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Abstract：
BACKGROUND: Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors.
METHODS: This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity.
RESULTS: The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related \"positive\" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain.
CONCLUSIONS: This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.
METHODS: This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity.
RESULTS: The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related \"positive\" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain.
CONCLUSIONS: This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.
摘要：
背景：膝骨关节炎（OA）是最常见和致残的持续性疼痛疾病之一，随着全球流行和影响的增加。在美国,膝关节OA患病率的上升与全膝关节置换术（TKA）的年增长率的增加平行，晚期膝关节OA的手术治疗选择。虽然TKA结果总体上是好的，术后疼痛和功能状态的轨迹差异很大;相当少的患者报告TKA后持续疼痛和功能受损。许多研究已经确定了TKA后不良结果的一组生物心理社会风险因素(例如，合并症,负面影响，感官敏感性)，但很少有前瞻性研究系统地评估了一系列因素的独特和综合影响。
方法：这项多点纵向队列研究调查了TKA后6个月疼痛和功能结局的预测因素。术前通过病史评估了广泛的相关生物心理社会预测因子。患者报告问卷，功能测试,对248例接受TKA的患者进行定量感觉测试，并随后检查了它们的预测能力。
结果：大多数患者在6个月时出现轻度或无疼痛，和最小的疼痛相关损伤，但约30%的患者报告疼痛强度评分为3/10或更高.在TKA后6个月报告更大的疼痛严重程度和功能障碍是通过较高的术前负面影响水平来预测的。既往疼痛史,阿片类药物的使用，扰乱睡眠。有趣的是,较低水平的与复原力相关的“积极”心理社会特征(即，较低的宜人性，较低的社会支持)是最强的，多变量线性回归模型中不良结局的最一致预测因素。疼痛调制的不适应概况(例如，疼痛的时间总和升高)，虽然不是强大的唯一预测因子，与心理社会危险因素相互作用,使得疼痛和功能障碍最多的TKA患者表现出较低的弹性和疼痛的时间总和增强.
结论：这项研究强调了考虑社会心理（尤其是积极取向的复原力变量）和感官概况的重要性，以及他们的互动，了解手术后的疼痛轨迹。
方法：这项多点纵向队列研究调查了TKA后6个月疼痛和功能结局的预测因素。术前通过病史评估了广泛的相关生物心理社会预测因子。患者报告问卷，功能测试,对248例接受TKA的患者进行定量感觉测试，并随后检查了它们的预测能力。
结果：大多数患者在6个月时出现轻度或无疼痛，和最小的疼痛相关损伤，但约30%的患者报告疼痛强度评分为3/10或更高.在TKA后6个月报告更大的疼痛严重程度和功能障碍是通过较高的术前负面影响水平来预测的。既往疼痛史,阿片类药物的使用，扰乱睡眠。有趣的是,较低水平的与复原力相关的“积极”心理社会特征(即，较低的宜人性，较低的社会支持)是最强的，多变量线性回归模型中不良结局的最一致预测因素。疼痛调制的不适应概况(例如，疼痛的时间总和升高)，虽然不是强大的唯一预测因子，与心理社会危险因素相互作用,使得疼痛和功能障碍最多的TKA患者表现出较低的弹性和疼痛的时间总和增强.
结论：这项研究强调了考虑社会心理（尤其是积极取向的复原力变量）和感官概况的重要性，以及他们的互动，了解手术后的疼痛轨迹。
