Persistent post-surgical pain and neuropathic pain after total knee replacement

Table 3 Studies including total knee replacement patients concerning the prevalence and etiology of neuropathic pain

Ref.	Design	No. of patients	Aim of the study	Scores-scales	Follow-up	Pain	Factors
Wylde et al[9]	Retrospective	632	To assess: (1) prevalence; (2) severity; (3) sensory qualities; and (4) postoperative determinants of persistent pain after primary THR and TKR	Western Ontario and McMaster Universities Index of Osteoarthritis Pain Scale Short-Form McGill Pain Questionnaire PainDETECT Questionnaire Two-item Patient Health Questionnaire	Median: 41 mo Range: 34-49 mo	PPSP: 44% Severe-extreme PPSP: 15% Constant PPSP: 5% Likely NP: 6%	Significant and independent postoperative determinants of number of PPSP: (1) No. of pain problems elsewhere; and (2) The presence of major depression
Masselin-Dubois et al[31]	Prospective	TKR patients: 89 breast cancer surgery patients: 100	To assess the predictive value of: (1) Anxiety; (2) Depression; (3) Pain catastrophizing; and (4) Baseline pain intensity for chronic post-surgical pain. The existence of neuropathic pain	BPI NRS Neuropathic Pain Diagnostic Questionnaire (DN4) Spielberger STAI 13-item BDI PCS	Pre-op. Post-op: (1) 2 d (2) 3 mo	TKR patients: (1) Pre-op: 84% at least moderate pain (2) 2 d: 46.9%; and (3) 3 mo: 50.6% Neuropathic pain TKR patients: (1) Pre-op: 30.7% (2) 3 mo: 42.2%	Regardless the type of surgery, state anxiety, pain catastrophizing (especially pain magnification) and acute post-surgical pain are predictive of persistent post-surgical pain Acute post-surgical pain was also predictive of NP pain. Baseline pain intensity, trait anxiety and depression had no independent impact on post-surgical pain (considering low baseline scores for depression in this study)
Lavand’homme et al[33]	Prospective	TKR and UKR patients: 120	To examine the relationship between postoperative pain trajectories and persistent pain, specifically neuropathic pain.	NRS Neuropathic Pain Diagnostic Questionnaire (DN4) PCS Spielberger STAI for Adults	Pre-op. Post-op: (1) Day 1 to day 8; (2) 3 mo	At 3 mo post-op: (1) 42% patients were pain free (2) 47% patients with persistent pain without NP pain; and (3) 11% patients with persistent pain involving neuropathic component	Patients with neuropathic pain displayed higher pain scores, particularly during mobilization No differences found among pain trajectories for pain at rest
Attal et al[32]	Prospective	TKR patients: 89 breast cancer surgery patients: 100	If: (1) cognitive functioning (2) emotional functioning and pain coping are predictors of persistent post-surgical pain and neuropathic pain	BPI Neuropathic Pain Diagnostic Questionnaire (DN4) TMT A TMT B ROCF-copy ROCF-immediate recall BDI Spielberger STAI CSQ Brief Version of the SOPA-B	Pre-op: (1) 1 mo; and (2) 1 d Post-op: (1) 2 d; (2) 6 mo, 12 mo	TKR patients (1) Pre-op: 84%; (2) 6 mo: 39%; and (3) 12 mo: 38% Neuropathic pain TKR patients: (1) Pre-op: 75 patients; (2) 6 mo: 32 patients; and (3) 12 mo: 26 patients	Cognitive functioning, emotional functioning and pain coping made an independent contribution to the prevalence and severity of persistent post-surgical pain, as well as its neuropathic quality. Results at ROCF-copy and ROCF- immediate recall test seemed to be predictors of pain with neuropathic nature

PPSP: Persistent postsurgical pain; BPI: Brief Pain Inventory; NRS: Numerical Rating Scale; STAI: State-Trait Anxiety Inventory; PCS: Pain Catastrophizing Scale; BDI: Beck Depression Inventory; TMT A: Trail-Making Test A; ROCF-copy: Rey-Osterrieth Complex Figure-copy; ROCF-immediate recall: Rey-Osterrieth Complex Figure-immediate recall; CSQ: Coping Strategies Questionnaire; SOPA-B: Survey of Pain Attitudes.