Association Of Preoperative Pain Catastrophizing And Chronic Post-Surgical Pain After Total Knee Arthroplasty

Objective:To explore the relationship between preoperative pain catastrophizing in patients with knee osteoarthritis and chronic post-surgical pain(CPSP)after total knee arthroplasty(TKA).Methods:240 patients who had undergone the initial unilateral TKA were chosen.They were of all genders,aged 45-70 years,body mass index(BMI)of 18-30 kg/m~2.American society of Anesthesiologists physical status(ASA)levelsⅠ-Ⅲ.Patients were divided into two groups:CPSP group(n=95)and Non-CPSP group(n=145)based on the pain visual analogue scale(VAS)at rest and/or during movement at 6 months postoperatively.All patients had the same anesthetic and surgical methods.Gender,age,BMI,ASA grade,K-L grade(kellgren-lawrence),knee osteoarthritis course,the concentration of C-reactive protein(CRP)before surgery,preoperative cardiovascular disease,and preoperative analgesic drug use were recorded.VAS scores at rest and during movement,the hospital anxiety and depression scale(HADS),central sensitization questionnaire(CSQ),and the pain catastrophizing scale(PCS)were recorded 1 day before surgery.Pain catastrophizing is considered to have occurred if PCS≥30.The intraoperative dosage of propofol,remifentanil,sufentanil,blood loss,tourniquet use time,number of relief analgesia cases,operation time,and postoperative hospital stays were recorded.VAS scores at rest and during movement were recorded at ward follow-up 3 days after surgery,at outpatient follow-up 3 and 6 months after surgery.The number of patients using non-steroidal anti-inflammatory drugs(NSAIDs)was recorded 6 months after surgery,and CPSP was defined as the occurrence of VAS score>3 at rest and/or during movement 6 months after surgery.Results:In this study,a total of 95 patients(39.6%)developed CPSP.Univariate analysis showed that the incidence of pain catastrophizing and HADS score≥8,the utilization rate of NSAIDs 6 months after surgery,and the VAS scores at rest and during movement 6 months after surgery in the CPSP group were significantly higher than those in the Non-CPSP group(P<0.05),and there was no significant difference between the two groups in other indicators(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Indicators with significant differences in univariate analysis and factors that have been shown to be associated with CPSP in previous studies(including:female,age,BMI,occurrence of preoperative pain catastrophizing,preoperative HADS score≥8,preoperative CSQ score≥40 and use of NSAIDs 6 months after surgery)were included in Logistic regression analysis.The results showed that preoperative pain catastrophizing(OR=2.187,95%CI 1.090-4.387,P=0.028)and HADS score≥8(OR=2.059,95%CI1.018-4.167,P=0.045)were the risk factors for CPSP in TKA patients.Conclusion:Preoperative pain catastrophizing is directly related to the occurrence of CPSP in TKA patients,and is an independent risk factor for the occurrence of CPSP in TKA patients.