PMID- 27986621 OWN - NLM STAT- MEDLINE DCOM- 20180314 LR - 20240213 IS - 1522-9653 (Electronic) IS - 1063-4584 (Print) IS - 1063-4584 (Linking) VI - 25 IP - 5 DP - 2017 May TI - The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty. PG - 667-675 LID - S1063-4584(16)30477-0 [pii] LID - 10.1016/j.joca.2016.12.013 [doi] AB - OBJECTIVE: Approximately 20% of total knee arthroplasty (TKA) recipients have suboptimal pain relief. We evaluated the association between pre-surgical widespread body pain and incomplete pain relief following TKA. METHOD: This prospective analysis included 241 patients with knee osteoarthritis (OA) undergoing unilateral TKA who completed questionnaires preoperatively and up to 12 months post-operatively. Questionnaires included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and a body pain diagram. We derived the number of non-index painful body regions from the diagram. We used Poisson regression to determine the association between painful body regions identified preoperatively and both WOMAC pain at follow-up and improvement in pain as defined by the minimal clinically important difference (MCID). RESULTS: Mean subject age was 66 years (SD 9), and 61% were females. Adjusting for age, sex, co-morbid conditions, baseline pain, pain catastrophizing, and mental health, we found that more widespread body pain was associated with a higher likelihood of reporting 12-month WOMAC pain score >15 (relative risk [RR] per painful body region 1.39, 95% CI 1.18-1.63) and a greater likelihood of failing to achieve the MCID (RR 1.47, 95% CI 1.16-1.86).). Pain catastrophizing was an independent predictor of persistent pain and failure to improve by the MCID (RR 3.57, 95% CI 1.73-7.31). CONCLUSIONS: Pre-operative widespread pain was associated with greater pain at 12-months and failure to reach the MCID. Widespread pain as captured by the pain diagram, along with the pain catastrophizing score, may help identify persons with suboptimal TKA outcome. CI - Copyright (c) 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved. FAU - Dave, A J AU - Dave AJ AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Selzer, F AU - Selzer F AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Losina, E AU - Losina E AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Usiskin, I AU - Usiskin I AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Collins, J E AU - Collins JE AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Lee, Y C AU - Lee YC AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Band, P AU - Band P AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Dalury, D F AU - Dalury DF AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Iorio, R AU - Iorio R AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Kindsfater, K AU - Kindsfater K AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. FAU - Katz, J N AU - Katz JN AD - Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jnkatz@partners.org. LA - eng GR - T32 AR007530/AR/NIAMS NIH HHS/United States GR - T32 AR055885/AR/NIAMS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural DEP - 20161214 PL - England TA - Osteoarthritis Cartilage JT - Osteoarthritis and cartilage JID - 9305697 SB - IM MH - Academic Medical Centers MH - Aged MH - Arthroplasty, Replacement, Knee/*methods MH - Boston MH - Cohort Studies MH - Female MH - Humans MH - Male MH - Middle Aged MH - Musculoskeletal Pain/*physiopathology MH - Osteoarthritis, Knee/diagnostic imaging/*surgery MH - *Pain Measurement MH - Poisson Distribution MH - Preoperative Care MH - Prognosis MH - Prospective Studies MH - *Quality of Life MH - Severity of Illness Index MH - Surveys and Questionnaires MH - Treatment Outcome PMC - PMC5403582 MID - NIHMS839991 OTO - NOTNLM OT - Catastrophizing OT - Pain diagram OT - Total knee arthroplasty OT - Widespread pain COIS- Competing Interests: None EDAT- 2016/12/18 06:00 MHDA- 2018/03/15 06:00 PMCR- 2018/05/01 CRDT- 2016/12/18 06:00 PHST- 2016/08/17 00:00 [received] PHST- 2016/11/18 00:00 [revised] PHST- 2016/12/07 00:00 [accepted] PHST- 2016/12/18 06:00 [pubmed] PHST- 2018/03/15 06:00 [medline] PHST- 2016/12/18 06:00 [entrez] PHST- 2018/05/01 00:00 [pmc-release] AID - S1063-4584(16)30477-0 [pii] AID - 10.1016/j.joca.2016.12.013 [doi] PST - ppublish SO - Osteoarthritis Cartilage. 2017 May;25(5):667-675. doi: 10.1016/j.joca.2016.12.013. Epub 2016 Dec 14.