Total Knee Athroplasty Neuropathic Pain

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

UNDER CONSTRUCTION 3.4.2024 Introduction

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

Neuropathic pain is distinguished by the following features: pain not relieved by rest

and analgesia; diffuse and difficult to localise pain; pain that radiates towards or away from the knee; pain associated with feelings of pressure, numbness, sensitivity, burning, stinging, electric shocks or rigidity.

Assessing

Neuropathic pain can be assessed by various validated scoring systems, the most commonly used is the

PainDETECT, a helpful assessment tool in this patient group.

There are UK NICE guidelines for the assessment and treatment of neuropathic pain. 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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