Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months
Background This study is a secondary analysis of 12‐month follow‐ups from two parallel, randomized controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by nonsurgical treatment compared with nonsurgical treatment. RCT2: Nonsurgical treatment co...
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| Veröffentlicht in: | European journal of pain 2018-07, Vol.22 (6), p.1088-1102 |
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| container_title | European journal of pain |
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| creator | Arendt‐Nielsen, L. Simonsen, O. Laursen, M.B. Roos, E.M. Rathleff, M.S. Rasmussen, S. Skou, S.T. |
| description | Background
This study is a secondary analysis of 12‐month follow‐ups from two parallel, randomized controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by nonsurgical treatment compared with nonsurgical treatment. RCT2: Nonsurgical treatment compared with usual care. The aims were to investigate (1) possible predictors of treatment outcome after TKR and nonsurgical interventions at 12 months, (2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitization) at baseline and after 12 months and (3) possible gender differences.
Method
Each RCT included 100 patients. Pain intensities, PPTs and number of painful sites were assessed at baseline and after 12 months.
Results
In all groups, pain improved and pain sensitization decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the nonsurgical group had the greatest improvement, with no between‐group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitization but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).
Conclusion
Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after nonsurgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values.
Significance
Human experimental pain assessment was used to assess the degree of pain sensitization in patients with painful knee osteoarthritis. High sensitization before TKR predicted worse outcome. Outcome after nonsurgical interventions could not be predicted. |
| doi_str_mv | 10.1002/ejp.1193 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1991184568</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1991184568</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2703-587e6d8c128fe18752b6d8c20fa81643ef50499eea8a13673185a81efd00808d3</originalsourceid><addsrcrecordid>eNp1kUFu1TAQhi0EoqUgcQLkJZsUj53k2exQVUpRpXbRriM3Gfe5JHawJ6peT8MBegpOhl9foStWnvF880mjn7H3IA5BCPkJb-dDAKNesH1olKwk1OZlqYURldIC9tibnG-FEPVKqNdsTxrVmroR--zhwvrAbRh4xpA9-XtLPpYfR5g4RbIj_xEQecJ5tD1OGIjHxEMMeUk3vi9zSmjpcVBUc9kvZeZ3nta71ZgJo020TsWfP_PToQDebXy44XOkbVMsc8LB9xRT5tHxuFAfJ-SWOMjfv6YYaJ3fslfOjhnfPb0H7Orr8eXRt-rs_OT06MtZ1ctyX9XoFbaD7kFqh6BXjbzetlI4q6GtFbpG1MYgWm1BtSsFuikTdIMQWuhBHbCPO--c4s8FM3WTzz2Oow0Yl9yBMQC6blr9jPYp5pzQdXPyk02bDkS3zaYr2XTbbAr64cm6XE84_AP_hlGAagfc-RE3_xV1x98vHoV_AOBvnQA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1991184568</pqid></control><display><type>article</type><title>Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Arendt‐Nielsen, L. ; Simonsen, O. ; Laursen, M.B. ; Roos, E.M. ; Rathleff, M.S. ; Rasmussen, S. ; Skou, S.T.</creator><creatorcontrib>Arendt‐Nielsen, L. ; Simonsen, O. ; Laursen, M.B. ; Roos, E.M. ; Rathleff, M.S. ; Rasmussen, S. ; Skou, S.T.</creatorcontrib><description>Background
This study is a secondary analysis of 12‐month follow‐ups from two parallel, randomized controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by nonsurgical treatment compared with nonsurgical treatment. RCT2: Nonsurgical treatment compared with usual care. The aims were to investigate (1) possible predictors of treatment outcome after TKR and nonsurgical interventions at 12 months, (2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitization) at baseline and after 12 months and (3) possible gender differences.
Method
Each RCT included 100 patients. Pain intensities, PPTs and number of painful sites were assessed at baseline and after 12 months.
Results
In all groups, pain improved and pain sensitization decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the nonsurgical group had the greatest improvement, with no between‐group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitization but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).
Conclusion
Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after nonsurgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values.
Significance
Human experimental pain assessment was used to assess the degree of pain sensitization in patients with painful knee osteoarthritis. High sensitization before TKR predicted worse outcome. Outcome after nonsurgical interventions could not be predicted.</description><identifier>ISSN: 1090-3801</identifier><identifier>EISSN: 1532-2149</identifier><identifier>DOI: 10.1002/ejp.1193</identifier><identifier>PMID: 29369450</identifier><language>eng</language><publisher>England</publisher><subject>Aged ; Arthroplasty, Replacement, Knee - adverse effects ; Female ; Humans ; Knee Joint - physiopathology ; Knee Joint - surgery ; Male ; Middle Aged ; Osteoarthritis, Knee - physiopathology ; Osteoarthritis, Knee - surgery ; Pain Measurement ; Pain Threshold - physiology ; Pressure ; Treatment Outcome</subject><ispartof>European journal of pain, 2018-07, Vol.22 (6), p.1088-1102</ispartof><rights>2018 European Pain Federation ‐ EFIC</rights><rights>2018 European Pain Federation - EFIC®.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2703-587e6d8c128fe18752b6d8c20fa81643ef50499eea8a13673185a81efd00808d3</citedby><cites>FETCH-LOGICAL-c2703-587e6d8c128fe18752b6d8c20fa81643ef50499eea8a13673185a81efd00808d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejp.1193$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejp.1193$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29369450$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arendt‐Nielsen, L.</creatorcontrib><creatorcontrib>Simonsen, O.</creatorcontrib><creatorcontrib>Laursen, M.B.</creatorcontrib><creatorcontrib>Roos, E.M.</creatorcontrib><creatorcontrib>Rathleff, M.S.</creatorcontrib><creatorcontrib>Rasmussen, S.</creatorcontrib><creatorcontrib>Skou, S.T.</creatorcontrib><title>Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months</title><title>European journal of pain</title><addtitle>Eur J Pain</addtitle><description>Background
This study is a secondary analysis of 12‐month follow‐ups from two parallel, randomized controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by nonsurgical treatment compared with nonsurgical treatment. RCT2: Nonsurgical treatment compared with usual care. The aims were to investigate (1) possible predictors of treatment outcome after TKR and nonsurgical interventions at 12 months, (2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitization) at baseline and after 12 months and (3) possible gender differences.
Method
Each RCT included 100 patients. Pain intensities, PPTs and number of painful sites were assessed at baseline and after 12 months.
Results
In all groups, pain improved and pain sensitization decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the nonsurgical group had the greatest improvement, with no between‐group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitization but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).
Conclusion
Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after nonsurgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values.
Significance
Human experimental pain assessment was used to assess the degree of pain sensitization in patients with painful knee osteoarthritis. High sensitization before TKR predicted worse outcome. Outcome after nonsurgical interventions could not be predicted.</description><subject>Aged</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Knee Joint - physiopathology</subject><subject>Knee Joint - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteoarthritis, Knee - physiopathology</subject><subject>Osteoarthritis, Knee - surgery</subject><subject>Pain Measurement</subject><subject>Pain Threshold - physiology</subject><subject>Pressure</subject><subject>Treatment Outcome</subject><issn>1090-3801</issn><issn>1532-2149</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUFu1TAQhi0EoqUgcQLkJZsUj53k2exQVUpRpXbRriM3Gfe5JHawJ6peT8MBegpOhl9foStWnvF880mjn7H3IA5BCPkJb-dDAKNesH1olKwk1OZlqYURldIC9tibnG-FEPVKqNdsTxrVmroR--zhwvrAbRh4xpA9-XtLPpYfR5g4RbIj_xEQecJ5tD1OGIjHxEMMeUk3vi9zSmjpcVBUc9kvZeZ3nta71ZgJo020TsWfP_PToQDebXy44XOkbVMsc8LB9xRT5tHxuFAfJ-SWOMjfv6YYaJ3fslfOjhnfPb0H7Orr8eXRt-rs_OT06MtZ1ctyX9XoFbaD7kFqh6BXjbzetlI4q6GtFbpG1MYgWm1BtSsFuikTdIMQWuhBHbCPO--c4s8FM3WTzz2Oow0Yl9yBMQC6blr9jPYp5pzQdXPyk02bDkS3zaYr2XTbbAr64cm6XE84_AP_hlGAagfc-RE3_xV1x98vHoV_AOBvnQA</recordid><startdate>201807</startdate><enddate>201807</enddate><creator>Arendt‐Nielsen, L.</creator><creator>Simonsen, O.</creator><creator>Laursen, M.B.</creator><creator>Roos, E.M.</creator><creator>Rathleff, M.S.</creator><creator>Rasmussen, S.</creator><creator>Skou, S.T.</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201807</creationdate><title>Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months</title><author>Arendt‐Nielsen, L. ; Simonsen, O. ; Laursen, M.B. ; Roos, E.M. ; Rathleff, M.S. ; Rasmussen, S. ; Skou, S.T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2703-587e6d8c128fe18752b6d8c20fa81643ef50499eea8a13673185a81efd00808d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Knee Joint - physiopathology</topic><topic>Knee Joint - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteoarthritis, Knee - physiopathology</topic><topic>Osteoarthritis, Knee - surgery</topic><topic>Pain Measurement</topic><topic>Pain Threshold - physiology</topic><topic>Pressure</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arendt‐Nielsen, L.</creatorcontrib><creatorcontrib>Simonsen, O.</creatorcontrib><creatorcontrib>Laursen, M.B.</creatorcontrib><creatorcontrib>Roos, E.M.</creatorcontrib><creatorcontrib>Rathleff, M.S.</creatorcontrib><creatorcontrib>Rasmussen, S.</creatorcontrib><creatorcontrib>Skou, S.T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arendt‐Nielsen, L.</au><au>Simonsen, O.</au><au>Laursen, M.B.</au><au>Roos, E.M.</au><au>Rathleff, M.S.</au><au>Rasmussen, S.</au><au>Skou, S.T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months</atitle><jtitle>European journal of pain</jtitle><addtitle>Eur J Pain</addtitle><date>2018-07</date><risdate>2018</risdate><volume>22</volume><issue>6</issue><spage>1088</spage><epage>1102</epage><pages>1088-1102</pages><issn>1090-3801</issn><eissn>1532-2149</eissn><abstract>Background
This study is a secondary analysis of 12‐month follow‐ups from two parallel, randomized controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by nonsurgical treatment compared with nonsurgical treatment. RCT2: Nonsurgical treatment compared with usual care. The aims were to investigate (1) possible predictors of treatment outcome after TKR and nonsurgical interventions at 12 months, (2) associations between pain intensity and pressure pain thresholds (PPTs) (pain sensitization) at baseline and after 12 months and (3) possible gender differences.
Method
Each RCT included 100 patients. Pain intensities, PPTs and number of painful sites were assessed at baseline and after 12 months.
Results
In all groups, pain improved and pain sensitization decreased. In RCT1, the TKR group had the greatest improvements in pain. In RCT2 the nonsurgical group had the greatest improvement, with no between‐group differences in PPTs. Lower PPTs at baseline predicted higher pain after TKR. Baseline pain intensity and PPT levels were associated with the number of painful sites. Subjects with the highest pain and lowest PPTs at baseline showed the largest relative improvement in pain and sensitization but were still experiencing highest absolute pain and lowest PPTs after 12 months (combined cohorts).
Conclusion
Low PPTs at baseline predicted worse pain outcome after TKR, but did not predict outcome after nonsurgical interventions. The number of painful sites was weakly associated with pain and PPTs, and the higher pain/lower PPTs, the higher pain/lower PPTs at 12 months with females showing the lowest PPT values.
Significance
Human experimental pain assessment was used to assess the degree of pain sensitization in patients with painful knee osteoarthritis. High sensitization before TKR predicted worse outcome. Outcome after nonsurgical interventions could not be predicted.</abstract><cop>England</cop><pmid>29369450</pmid><doi>10.1002/ejp.1193</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of pain, 2018-07, Vol.22 (6), p.1088-1102 |
| issn | 1090-3801 1532-2149 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Aged Arthroplasty, Replacement, Knee - adverse effects Female Humans Knee Joint - physiopathology Knee Joint - surgery Male Middle Aged Osteoarthritis, Knee - physiopathology Osteoarthritis, Knee - surgery Pain Measurement Pain Threshold - physiology Pressure Treatment Outcome |
| title | Pain and sensitization after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis: Identifying potential predictors of outcome at 12 months |
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