle surgery may affect their patient-reported outcomes. Methods: This study prospectively assessed a consecutive cohort of 46 patients undergoing foot and ankle reconstruction to describe the relationship between Pain Catastrophizing Scale (PCS) and patient-reported outcomes measured by 12-item Short Form Health Survey and Foot and Ankle Outcome Score (FAOS). RESULTS The 1-year postoperative FAOS pain, activities of daily living, and quality of life scores correlated significantly with all baseline PCS subcategories. We found that the mental domain of the SF-12 had a statistically significant correlation with the rumination and helplessness PCS subcategories. CONCLUSION This study showed a significant association between a high preoperative PCS and a worse 1-year FAOS. As such, catastrophization could be screened for and potentially treated preoperatively to improve patient-reported outcomes in elective foot and ankle surgery. LEVEL OF EVIDENCE Therapeutic, Level III Evidence.
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Affiliation(s)
- Andrea Veljkovic
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Oliver Gagne
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | | | - Alastair S E Younger
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Michael Symes
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Murray J Penner
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Kevin J Wing
- Department of Orthopedics, Footbridge Centre for Integrated Foot and Ankle Care, St. Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Khalid A Syed
- Arthritis Program, Toronto Western Hospital and Research Institute, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Johnny Lau
- Arthritis Program, Toronto Western Hospital and Research Institute, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada
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13
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Ustunel F, Erden S. Evaluation of Fear of Pain Among Surgical Patients in the Preoperative Period. J Perianesth Nurs 2021; 37:188-193. [PMID: 34922831 DOI: 10.1016/j.jopan.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the fear of surgery-related pain of patients in the preoperative period. DESIGN A descriptive, cross-sectional study. METHODS A total of 419 patients who were scheduled for a variety of surgical procedures in a tertiary hospital were included. Data were collected using a Patient Identification Information Form and fear of pain was evaluated using the Fear of Pain Questionnaire-III. FINDINGS 50.8% of the patients were males with a mean age of 49.2 ± 17.3 years. A total of 88.8% patients had a fear of pain after surgery, and 89.3% of them had a moderate to severe fear of pain. 84.5% of female patients, 82.5% of literate patients, and 86.1% of patients who had previously experienced severe pain had a fear of pain of moderate to severe intensity (P < .05). The mean Fear of Pain Questionnaire-III score was 75.1 ± 20.2, and the most commonly identified fears were severe pain (30.64 ± 9.5), and medical pain (24.17 ± 7.7). Patients who had a higher score of fear of severe pain and medical pain were those who had experienced severe pain previously and those who believed that they would experience postoperative pain (P < .05). CONCLUSIONS Almost all patients included in this study had a fear of moderate to severe postoperative pain while in the preoperative period. Nurses should question pain history with each patient, obtain a detailed pain history, and identify the degree of fear of pain in the preoperative period. Fear of pain should be reduced using necessary interventions and pain control should be maintained. Reduced fear of pain in the preoperative period may decrease postoperative pain and yield favorable patient outcomes.
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Affiliation(s)
- Fatmagul Ustunel
- Cukurova University Institute of Health Sciences, Adana, Turkey.
| | - Sevilay Erden
- Cukurova University Institute of Health Sciences, Adana, Turkey
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14
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Candela CF, Pia LJ, Pons-Fuster E, Tvarijonaviciute A. Impact of the COVID-19 pandemic upon patients with burning mouth syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:101-104. [PMID: 34246819 PMCID: PMC8265185 DOI: 10.1016/j.jormas.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 12/09/2022]
Abstract
INTRODUCTION The global COVID-19 pandemic has caused changes in the daily life of people, with a particularly relevant impact upon certain groups of individuals that have difficulties in facing stress. A study is made of the impact of the pandemic upon patients with burning mouth syndrome (BMS). MATERIAL AND METHODS A total of 40 patients with BMS diagnosed in the Unit of Oral Medicine (University of Murcia, Spain) were included. In all cases the study comprised a standardized clinical interview by the same professional and an exploration of the oral cavity. The first visit took place before the pandemic and consisted of the evaluation of anxiety (Hospital and Anxiety Depression Scale [HADS]), the Pain Catastrophizing Scale (PCS), pain intensity (visual analog scale [VAS]) and sleep quality (Pittsburg Sleep Quality Index [PSQI]), while the second visit took place one and a half months after the start of lockdown due to the pandemic in Spain. RESULTS The study sample consisted of 36 women (90%) and four men (10%) aged between 39 and s86 years. Statistically significant differences were recorded between the two visits in terms of anxiety (p < 0.001), sleep quality (p < 0.001) and pain intensity (p < 0.001). CONCLUSIONS The appearance of the COVID-19 pandemic has triggered worsening of anxiety, sleep quality and pain intensity in patients with BMS.
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Affiliation(s)
- Castillo-Felipe Candela
- Colaborate Department Stomatology School of Medicine, Faculty of Medicine and Odontology, University of Murcia; 30008 Murcia, Spain.
| | - Lope-Jornet Pia
- Biomedical Research Institute (IMIB-Arrixaca), Faculty of Medicine and Odontology, University of Murcia, 30008 Adv Marques de los Velez s/n, Spain.
| | - Eduardo Pons-Fuster
- Biomedical Research Institute (IMIB-Arrixaca), Faculty of Medicine and Odontology, University of Murcia, 30008 Adv Marques de los Velez s/n, Spain
| | - Asta Tvarijonaviciute
- Interdisciplinary Laboratory of Clinical Analysis, Interlab-UMU, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Espinardo, 30100 Murcia, Spain.
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15
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Young-Shand KL, Dunbar MJ, Laende EK, Mills Flemming JE, Astephen Wilson JL. Early Identification of Patient Satisfaction Two Years After Total Knee Arthroplasty. J Arthroplasty 2021; 36:2473-2479. [PMID: 33766448 DOI: 10.1016/j.arth.2021.02.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are numerous reports of poor satisfaction after total knee arthroplasty (TKA), yet there is little known about when to use evidence-based models of care to improve patient outcomes. OBJECTIVE This study aimed to characterize longitudinal changes in patient-reported satisfaction after TKA and to identify factors for early identification of poor satisfaction. METHODS For a cohort of primary TKA surgeries (n = 86), patient-reported outcomes were captured one week before TKA and 6 weeks, 12 weeks, 6 months, and 1 and 2 years after TKA. "Satisfied" versus "not fully satisfied" patients were defined using a binary response (≥90 vs <90) from a 100-point scale. Wilcoxon signed-rank tests identified changes in satisfaction between follow-up times, and longitudinal analyses examined demographic and questionnaire factors associated with satisfaction. RESULTS Improvements in satisfaction occurred within the first 6 months after TKA (P ≤ 0.01). Preoperative patient-reported outcome measures alone were not predictive of satisfaction. Key factors that improved longitudinal satisfaction included higher Oxford Knee Scores (odds ratio (OR) = 2.1, P < .001), general health (EQ-VAS, OR = 1.3, P = .03), and less visual analog scale pain (VAS; OR = 1.7, P < .001). Differences in these factors between satisfied and not fully satisfied patients were identified as early as 6 weeks after surgery. CONCLUSION Visibly different satisfaction profiles were captured among satisfied and not fully satisfied patient responses, with differences in patient-perceived joint function, general health, and pain severity occurring as early as 6 weeks after surgery. This study provides metrics to support early identification of patients at risk of poor TKA satisfaction, enabling clinicians to apply timely targeted treatment and support interventions, with the aim of improving patient outcomes.
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Affiliation(s)
- Kathryn L Young-Shand
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University & QEII Health Sciences Centre; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Elise K Laende
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University & QEII Health Sciences Centre; Nova Scotia Health Authority, Halifax, Nova Scotia, Canada; Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada
| | - Joanna E Mills Flemming
- Department of Mathematics and Statistics, Dalhousie University; Halifax, Nova Scotia, Canada
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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16
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Tavares DRB, Moça Trevisani VF, Frazao Okazaki JE, Valéria de Andrade Santana M, Pereira Nunes Pinto AC, Tutiya KK, Gazoni FM, Pinto CB, Cristina Dos Santos F, Fregni F. Risk factors of pain, physical function, and health-related quality of life in elderly people with knee osteoarthritis: A cross-sectional study. Heliyon 2020; 6:e05723. [PMID: 33376818 PMCID: PMC7758370 DOI: 10.1016/j.heliyon.2020.e05723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/09/2020] [Accepted: 12/10/2020] [Indexed: 10/26/2022] Open
Abstract
Data on the precise mechanisms of the complex interactions of factors related to clinical impact of knee osteoarthritis (KOA) in the elderly population remain limited. To find predictors that explain pain intensity, physical function, and quality of life in elderly KOA subjects, we performed a cross-sectional analysis of the baseline data from a randomized trial. The trial included 104 subjects (aged ≥60) with KOA pain and dysfunctional endogenous pain-inhibitory system activity assessed by conditioned pain modulation (CPM). Three multiple linear regression models were performed to understand the independent predictors of Brief Pain Inventory (BPI), WOMAC function subscale (WOMACFunc), and SF-12 physical subscale (SF12-PCS). Model 1 showed that BPI pain score was predicted by low CPM response, high von-Frey light touch threshold, worse radiological severity as indexed by Kellgren-Lawrence grade (KL), high von-Frey punctate pain intensity and high levels of anxiety (adjusted R2 = 27.1%, F (6,95) = 7.27, P < 0.0001). In model 2, von-Frey light touch threshold, KL, depressive symptoms indexed by Beck Depression Inventory (BDI), level of sleepiness and pain pressure threshold were risk factors for SF12-PCS (adjusted R2 = 31.9%, F (5,96) = 10.5, P < 0.0001). Finally, model 3 showed that WOMACFunc was predicted by BDI, KL and BPI (adjusted R2 = 41%, F (3,98) = 24.42, P < 0.0001). Our data provides an interesting framework to understand the predictors of KOA pain in the elderly and highlights how its related outcomes are affected by disease-specific factors, somatosensory dysfunction and emotional factors.
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Affiliation(s)
- Daniela Regina Brandão Tavares
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Virginia Fernandes Moça Trevisani
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Rheumatology, Santo Amaro University, São Paulo, SP, Brazil
| | - Jane Erika Frazao Okazaki
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Ana Carolina Pereira Nunes Pinto
- Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Physical Therapy, University of Pittsburgh, Fullbright Program, USA
| | - Karina Kuraoka Tutiya
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Fernanda Martins Gazoni
- Department of Geriatrics and Gerontology, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Evidence-Based Medicine, Brazilian Cochrane Centre, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Camila Bonin Pinto
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Felipe Fregni
- Laboratory of Neuromodulation, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sveinsdóttir H, Kristiansen K, Skúladóttir H. Health related quality of life in patients having total knee replacement and associations with symptoms, recovery, and patient education: A six month follow up study. Int J Orthop Trauma Nurs 2020; 42:100830. [PMID: 33518438 DOI: 10.1016/j.ijotn.2020.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/16/2023]
Abstract
AIM To describe the symptoms, recovery, patient education, and health related quality of life (HRQOL) of patients having total knee replacements at three time points and to detect experiences and situations that predict HRQOL six weeks and six months post-surgery. METHOD A prospective exploratory two-site study assessing 123 patients, while in hospital (T1), at six weeks (T2), and at six months (T3) post-discharge. HRQOL was measured using the SF-36v2 and symptoms were measured with the Hospital and Anxiety Scale. Two questions considered pain and two considered movement and tiredness while two questions addressed recovery and patient education. Linear regression models were used to calculate predictors of mental and physical HRQOL at T2 and T3. RESULTS HRQOL improved from T1 to T3. The main predictors of higher physical scores at T2 were; being older, fewer symptoms of depression and little distress related to movement. At T3 the main predictors were; having resumed work, finding patient education very useful, experiencing no pain in the last 24 h and fewer symptoms of depression. The main predictors of higher mental scores at T2 were fewer symptoms of anxiety and depression and little distress related to movement while at T3 these were fewer symptoms of anxiety and depression and experiencing no pain last 24 h. CONCLUSION Apart from pain, function and resumption of activities, the symptoms of anxiety and depression influence HRQOL. These symptoms should be assessed during the hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; Landspitali University Hospital, Surgical Services, 101, Reykjavík, Iceland.
| | | | - Hafdís Skúladóttir
- University of Iceland, Faculty of Nursing, Eirberg, Eiríksgötu 34, 101, Reykjavík, Iceland; University of Akureyri, School of Health Sciences, Iceland
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18
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Niederstrasser NG, Cook S. Investigating the True Effect of Psychological Variables Measured Prior to Arthroplastic Surgery on Postsurgical Outcomes: A P-Curve Analysis. THE JOURNAL OF PAIN 2020; 22:400-414. [PMID: 33098977 DOI: 10.1016/j.jpain.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 12/27/2022]
Abstract
Patients' presurgical psychological profiles have been posited to predict pain and function following arthroplastic surgery of the hip and knee. Nevertheless, findings are conflicting, and this may be rooted in biased reporting that makes the determination of evidential value difficult. This ambiguity may have negative consequences for researchers and governmental agencies, as these rely on findings to accurately reflect reality. P-Curve analyses were used to establish the presence of evidential value and selective reporting in a sample of studies examining the effect of presurgical psychological predictors on outcomes following knee and hip arthroplastic surgery. A systematic search of the literature revealed 26 relevant studies. The examined sets of studies indicate that there is evidential value for the effect of depression on pain intensity and function, anxiety on pain intensity and function, pain catastrophizing on pain intensity, as well as the combined effects of all psychological predictors on pain intensity and function. The presence of evidential value was inconclusive for the effect of optimism on pain intensity. There were no signs that any results were influenced by biased reporting. The results highlight the importance of patients' psychological profiles in predicting surgical outcomes, which represent a promising avenue for future treatment approaches. PERSPECTIVE: The effects of P-hacking are difficult to detect and might be at the root of conflicting findings pertaining to the predictive properties of presurgical psychological variables on postsurgical outcomes. P-Curve analysis allows the determination of evidential value underlying these relationships and detection of P-hacking to ensure that findings are not the result of selective reporting.
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Affiliation(s)
| | - Stephanie Cook
- School of Applied Social Sciences, De Montfort University, Leicester, UK
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19
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Nielsen NI, Kehlet H, Gromov K, Troelsen A, Husted H, Varnum C, Kjærsgaard‐Andersen P, Rasmussen LE, Mandøe H, Foss NB. Preoperative high-dose Steroids in Total Knee and Hip Arthroplasty - Protocols for three randomized controlled trials. Acta Anaesthesiol Scand 2020; 64:1350-1356. [PMID: 32533723 DOI: 10.1111/aas.13656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients undergoing total knee arthroplasty (TKA)/ total hip arthroplasty (THA) still experience moderate-severe postoperative pain despite optimized pain management regimes. The patients already on opioid treatment and pain catastrophizers (PCs) have a higher risk of postoperative pain. The use of preoperative intravenous high-dose glucocorticoids decreases postoperative pain after TKA and THA, but optimal dose is yet to be found, and the effect on subpopulations at high pain risk is unknown. AIM To investigate the effect of a higher than previously used dose of glucocorticoids (dexamethasone (DXM)), administered intravenously before surgery, as part of standardized fast-track regimen, on postoperative pain in TKA/THA subgroups. METHOD Three separate randomized, double-blinded, controlled trials were planned to compare a new higher dose DXM (1 mg/kg) to the earlier used high-dose DXM (0.3 mg/kg). Study 1: predicted Low Pain TKA; study 2: predicted High Pain Responder (HPR) TKA; study 3: predicted HPR THA. Predicted HPR groups consist of either PCs with PCS-score of ≥ 21 and/or history of ongoing opioid-treatment of 30 mg/day of morphine or equivalents > 30 days. In total, 408 patients were planned for inclusion (160 Low Pain TKA, 88 HPR TKA, 160 HPR THA). PRIMARY OUTCOME Pain upon ambulation in a 5-meter walk test 24 hours after surgery. Secondary outcomes include use of analgesics, rescue-opioids, antiemetics, cumulated pain, CRP, OR-SDS, QoR-15, quality of sleep, length of stay (LOS), reasons for hospitalization, readmission, morbidity, and mortality. Patients completed follow-up on day 90. Recruiting commenced February 2019 and is expected to finish in September 2020.
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Affiliation(s)
- Niklas I. Nielsen
- Department of Anaesthesiology Copenhagen UniversityHvidovre Hospital Hvidovre Denmark
| | - Henrik Kehlet
- Section of Surgical Pathophysiology 7621, RigshospitaletUniversity of Copenhagen Blegdamsvej Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery Copenhagen UniversityHvidovre Hospital Hvidovre Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery Copenhagen UniversityHvidovre Hospital Hvidovre Denmark
| | - Henrik Husted
- Department of Orthopedic Surgery Copenhagen UniversityHvidovre Hospital Hvidovre Denmark
| | - Claus Varnum
- Department of Orthopedic Surgery Lillebaelt Hospital ‐ Vejle Vejle Denmark
| | | | - Lasse E. Rasmussen
- Department of Orthopedic Surgery Lillebaelt Hospital ‐ Vejle Vejle Denmark
| | - Hans Mandøe
- Department of Anaesthesiology Lillebaelt Hospital –Vejle Vejle Denmark
| | - Nicolai B. Foss
- Department of Anaesthesiology Copenhagen UniversityHvidovre Hospital Hvidovre Denmark
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20
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Terradas-Monllor M, Ochandorena-Acha M, Salinas-Chesa J, Ramírez S, Beltran-Alacreu H. Assessment of postoperative health functioning after knee arthroplasty in relation to pain catastrophizing: a 6-month follow-up cohort study. PeerJ 2020; 8:e9903. [PMID: 32974103 PMCID: PMC7486825 DOI: 10.7717/peerj.9903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knee arthroplasty (KA) is a typically successful surgical procedure commonly performed to alleviate painin participants with end-stage knee osteoarthritis. Despite its beneficial effects, a significant proportion of individuals with KA continue experiencing persistent pain and functional limitations. The purpose of this study was to assess the postoperative outcomes after KA in relation to postoperative pain catastrophizing. METHODS Participants were recruited at a domiciliary physiotherapy service, using a prospective, observational, hypothesis-generating cohort design. Participants were divided into two groups based on their Pain Catastrophizing Scale (PCS) total score (50th percentile), which resulted in high and low PCS groups. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, quality of life, walking speed, physical performance, range of motion, and pain were measured. Outcome measures were collected at baseline (1 week postoperatively) and at follow-up (1, 3, and 6 months postoperatively). RESULTS A total of 60 participants (21 total KA and 39 unicompartmental KA) were recruited. Individuals with a higher degree of pain catastrophizing showed significantly higher WOMAC total scores at every follow-up, indicating poorer health functioning (p < 0.01). Similarly, the high PCS group showed higher WOMAC pain, stiffness and disability subscale scores (p < 0.05), poorer quality of life (p < 0.01), and poorer physical performance (p < 0.05) at every follow-up. In addition, the high PCS group achieved a slower walking speed at baseline and at 3 months follow-up (p < 0.05), and a higher degree of pain at rest, on walking and on knee flexion at every follow-up (p < 0.01, p < 0.05 and p < 0.05, respectively) except for walking pain at 3 months follow-up. No significant differences were observed between groups in range of motion, except for active knee extension at the 6-month follow-up (p < 0.05). Effect size was large at 1 month follow-up in WOMAC total score (r = 0.578) and pain intensity during knee flexion (r = 0.529). Longitudinal analyses revealed different improvement trends during the rehabilitation process between groups, with a lack of significant improvements in the high PCS group between the 3- and 6-month follow-up in WOMAC total score, WOMAC pain, WOMAC disability, quality of life, physical performance, active knee extension and resting pain (p > 0.05). CONCLUSION The results of the present study suggest that participants with high postoperative pain catastrophizing might have poorer outcomes during the rehabilitation process after KA. Future work should seek to clarify if this relationship is causal.
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Affiliation(s)
- Marc Terradas-Monllor
- Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia, Vic, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Vic, Spain
- Institut de Rehabilitació i Terapèutica Biofísica (IRITEB), Badalona, Spain
- Programa de Doctorat en Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Mirari Ochandorena-Acha
- Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia, Vic, Spain
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVIC-UCC), Vic, Spain
| | | | - Sergi Ramírez
- Institut de Rehabilitació i Terapèutica Biofísica (IRITEB), Badalona, Spain
| | - Hector Beltran-Alacreu
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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21
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Serafini RA, Pryce KD, Zachariou V. The Mesolimbic Dopamine System in Chronic Pain and Associated Affective Comorbidities. Biol Psychiatry 2020; 87:64-73. [PMID: 31806085 PMCID: PMC6954000 DOI: 10.1016/j.biopsych.2019.10.018] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Chronic pain is a complex neuropsychiatric disorder characterized by sensory, cognitive, and affective symptoms. Over the past 2 decades, researchers have made significant progress toward understanding the impact of mesolimbic dopamine circuitry in acute and chronic pain. These efforts have provided insights into the circuits and intracellular pathways in the brain reward center that are implicated in sensory and affective manifestations of chronic pain. Studies have also identified novel therapeutic targets as well as factors that affect treatment responsiveness. Dysregulation of dopamine function in the brain reward center may further promote comorbid mood disorders and vulnerability to addiction. This review discusses recent clinical and preclinical findings on the neuroanatomical and neurochemical adaptations triggered by prolonged pain states in the brain reward pathway. Furthermore, this discussion highlights evidence of mechanisms underlying comorbidities among pain, depression, and addiction.
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Affiliation(s)
- Randal A Serafini
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kerri D Pryce
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Venetia Zachariou
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Chen YP, Huang YY, Wu Y, Kuo YJ, Lin CY. Depression negatively affects patient-reported knee functional outcome after intraarticular hyaluronic acid injection among geriatric patients with knee osteoarthritis. J Orthop Surg Res 2019; 14:387. [PMID: 31775836 PMCID: PMC6882243 DOI: 10.1186/s13018-019-1419-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 10/15/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Intraarticular hyaluronic acid injection (IAHA) is a popular treatment for knee osteoarthritis (OA). This study investigates whether depression, anxiety, and pain affect self-reported knee function in geriatric OA people who have received IAHA. METHODS Through convenience sampling, 102 geriatric patients (mean age = 70.91 ± 7.19; 28 males) with knee OA who had undergone IAHA participated in this study. All participants self-reported depression using the Geriatric Depression Scale (GDS), anxiety using the State-Trait Anxiety Inventory (STAI), knee function using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the International Knee Documentation Committee subjective knee evaluation form (IKDC), and pain severity using the Visual Analogue Scale (VAS). They completed the aforementioned questionnaires at baseline before injection and then again at 2-, 4-, and 6-month follow-ups. RESULTS Depression was significantly associated with IKDC, WOMAC physical function subscale, and total WOMAC scores. Anxiety was only significantly associated with the WOMAC pain subscale score. Pain severity was significantly associated with IKDC, WOMAC stiffness subscale, WOMAC physical function subscale, and total WOMAC scores. CONCLUSION Given that depression negatively affected patient-reported knee function among geriatric OA patients who had undergone IAHA, further attention should be paid to the depressive status of this population.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Yun Huang
- Graduate Institute of Nursing- Linkou campus, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yueh Wu
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Hong Kong
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Suso-Ribera C, Martínez-Borba V, Martín-Brufau R, Suso-Vergara S, García-Palacios A. Individual differences and health in chronic pain: are sex-differences relevant? Health Qual Life Outcomes 2019; 17:128. [PMID: 31331336 PMCID: PMC6647055 DOI: 10.1186/s12955-019-1182-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. METHODS Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. RESULTS The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = - 0.30, p < .001) and a negative problem orientation (β = - 0.26, p < .001). CONCLUSIONS There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex.
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Affiliation(s)
- C Suso-Ribera
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain.
| | - V Martínez-Borba
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain
| | | | | | - A García-Palacios
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Barcelona, Spain
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