Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.

Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.

Cremeans-Smith Julie K; Greene Kenneth; Delahanty Douglas L

Pain medicine (Malden, Mass.)

2016

2016-05

OBJECTIVE: The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS: Participants included 110 patients undergoing total knee arthroplasty. METHODS: Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a

*Cardiovascular; *Cortisol; *Epinephrine; *Post-operative Pain; *Severity of Illness Index; *Stress; *Surgery; 80 and over; 80 and Over; Aged; Arthroplasty; Catecholamines – Urine; Center for Epidemiological Studies Depression Scale; Cohort Studies; Data Analysis Software; Descriptive Statistics; Effect Size; Female; Human; Humans; Hydrocortisone – Urine; Knee; Knee/*adverse effects/psychology; Male; Middle Age; Middle Aged; Nonexperimental Studies; Ohio; Pain; Pain Measurement/methods; Physiological; Postoperative Pain – Risk Factors; Postoperative/*diagnosis/etiology/*psychology; Predictive Value of Tests; Prospective Studies; Psychological/complications/*diagnosis/*psychology; Regression; Replacement; Scales; Stress; Summated Rating Scaling; Treatment Outcome

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

970–979

5

17