Total Knee Athroplasty Neuropathic Pain
Introduction[edit | edit source]
Knee Replacement (KR) procedures are regularly performed now. However up to 1/5 of these replacements
cause patients to have a degree of long-term pain or are not satisfied with their surgery.
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Neuropathic pain rates post KJA reach their max at six to twelve weeks after surgery, and approximately 6% patients will go on to have neuropathiclong term neuropathic pain.
Post-surgical pain with a neuropathic component likely to be greater than pure nociceptive pain, poorly affecting QOL.
Neuropathic pain may stem from sensitisation of peripheral nociceptors many sources eg inflamed synovium, damaged subchondral bone, surgery trauma.
Patients with a pre existing neuropathic pain elsewhere have a greater potential for chronic nociceptor stimulation and central pain transmission.
Features[edit | edit source]
Features of neuropathic pain may include pain that is unchanged by surgery, pain from which there is no relief despite rest
and analgesia, pain that is diffuse and hard to localise, pain that radiates towards or away from the knee, feelings of pressure,
numbness, sensitivity, burning, stinging, electric shocks or rigidity.
Neuropathic pain can be assessed using a number of validated scoring systems the most widely used of which is the
PainDETECT which can be a useful assessment tool in these patients [15,16].
There are UK NICE guidelines for the assessment and treatment of neuropathic pain [17]. These include offering a choice of
amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment. Capsaicin cream or topical lidocaine can be considered
for people with localised neuropathic pain or neuroma
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Resources[edit | edit source]
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