Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review.
Jasper MurphySery PakLana ShteynmanIan WinkelerZhaosheng JinMartin KaczochaSergio D BergesePublished in: International journal of molecular sciences (2024)
Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA. While the etiology of CPSP is not fully understood, several factors such as chronic inflammation and preoperative central sensitization have been identified. Other potential mechanisms include genetic factors (e.g., catechol-O-methyltransferase (COMT) and potassium inwardly rectifying channel subfamily J member 6 (KCNJ6) genes), lipid markers, and psychological risk factors (anxiety and depression). With regards to therapeutics and prevention, multimodal pharmacological analgesia, emphasizing nonopioid analgesics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has gained prominence over epidural analgesia. Nerve blocks and local infiltrative anesthesia have shown mixed results in preventing CPSP. Ketamine, an N-methyl-D-aspartate (NMDA)-receptor antagonist, exhibits antihyperalgesic properties, but its efficacy in reducing CPSP is inconclusive. Lidocaine, an amide-type local anesthetic, shows tentative positive effects on CPSP. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have mixed results, while gabapentinoids, like gabapentin and pregabalin, present hopeful data but require further research, especially in the context of TKA and THA, to justify their use for CPSP prevention.
Keyphrases
- total knee arthroplasty
- pain management
- anti inflammatory drugs
- neuropathic pain
- risk factors
- total hip
- chronic pain
- postoperative pain
- total hip arthroplasty
- minimally invasive
- patient satisfaction
- sleep quality
- spinal cord
- type diabetes
- coronary artery bypass
- meta analyses
- patients undergoing
- systematic review
- cardiovascular disease
- spinal cord injury
- genome wide
- ultrasound guided
- multiple sclerosis
- healthcare
- oxidative stress
- gene expression
- stem cells
- drug delivery
- human health
- machine learning
- dna methylation
- young adults
- genome wide identification
- bone marrow
- climate change
- electronic health record
- insulin resistance
- cell therapy
- case control
- peripheral nerve