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Pain after total knee arthroplasty

机译：全膝关节置换术后疼痛

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The patient with a painful arthritic knee awaitingtotal knee arthroplasty (TKA) requires a multidisciplinary approach.Optimal control of acute post-operative pain and the preventionof chronic persistent pain remains a challenge. The aim of thispaper is to evaluate whether stratification of patients can helpidentify those who are at particular risk for severe acute or chronicpain. Intense acute post-operative pain, which is itself a risk factorfor chronic pain, is more common in younger, obese female patientsand those suffering from central pain sensitisation. Pre-operativepain, in the knee or elsewhere in the body, predisposes to centralsensitisation. Pain due to osteoarthritis of the knee may also triggerneuropathic pain and may be associated with chronic medication likeopioids, leading to a state of nociceptive sensitisation called‘opioid-induced hyperalgesia’. Finally, genetic and personalityrelated risk factors may also put patients at a higher risk forthe development of chronic pain. Those identified as at risk for chronic pain would benefit fromspecific peri-operative management including reduction in opioidintake pre-operatively, the peri-operative use of antihyperalgesicdrugs such as ketamine and gabapentinoids, and a close post-operativefollow-up in a dedicated chronic pain clinic.Cite this article: Bone Joint J 2015;97-B(10Suppl A):45–8.
机译：等待膝关节置换术（TKA）的膝关节疼痛患者需要多学科的研究方法，对急性术后疼痛的最佳控制和慢性持续性疼痛的预防仍然是一个挑战。本文的目的是评估患者的分层是否可以帮助识别那些处于严重急性或慢性疼痛风险中的患者。剧烈的急性术后疼痛本身是慢性疼痛的危险因素，在年轻，肥胖的女性患者和中枢痛敏症患者中更为常见。术前膝盖或身体其他部位的疼痛易导致中枢过敏。膝盖骨关节炎引起的疼痛也可能引发神经性疼痛，并可能与类阿片类药物长期服用有关，从而导致一种伤害性敏化状态，称为“阿片类药物引起的痛觉过敏”。最后，遗传和与人格相关的危险因素也可能使患者处于发生慢性疼痛的较高风险中。那些被确定为有慢性疼痛风险的患者将受益于特殊的围手术期管理，包括术前减少阿片类药物的摄入，围手术期使用氯胺酮和加巴喷丁类抗痛觉过敏药物以及在专门的慢性疼痛诊所进行密切的随访。引用本文：Bone Joint J 2015; 97-B（10Suppl A）：45-8。

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