术前神经性疼痛和中枢致敏是全膝关节置换术后慢性疼痛的危险因素：一项系统回顾和荟萃分析

IF 2.8

Osteoarthritis and cartilage open Pub Date : 2025-08-29 DOI:10.1016/j.ocarto.2025.100674

Felipe F. Gonzalez , Alessandro Barone , Rithik Palaniappan , Raffaella Russo , Giorgio Gasparini , Leonardo Metsavaht , Jorge Chahla , Filippo Familiari

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引用次数: 0

摘要

目的探讨术前神经性疼痛和中枢致敏对全膝关节置换术（TKA）临床疗效的影响。本系统评价和荟萃分析遵循PRISMA指南，并进行前瞻性注册。如果研究在TKA前评估术前神经性疼痛或中枢致敏，以及手术后的临床结果，如疼痛、功能或心理状态，则纳入研究。横断面研究和病例报告被排除在外。两位作者独立筛选、提取数据并使用质量评估工具对文章质量进行评级。对报告可比较方法和结果的研究进行荟萃分析。结果6061份纳入记录中，有15项研究符合纳入标准（总样本：2385人，随访时间：少于1年至5年）。大多数研究显示低/中等偏倚风险，主要是由于样本量小。神经性疼痛（PainDETECT评分≥13）患者慢性疼痛（至少3个月后VAS≥3）的风险比为2.75 （CI: 1.78; 4.26）。11项研究中有7项确定神经性样疼痛和中枢致敏是临床结果的危险因素，如自我报告功能、满意度和焦虑下降（p < 0.05）。对协变量进行调整后的研究结果喜忧参半，有些研究失去了统计学意义。结论神经性疼痛和中枢致敏是TKA患者术后慢性疼痛的危险因素。功能、满意度和心理状况下降的证据并不一致。术前筛查和处理神经性疼痛和中枢致敏可能会改善临床结果。需要采用标准化方法进行进一步研究。普洛斯彼罗idCRD42024622693。

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Preoperative neuropathic-like pain and central sensitisation are risk factors for chronic pain after total knee arthroplasty: A systematic review and meta-analysis

Objective

To investigate the effects of preoperative neuropathic-like pain and central sensitisation on clinical outcomes after total knee arthroplasty (TKA).

Design

This systematic review and meta-analysis followed PRISMA guidelines and was prospectively registered. Studies were included if they assessed preoperative neuropathic-like pain or central sensitisation before TKA and clinical outcomes after surgery, such as pain, function, or psychological status. Cross-sectional studies and case reports were excluded. Two authors independently screened, extracted data and rated articles' quality using a quality assessment tool. A meta-analysis was performed for studies reporting comparable methods and outcomes.

Results

From 6061 identified records, 15 studies met the inclusion criteria (total sample: 2385 individuals; follow-up periods: less than 1 year to 5 years). Most studies exhibited low/moderate risk of bias, primarily due to small sample sizes. The risk ratio of chronic pain (VAS ≥3 after at least 3 months) was 2.75 (CI: 1.78; 4.26) for patients with neuropathic-like pain (PainDETECT score ≥13). Seven out of eleven studies identified neuropathic-like pain and central sensitisation as risk factors for clinical outcomes such as decreased self-reported function, satisfaction, and anxiety (p < 0.05). Studies that adjusted for covariates showed mixed results, with some losing statistical significance.

Conclusion

The presence of neuropathic-like pain and central sensitisation in candidates for TKA is a risk factor for postoperative chronic pain. Evidence for decreased function, satisfaction, and psychological conditions is inconsistent. Screening and managing neuropathic-like pain and central sensitisation preoperatively could possibly improve clinical outcomes. Further research with standardized methods is needed.

Prospero id

CRD42024622693.

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来源期刊

Osteoarthritis and cartilage open Orthopedics, Sports Medicine and Rehabilitation

CiteScore

3.30

自引率

0.00%

发文量