Dataset Information

Rest Pain and Movement-Evoked Pain as Unique Constructs in Hip and Knee Replacements.

ABSTRACT:

Objective

There is limited information about the extent to which the association between preoperative and chronic postoperative pain is mediated via pain-on-movement or pain-at-rest. We explored these associations in patients undergoing total hip replacement (THR) and total knee replacement (TKR).

Methods

A total of 322 and 316 patients receiving THR and TKR, respectively, were recruited into a single-center UK cohort (Arthroplasty Pain Experience) study. Preoperative, acute postoperative, and 12-month pain severity was measured using self-reported pain instruments. The association between preoperative/acute pain and chronic postoperative pain was investigated using structural equation modeling (SEM).

Results

Patients with high levels of preoperative pain were more likely to report chronic pain after THR (??=?0.195, P?=?0.02) and TKR (??=?0.749, P < 0.0001). Acute postoperative pain-on-movement was not associated with chronic pain after TKR or THR after adjusting for preoperative pain; however, acute pain-at-rest was associated with chronic pain after THR (??=?0.20, P < 0.0002) but not TKR after adjusting for preoperative pain. Analysis of pain-at-rest and pain-on-movement highlighted differences between THR and TKR patients. Chronic pain-at-rest after THR was weakly associated with pain-at-rest during the preoperative (??=?0.11, P?=?0.068) and acute postoperative period (??=?0.21, P < 0.0001). In contrast, chronic pain-on-movement after TKR was strongly associated with the severity of pain-on-movement during the preoperative period (??=?0.51, P?=?0.001).

Conclusion

SEM illustrated the different patterns of association between measures of pain over time in patients undergoing THR and TKR for osteoarthritis. These findings highlight the importance of future work that explores the mechanisms underlying pain-on-movement and pain-at-rest.

SUBMITTER: Sayers A

PROVIDER: S-EPMC5053254 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Rest Pain and Movement-Evoked Pain as Unique Constructs in Hip and Knee Replacements.

Sayers Adrian A Wylde Vikki V Lenguerrand Erik E Beswick Andrew D AD Gooberman-Hill Rachael R Pyke Mark M Dieppe Paul P Blom Ashley W AW

Arthritis care & research 20160201 2

<h4>Objective</h4>There is limited information about the extent to which the association between preoperative and chronic postoperative pain is mediated via pain-on-movement or pain-at-rest. We explored these associations in patients undergoing total hip replacement (THR) and total knee replacement (TKR).<h4>Methods</h4>A total of 322 and 316 patients receiving THR and TKR, respectively, were recruited into a single-center UK cohort (Arthroplasty Pain Experience) study. Preoperative, acute posto ...[more]

PMID: 26212349

Similar Datasets

Project description:BACKGROUND:Postoperative pain is one of the most prevalent and disabling complications of surgery that is associated with personal suffering, delayed functional recovery, prolonged hospital stay, perioperative complications, and chronic postsurgical pain. Accumulating evidence has pointed to the important distinction between pain at rest (PAR) and movement-evoked pain (MEP) after surgery. In most studies including both measures, MEP has been shown to be substantially more severe than PAR. Furthermore, as MEP is commonly experienced during normal activities (eg, breathing, coughing, and walking), it has a greater adverse functional impact than PAR. In a previous systematic review conducted in 2011, only 39% of reviewed trials included MEP as a trial outcome and 52% failed to identify the pain outcome as either PAR or MEP. Given the recent observations of postsurgical pain trials that continue to neglect the distinction between PAR and MEP, this updated review seeks to evaluate the degree of progress in this area. OBJECTIVE:This updated review will include postsurgical clinical trials and meta-analyses in which the primary outcome was early postoperative pain intensity. The primary outcome for this review is the reporting of MEP (vs PAR) as an outcome measure for each trial and meta-analysis. Secondary outcomes include whether trials and meta-analyses distinguished between PAR and MEP. METHODS:To be consistent with the 2011 review that we are updating, this review will again focus on randomized controlled trials and meta-analyses, from Medical Literature Analysis and Retrieval System Online and EMBASE databases, focusing on pain treatment after thoracotomy, knee arthroplasty, and hysterectomy in humans. Trials and meta-analyses will be characterized as to whether or not they assessed PAR and MEP; whether their pain outcome acknowledged the distinction between PAR and MEP; and, for trials assessing MEP, which pain-evoking maneuver(s) were used. RESULTS:Scoping review and pilot data extraction are under way, and the results are expected by March 2020. CONCLUSIONS:It is our belief that every postsurgical analgesic trial should include MEP as an outcome measure. The previous 2011 review was expected to have an impact on more widespread assessment of MEP in subsequent postoperative pain treatment trials. Thus, the purpose of this follow-up review is to reevaluate the frequency of use of MEP as a trial outcome, compared with PAR, in more recently published postoperative pain trials. TRIAL REGISTRATION:PROSPERO CRD42019125855; https://tinyurl.com/qw9dty8. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/15309.

Project description:CONTEXT: Knee injuries are prevalent, and the associated knee pain is linked to disability. The influence of knee pain on movement biomechanics, independent of other factors related to knee injuries, is difficult to study and unclear. OBJECTIVE: (1) To evaluate a novel experimental knee-pain model and (2) better understand the independent effects of knee pain on walking and running biomechanics. DESIGN: Crossover study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve able-bodied volunteers (age = 23 ± 3 years, height = 1.73 ± 0.09 m, mass = 75 ± 14 kg). INTERVENTION(S): Participants walked and ran at 3 time intervals (preinfusion, infusion, and postinfusion) for 3 experimental conditions (control, sham, and pain). During the infusion time interval for the pain and sham conditions, hypertonic or isotonic saline, respectively, was continuously infused into the right infrapatellar fat pad for 22 minutes. MAIN OUTCOME MEASURE(S): We used repeated-measures analyses of variance to evaluate the effects of time and condition on (1) perceived knee pain and (2) key biomechanical characteristics (ground reaction forces, and joint kinematics and kinetics) of walking and running (P < .05). RESULTS: The hypertonic saline infusion (1) increased perceived knee pain throughout the infusion and (2) reduced discrete characteristics of each component of the walking ground reaction force, walking peak plantar-flexion angle (range = 62°-67°), walking peak plantar-flexion moment (range = 95-104 N·m), walking peak knee-extension moment (range = 36-49 N·m), walking peak hip-abduction moment (range = 62-73 N·m), walking peak support moment (range = 178-207 N·m), running peak plantar-flexion angle (range = 38°-77°), and running peak hip-adduction angle (range = 5-21°). CONCLUSIONS: This novel experimental knee pain model consistently increased perceived pain during various human movements and produced altered running and walking biomechanics that may cause abnormal knee joint-loading patterns.

Dataset Information

Rest Pain and Movement-Evoked Pain as Unique Constructs in Hip and Knee Replacements.

Objective

Methods

Results

Conclusion

Publications

Rest Pain and Movement-Evoked Pain as Unique Constructs in Hip and Knee Replacements.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets