Presurgical anxiety and acute postsurgical pain predict worse chronic pain profiles after total knee/hip arthroplasty

IF 2 3区 医学 Q2 ORTHOPEDICS
Ana Cristina Paredes, Patrício Costa, Armando Almeida, Patrícia R. Pinto
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引用次数: 0

Abstract

Introduction

Total joint arthroplasties generally achieve good outcomes, but chronic pain and disability are a significant burden after these interventions. Acknowledging relevant risk factors can inform preventive strategies. This study aimed to identify chronic pain profiles 6 months after arthroplasty using the ICD-11 (International Classification of Diseases) classification and to find pre and postsurgical predictors of these profiles.

Materials and methods

Patients undergoing total knee/hip arthroplasty (n = 209, female = 54.5%) were assessed before surgery, 48 h and 6 months postsurgery for sociodemographic, pain-related, disability and psychological characteristics. K-means-constrained cluster analysis identified chronic pain profiles based on 6-month pain intensity, pain interference and disability. Chi-square tests or one-way ANOVA explored between-cluster differences. Multinomial regression identified predictors of cluster membership. Separate models analyzed presurgical (model 1), postsurgical (model 2) and a combination of previously significant pre and postsurgical (model 3) variables.

Results

A three-cluster solution was selected, translating increasingly worse chronic pain severity: cluster 1 (C1, n = 129), cluster 2 (C2, n = 60) and cluster 3 (C3, n = 20). There were presurgical differences among clusters in the presence of other painful sites (p = 0.013, ϕc = 0.20), pain interference (p = 0.038, η2 = 0.031), disability (p = 0.020, η2 = 0.037), pain catastrophizing (p = 0.019, η2 = 0.060), anxiety (p < 0.001, η2 = 0.087), depression (p = 0.017; η2 = 0.039), self-efficacy (p = 0.018, η2 = 0.038) and satisfaction with life (p = 0.034, η2 = 0.032), postsurgical pain frequency (p = 0.003, ϕc = 0.243) and intensity (p < 0.001, η2 = 0.101). In model 1, disability predicted C2 (OR = 1.040) and anxiety predicted C3 (OR = 1.154) membership. In model 2, pain intensity predicted C3 (OR = 1.690) membership. In model 3, presurgical anxiety predicted C3 (OR = 1.181) and postsurgical pain intensity predicted C2 (OR = 1.234) and C3 (OR = 1.679) membership.

Conclusions

Most patients had low chronic pain severity at 6 months, but a relevant percentage exhibited poor outcomes. Membership to different outcome profiles was predicted by presurgical anxiety and acute postsurgical pain. These seem promising targets to prevent pain chronification that should be optimized for better surgical outcomes.

Abstract Image

术前焦虑和术后急性疼痛预示着全膝关节/髋关节置换术后更严重的慢性疼痛
全关节置换术通常取得良好的效果,但慢性疼痛和残疾是这些干预后的重大负担。承认相关的风险因素可以为预防战略提供信息。本研究旨在利用ICD-11(国际疾病分类)分类确定关节置换术后6个月的慢性疼痛情况,并寻找这些情况的术前和术后预测因素。材料与方法对接受全膝关节/髋关节置换术的患者(209例,女性54.5%)术前、术后48小时和6个月的社会人口学、疼痛相关、残疾和心理特征进行评估。k均值约束聚类分析确定了基于6个月疼痛强度、疼痛干扰和残疾的慢性疼痛概况。卡方检验或单因素方差分析探讨了聚类之间的差异。多项回归确定了聚类隶属度的预测因子。单独的模型分析术前(模型1)、术后(模型2)以及先前重要的术前和术后(模型3)变量的组合。结果选择了三组解决方案,慢性疼痛程度逐渐加重:1组(C1, n = 129)、2组(C2, n = 60)和3组(C3, n = 20)。手术前存在其他疼痛部位(p = 0.013, ϕc = 0.20)、疼痛干扰(p = 0.038, η2 = 0.031)、残疾(p = 0.020, η2 = 0.037)、疼痛灾难化(p = 0.019, η2 = 0.060)、焦虑(p < 0.001, η2 = 0.087)、抑郁(p = 0.017;η2 = 0.039)、自我效能感(p = 0.018, η2 = 0.038)、生活满意度(p = 0.034, η2 = 0.032)、术后疼痛频率(p = 0.003, η c = 0.243)、疼痛强度(p < 0.001, η2 = 0.101)。在模型1中,残疾预测C2 (OR = 1.040),焦虑预测C3 (OR = 1.154)。在模型2中,疼痛强度预测C3隶属度(OR = 1.690)。在模型3中,术前焦虑预测C3 (OR = 1.181),术后疼痛强度预测C2 (OR = 1.234)和C3 (OR = 1.679)。结论大多数患者在6个月时慢性疼痛严重程度较低,但相关比例的患者预后较差。通过术前焦虑和术后急性疼痛来预测不同的预后概况。这些似乎有希望的目标,以防止疼痛的慢性化,应该优化更好的手术结果。
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来源期刊
CiteScore
4.30
自引率
13.00%
发文量
424
审稿时长
2 months
期刊介绍: "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).
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