Correlation Between Preoperative Widespread Pain And Chronic Pain After Total Knee Arthroplasty In Patients With Knee Osteoarthritis

Objective To investigate the correlation between preoperative widespread pain(WSP)and chronic post-surgical pain(CPSP)after total knee arthroplasty(TKA)in patients with knee osteoarthritis.Methods A total of 178 patients with first unilateral TKA under elective general anesthesia in Provincial Hospital Affiliated to Anhui Medical University from September 2021 to March 2022 were included.They were of all genders,aged 45 to 70 years,The American Society of Anesthesiologists(ASA)grade I-III.All patients were anesthetized in the same way,and the surgery was performed by the same team of doctors.Patients were evaluated and scores were recorded using relevant scales before surgery,such as widespread pain index(WPI)score,visual analogue scale(VAS)score,the hospital anxiety and depression scale(HAD)score and central sensitization inventory(CSI)score.WPI>1 is defined as WSP.Intraoperative data,such as tourniquet and operation time were collected.The patient was followed up 3 days after surgery,patients with surgical joint VAS pain scores greater than 3 at rest were given flurbiprofen extranate and analgesia was recorded.Outpatient or telephone follow-up was performed 6 months after surgery to record the pain score of VAS in the surgical joint at rest and in motion,and VAS>3 at rest or(and)exercise was CPSP positive and recorded as CPSP positive group(n=68),VAS≤3 was classified as CPSP negative and recorded as CPSP negative group(n=110).Results The incidence of CPSP in this study was 38%(n = 68).Univariate analysis showed that compared with the CPSP-negative group,the proportion of women in the CPSP-positive group was higher(P<0.05),the course of knee osteoarthritis was longer(P<0.05),the preoperative WPI,HAD and CSI scores were higher(P<0.05),and the VAS pain score was higher at rest and exercise 6 months after surgery.There was no significant difference between the remaining two groups.The indicators of P<0.05 in univariate analysis and clinical indicators that may be related to CPSP were included in the multivariate dichotomous logistic regression analysis,and the results showed that the more pain areas in WPI,the greater the risk of CPSP(OR: 2.328,95%CI1.126-4.812,P<0.05).The longer course of knee osteoarthritis is associated with a higher risk of CPSP.Conclusion Preoperative widespread pain was well associated with post-TKA CPSP in patients with knee osteoarthritis.Patients with widespread pain before surgery were at higher risk of developing CPSP after TKA.WSP is a good predictor of CPSP after TKA in patients with knee osteoarthritis.