Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty
Open accessAbstract
The goal of this study was to follow a cohort of patients undergoing total knee arthroplasty over time to: (1) identify and describe the various pain trajectories beginning preoperatively and for up to 12 months after surgery, (2) identify baseline predictors of trajectory group membership, and (3) identify trajectory groups associated with poor psychosocial outcomes 12 months after surgery. One hundred seventy-three participants (female = 85 [49%]; mean age [years] = 62.9, SD = 6.8) completed pain and psychological questionnaires and functional performance tests preoperatively and 4 days, 6 weeks, and 3 and 12 months after total knee arthroplasty. Using growth mixture modeling, results showed that a 4-group model, with a quadratic slope and baseline pain data predicting trajectory group membership, best fit the data (Akaike information criterion = 2772.27). The first 3 pain trajectories represent various rates of recovery ending with relatively low levels of pain 12 months after surgery. Group 4, the constant high pain group, comprises patients who have a neutral or positive pain slope and do not show improvement in their pain experience over the first year after surgery. This model suggests that preoperative pain levels are predictive of pain trajectory group membership and moderate preoperative pain, as opposed to low or high pain, is a risk factor for a neutral or positive pain trajectory postoperatively. Consistent with previous studies, these results show that postoperative pain is not a homogeneous condition and point to the importance of examining intraindividual pain fluctuations as they relate to pain interventions and prevention strategies.
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Perioperative anxiety predicts the development of chronic postsurgical pain.
“Negative cognitive–affective states including perioperative depression,42,43 anxiety,25,32,35,43,44 pain catastrophizing,18,44 and posttraumatic stress symptoms45 also predict the development of CPSP.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [25]
Section 3.5 reports that patients in the persistent-high-pain group had higher preoperative anxiety than patients in one recovery group. The Discussion suggests that preoperative psychological variables may influence CPSP risk, but the paper does not establish anxiety as an independent predictor; the anxiety difference was not significant against the other two recovery groups. Page numbers were unavailable in our copy. (LLM, conf=0.86)
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- Authors
- Pagé, M. G., Katz, J., Romero Escobar, E. M., Lutzky-Cohen, N., Curtis, K., Fuss, S., & Clarke, H. A.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Clarke, Hance A.
- Venue
- Pain
- Published
- 2015-03
- Volume
- 156
- Issue
- 3
- Pages
- 460-468
- ISSN
- 0304-3959 (ISSN-L)
- OpenAlex
- W2099052157
- Semantic Scholar
- 1956195a08720cc8b68c8504edf706d3534f35f6
- Cited by
- 91
- References
- 59
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 12 · 2020: 11 · 2019: 13 · 2018: 9 · 2017: 8 · 2016: 5 · 2015: 6
- FWCI
- 9.41
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- YorkSpace (York University) (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- postoperative pain, total knee arthroplasty, pain trajectories, chronic postoperative pain, preoperative pain, pain recovery, psychosocial outcomes, growth mixture modeling
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Pain Measurement, Pain, Postoperative, Postoperative Pain, Psychiatric Status Rating Scales, Surveys and Questionnaires, Cohort Studies, Range of Motion, Articular, Walking, Arthroplasty, Replacement, Knee, Mood Disorders, Lower Extremity, Young Adult
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