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Mediating role of pain sensitization in preoperative and postoperative pain in knee osteoarthritis patients

European Journal of Medical Research volume 30, Article number: 301 (2025) Cite this article

Abstract

Objective

This study aims to explore the relationship between preoperative and postoperative pain in patients with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR), and to assess the mediating roles of central and peripheral sensitization.

Methods

This prospective cohort study enrolled a total of 105 eligible KOA patients. The Visual Analog Scale (VAS) was used to assess preoperative and postoperative pain levels. Multivariate linear regression analysis and Bootstrap mediation analysis were conducted to investigate the impact of preoperative pain intensity on postoperative pain.

Results

This study revealed a significant positive correlation between preoperative VAS scores during movement and pain scores 3 days postoperatively (β = 0.4018, p = 0.0017), as well as a significant correlation with pain scores 6 months postoperatively (β = 0.735, p = 0.004). Central sensitization (β = 0.0446, p < 0.0001) and peripheral sensitization (β = 0.0333, p = 0.0015) exhibited significant mediation effects between preoperative and postoperative pain. Additionally, preoperative VAS scores (B = 1.107, p = 0.014, OR = 3.027), age (B = 0.207, p = 0.036, OR = 1.229), and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were significant predictors of postoperative analgesic demand.

Conclusion

This study demonstrates that preoperative pain intensity is closely related to postoperative pain in KOA patients undergoing TKA and UKR, with central and peripheral sensitization playing significant mediating roles in this process. In particular, preoperative pain management is crucial for alleviating postoperative pain and improving patients' quality of life. Therefore, when formulating individualized pain management strategies, the central and peripheral sensitivity of patients should be comprehensively considered. Future research is necessary to develop and evaluate innovative pain control methods integrating central and peripheral mechanisms to optimize postoperative rehabilitation and long-term health outcomes.

Introduction

Osteoarthritis (OA) is the most prevalent form of arthritis in adults, characterized by chronic pain and loss of mobility [1, 2]. It most commonly occurs after the age of 40, with prevalence rates rising sharply with age [1, 2]. OA can coexist with other chronic conditions and exert negative impacts. Globally, 595 million people were living with OA in 2020, equivalent to 7.6% (6.8–8.4%) of the global population, and it is projected that the number of knee OA cases will increase by 74.9% (59.4–89.9%) by 2050 compared to 2020 [1, 2]. Hip and knee osteoarthritis (KOA) are among the leading causes of disability worldwide, significantly affecting patients' quality of life and imposing a heavy socioeconomic burden [2,3,4]. The World Health Organization has designated 2021–2030 as the “Decade of Healthy Aging,” emphasizing the need to address conditions like OA that severely impact functional ability and quality of life [1, 2].

For patients with severe symptoms of KOA, joint replacement surgery can effectively alleviate pain and improve joint function [5,6,7]. Total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR) are two types of knee replacement surgeries [8]. However, the incidence of chronic post-surgical pain (CPSP) is high, and its formation is complex, potentially related to factors such as postoperative tissue damage, inflammatory responses, and the patient's physiological and psychological state [9]. Pain sensitization plays a crucial role in the onset and maintenance of chronic pain [10]. Central sensitization refers to an increase in the sensitivity of pain transmission pathways in the spinal cord and brain, leading to enhanced pain perception [10, 11]. Peripheral sensitization involves an increased response of peripheral nerve endings to painful stimuli, with these mechanisms acting collectively in the generation of chronic pain [10,11,12]. Studies have indicated that preoperative pain intensity is closely associated with the occurrence of CPSP. [10] High preoperative pain intensity may increase the risk of CPSP, a relationship that may be explained by mechanisms of pain sensitization [13]. The aim of this study is to explore the mediating role of pain sensitization in the association between preoperative pain and CPSP in patients with KOA. Through this research, we hope to uncover important mechanisms influencing CPSP.

Methods

General information

This is a prospective and observational study conducted at the First Affiliated Hospital of the University of Science and Technology of China(USTC). This study obtained approval from the Ethics Committee (Ethics Approval Number: 2021 KY Ethics Review No. 158). All participants signed informed consent forms before enrolling in the study. Inclusion criteria were as follows: patients with KOA aged between 45 and 75 years; diagnosed with KOA of Kellgren–Lawrence grade II or above confirmed by X-ray; scheduled to undergo TKA or UKR; and capable of completing questionnaires and follow-ups. Exclusion criteria were as follows: history of mental illness, substance abuse, severe neurological or cardiovascular diseases; previous knee surgery; coexistence with other chronic pain syndromes (e.g., fibromyalgia); use of medications affecting the central nervous system within the past 3 months; and pregnant or lactating women. Note: Patients with well-controlled hypertension were not excluded.

Research methods

This is a prospective cohort study conducted from November 2021 to December 2022. Patients with KOA who met the inclusion criteria were consecutively recruited. Sample size calculation was based on the requirements for mediation analysis, referring to the recommendations of Fritz and MacKinnon [14], using the bias-corrected Bootstrap method. With 80% power and a significance level of 0.05, the minimum required sample size was 71 cases. During the study, we recruited a total of 165 eligible patients. After several months of follow-up and data screening, 105 patients were ultimately included for analysis (Fig. 1).

Fig. 1
figure 1

Flow diagram of the recruitment process

Full size image

Preoperative assessment

All patients completed the following assessments 1–2 weeks before surgery. 1. Collection of demographic information and medical history; 2. Pain assessment: The Visual Analog Scale (VAS) was used to evaluate patients' pain levels at rest and during activity. Patients marked their pain level on a 10-cm straight line, with the VAS score ranging from 0 to 10, where a higher score indicated greater pain intensity; 3. Pain sensitization assessment: Central sensitization: Pressure pain thresholds of the anterior wall muscles were measured using the Wagner FPX™ pressure algometer [15]; Peripheral sensitization: Pressure pain thresholds were measured at three standard tender points around the knee joint.

Surgery and perioperative management

Surgical type (TKA or UKR), surgical duration, anesthesia method, and medication use were recorded. All patients were treated according to a standardized perioperative management protocol, including preoperative antibiotic prophylaxis, intraoperative blood loss control, postoperative pain management, and early functional exercise.

Postoperative assessment

Follow-up assessments were conducted 3 days and 6 months postoperatively, including pain assessment (using the VAS to evaluate pain at rest and during movement); complication recording, such as nausea and vomiting, blood transfusion needs, and length of hospital stay; and analgesic medication use.

Statistical analysis

In this study, we used SPSS 27.0 software for data analysis. For baseline characteristics, descriptive statistical methods were employed, with continuous variables presented as means and standard deviations, and categorical variables presented as frequencies and percentages. To assess the relationship between preoperative factors and postoperative pain, we used multiple linear regression analysis, controlling for confounding factors such as age, gender, BMI, surgical type, and hypertension. Additionally, mediation effect analysis was conducted using the Bootstrap method (5000 Bootstrap samples) and the Process plugin in SPSS (Model 4) to explore the mediation role of preoperative pain (independent variable: preoperative VAS score during movement) on postoperative pain at 3 days (dependent variable), with central sensitization (pressure pain threshold of the anterior wall muscles) and peripheral sensitization (pressure pain threshold of the knee joint) as mediator variables. The significance of the mediation effect was determined by a 95% confidence interval not containing zero (p < 0.05). Furthermore, binary logistic regression analysis was performed to investigate the factors influencing postoperative rescue analgesia needs, examining the predictive effects of preoperative VAS scores, age, and duration of arthritis, and analyzing the relationship between remifentanil usage and postoperative nausea.

Results

Baseline characteristics

A total of 105 patients with knee OA were included in this study, including 84 females (80.0%) and 21 males (20.0%). The mean age of the patients was 57.8 ± 3.2 years, and the mean BMI was 26.3 ± 2.5 kg/m2. In terms of surgical types, 50 patients (47.6%) underwent TKA, and 55 patients (52.4%) underwent UKR. Detailed baseline characteristics of the patients are presented in Table 1.

Table 1 Patients baseline clinical features analysis (n = 105)
Full size table

Relationship between preoperative and postoperative pain

Multiple linear regression analysis showed that the preoperative pain level (VAS score during movement) was significantly positively correlated with the pain level 3 days after surgery (VAS score during movement) (β = 0.4018, SE = 0.1247, p = 0.0017, 95% CI [0.1543, 0.6493]), and it was also significantly correlated with the pain level 6 months after surgery (β = 0.735, p = 0.004). The overall model was significant (F(7, 96) = 2.142, p = 0.046). This indicates that higher preoperative pain levels are associated with higher postoperative pain levels.

Mediation analysis

The mediation effects of central sensitization (indicated by anterior wall muscle tenderness value) and peripheral sensitization (indicated by knee joint tenderness value) on the relationship between preoperative movement pain (X) and postoperative movement pain 3 days after surgery (Y) were analyzed using the Bootstrap method (5000 samples) (Table 2).

Table 2 Analysis of the mediating effect of preoperative pain on postoperative pain
Full size table

The analysis of central sensitization showed that preoperative movement pain had a significant effect on the anterior wall muscle tenderness value (β = 2.9817, SE = 1.2230, p = 0.0166, 95% CI [0.5543, 5.4091]), and the anterior wall muscle tenderness value had a significant effect on postoperative movement pain 3 days after surgery (β = 0.0446, SE = 0.0094, p < 0.0001, 95% CI [0.0260, 0.0632]). The indirect effect was 0.1329 (Bootstrap SE = 0.0633, 95% CI [0.0310, 0.2772])(Fig. 2).

Fig. 2
figure 2

Sensitization model of the central nervous system

Full size image

The analysis of peripheral sensitization showed that preoperative movement pain significantly affected the knee joint tenderness value (β = 2.6132, SE = 1.1891, p = 0.0304, 95% CI [0.2530, 4.9733]), and the knee joint tenderness value also had a significant effect on postoperative movement pain 3 days after surgery (β = 0.0333, SE = 0.0102, p = 0.0015, 95% CI [0.0131, 0.0534]). The indirect effect was 0.0870 (Bootstrap SE = 0.0473, 95% Bootstrap CI [0.0079, 0.1931]). The results indicate that both central and peripheral sensitization play important mediation roles in the impact of preoperative pain on postoperative pain (Fig. 3).

Fig. 3
figure 3

Sensitization model of the peripheral nerves

Full size image

The duration of arthritis had a significant effect on both the anterior wall muscle tenderness value and the knee joint tenderness value (β = 0.7291, SE = 0.2326, p = 0.0023, 95% CI [0.2674, 1.1907]), (β = 0.4558, SE = 0.2262, p = 0.0466, 95% CI [0.0069, 0.9047]), while factors such as age, gender, and BMI had no significant effects (p > 0.05).

Postoperative outcomes and influencing factors in KOA patients

We employed binary logistic regression analysis to identify factors associated with postoperative rescue analgesia requirements. The results indicated a significant correlation between preoperative VAS scores and the need for rescue analgesia (B = 1.107, p = 0.014, OR = 3.027), suggesting that patients with higher preoperative pain scores are more likely to require postoperative rescue analgesia. Additionally, age (B = 0.207, p = 0.036, OR = 1.229) and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were also identified as significant predictors. Gender, surgical approach, BMI, and hypertension did not demonstrate significant associations. The predictive accuracy of the model was 84.8%. Furthermore, we explored the relationship between remifentanil usage and postoperative nausea. The results showed no significant correlation between remifentanil usage and postoperative nausea (B = 0.008, p = 0.107, OR = 1.008). The overall predictive accuracy of this model was 90.5%. Among other postoperative outcomes, the average length of hospital stay was 3.095 days (SD = 0.354), with 4.76% of patients requiring blood transfusions; 2 patients (1.9%) were admitted to the ICU, and 1 patient (0.95%) experienced hypothermia. These findings provide important insights for postoperative management in clinical practice and are detailed in Table 3.

Table 3 Analysis of Postoperative Outcomes and influencing factors in KOA patients
Full size table

Discussion

Based on the Global Burden of Disease (GBD) database [16, 17], the age-standardized years lived with disability (YLDs) rate for OA has been continuously rising [1]. Population growth, aging, and the lack of effective treatments are expected to significantly increase the number of cases [1, 2]. As a significant public health issue, the severity of KOA underscores the necessity of improving pain management after knee arthroplasty. This study reveals the relationship between preoperative and postoperative pain in KOA patients undergoing TKA and UKR, emphasizing the importance of preoperative pain management. The results show a significant positive correlation between preoperative pain intensity and postoperative pain, indicating that patients with higher preoperative pain levels may experience more severe postoperative pain symptoms. This finding is consistent with those of Hasegawa et al. [18] and Wylde [19]. Pua et al. [20] further pointed out that preoperative psychological status and physiological factors also affect postoperative pain manifestation.

In randomized, double-blind, placebo-controlled trials, although preoperative intra-articular injection of methylprednisolone acetate (MP) significantly reduced preoperative inflammatory markers such as IL-6, its impact on acute pain and sensitization after TKA was not significant. This suggests that managing peripheral inflammation alone may not be sufficient for comprehensive relief of postoperative pain [21]. Our study found that central and peripheral neural sensitization have significant mediating effects in the influence of preoperative pain on short-term chronic pain after surgery, aligning with existing literature [22,23,24] that observes the impact of preoperative pain on postoperative chronic pain. Kurien et al. [25] found that patients with neuropathic pain symptoms identified by the PainDETECT questionnaire are prone to developing chronic pain postoperatively. However, Høvik et al. [26] did not find an association between preoperative pain catastrophizing and long-term pain, but these results emphasize the importance of the sensitization process in early postoperative pain management. GBD data show that the burden of KOA is heaviest among individuals over 65 years old [1, 2], which aligns with the characteristics of our study population and supports the analysis results regarding the impact of age on the mediating effect of central neural sensitization.

Furthermore, through binary logistic regression analysis, we found that preoperative VAS scores, age, and duration of arthritis are important predictors of postoperative analgesic demand. This suggests that special attention should be given to these factors during preoperative assessment to develop individualized pain management strategies. Although there was no significant correlation between remifentanil usage and the occurrence of postoperative nausea, its overall prediction accuracy was 90.5%, demonstrating its potential clinical value.

This study is the first to explore the mediating role of central and peripheral nociceptive sensitization in TKA and UKR knee arthroplasty, providing a new perspective on understanding the impact of preoperative pain on short-term postoperative pain. However, the study’s single-center design may limit the generality of the results. Future large-sample, multicenter studies are needed to validate our findings. Intervention strategies targeting nociceptive sensitization are a focus of future research. Existing literature suggests that specific medications and physical therapies may help alleviate neural sensitization [27]. In clinical practice, the importance of preoperative nociceptive sensitization assessment cannot be overlooked, as it helps identify high-risk patients and develop individualized pain management strategies. Postoperative rehabilitation programs should also comprehensively consider nociceptive sensitization to optimize rehabilitation plans and reduce long-term pain and functional limitations.

Conclusion

This study provides an in-depth analysis of the relationship between preoperative and postoperative pain in KOA patients undergoing TKA and UKR, finding a significant positive correlation between preoperative pain intensity and postoperative pain. Central and peripheral neural sensitization play critical mediating roles in the influence of preoperative pain on postoperative pain, indicating the need to prioritize neural sensitization factors in preoperative assessment. Additionally, preoperative VAS scores, age, and duration of arthritis are important predictors of postoperative analgesic demand, suggesting the adoption of individualized strategies in pain management. This study provides clear guidance for clinical practice, emphasizing the importance of integrating multilevel analgesic strategies targeting both central and peripheral mechanisms.

Data availability

No datasets were generated or analysed during the current study.

References

  1. El-khodary H, Mahmoud AN, Horwitz DS, Elzaher EH, Elabd MA, Sovalkina M, Kamel AS, Mohasseb A. Synovial fluid white blood cell count as a potential biomarker for the clinical severity of knee osteoarthritis: a prospective study. Medinformatics. 2024;1(4):195–201.

    Article  Google Scholar 

  2. Duan WL, Zhang LN, Bohara R, Martin-Saldaña S, Yang F, Zhao YY, Xie Y, Bu YZ, Pandit A. Adhesive hydrogels in osteoarthritis: from design to application. Mil Med Res. 2023;10(1):4. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40779-022-00439-3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Giorgino R, Albano D, Fusco S, Peretti GM, Mangiavini L, Messina C. Knee osteoarthritis: epidemiology, pathogenesis, and mesenchymal stem cells: what else is new? An update. Int J Mol Sci. 2023;24(7):6405. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/ijms24076405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):2133–61. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/S0140-6736(24)00757-8.

    Article  Google Scholar 

  5. Zhang L, Yang H, Liu J, Wang K, Cai X, Xiao W, Wang L, Wang M, Zhang C, Zhang J. Metabolomics-based approach to analyze the therapeutic targets and metabolites of a synovitis ointment for knee osteoarthritis. Curr Pharm Anal. 2023;19(3): e231222212163. https://doiorg.publicaciones.saludcastillayleon.es/10.2174/1573412919666221223152915.

    Article  CAS  Google Scholar 

  6. Riddle DL, Golladay GJ. Preoperative risk factors for postoperative falls in persons undergoing hip or knee arthroplasty: a longitudinal study of data from the osteoarthritis initiative. Arch Phys Med Rehabil. 2018;99(5):967–72. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.apmr.2017.12.030.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhang Q, Sun X, Pan JB, Kong G. Feasibility of mNGS in joint replacement patients exhibiting elevated ESR and CRP levels without an underlying diagnosis. Eur J Med Res. 2024;29(1):515. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40001-024-02118-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Panzram B, Mandery M, Reiner T, Gotterbarm T, Schiltenwolf M, Merle C. Cementless Oxford medial unicompartmental knee replacement-clinical and radiological results of 228 knees with a minimum 2-year follow-up. J Clin Med. 2020;9(5):1476. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm9051476.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tchetina EV, Glemba KE, Markova GA, Glukhova SI, Makarov MA, Lila AM. Metabolic dysregulation and its role in postoperative pain among knee osteoarthritis patients. Int J Mol Sci. 2024;25(7):3857. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/ijms25073857.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Li S, Huang J, Tong P. Research progress of hyperalgesia in knee osteoarthritis. Tradit Chin Med Bone Sett. 2020;32(05):35–8+42.

    Google Scholar 

  11. Ohga S, Matsubara T. Pain sensitization and neuropathic pain-like symptoms associated with effectiveness of exercise therapy in patients with hip and knee osteoarthritis. Pain Res Manag. 2022;29(2022):4323045. https://doiorg.publicaciones.saludcastillayleon.es/10.1155/2022/4323045.

    Article  Google Scholar 

  12. Hattori T, Ohga S, Shimo K, Matsubara T. Pathology of knee osteoarthritis pain: contribution of joint structural changes and pain sensitization to movement-evoked pain in knee osteoarthritis. Pain Rep. 2024;9(1): e1124. https://doiorg.publicaciones.saludcastillayleon.es/10.1097/PR9.0000000000001124.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Vervullens S, Meert L, Smeets RJEM, Verbrugghe J, Baert I, Rahusen FTG, Heusdens CHW, Verdonk P, Meeus M. Preoperative glycaemic control, number of pain locations, structural knee damage, self-reported central sensitisation, satisfaction and personal control are predictive of 1-year postoperative pain, and change in pain from pre- to 1-year posttotal knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/ksa.12265.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fritz MS, MacKinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18(3):233–9.

    Article  PubMed  Google Scholar 

  15. Cygańska AK, Tomaszewski P, Cabak A. Pain threshold in selected trigger points of superficial muscles of the back in young adults. PeerJ. 2022;1(10): e12780. https://doiorg.publicaciones.saludcastillayleon.es/10.7717/peerj.12780.

    Article  Google Scholar 

  16. Lv B, Lan JX, Si YF, Ren YF, Li MY, Guo FF, Tang G, Bian Y, Wang XH, Zhang RJ, Du ZH, Liu XF, Yu SY, Tian CL, Cao XY, Wang J. Epidemiological trends of subarachnoid hemorrhage at global, regional, and national level: a trend analysis study from 1990 to 2021. Mil Med Res. 2024;11(1):46. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40779-024-00551-6.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Alemu C, Wudu H, Bogale B, Getachew Z, Nega A. Time to death and its determinant factors of stroke patients at Gambella General Hospital, Gambella, Ethiopia. Eur J Med Res. 2024;29(1):452. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40001-024-02026-9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hasegawa M, Tone S, Naito Y, Sudo A. Preoperative pain catastrophizing affects pain outcome after total knee arthroplasty. J Orthop Sci. 2022;27(5):1096–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jos.2021.05.011.

    Article  PubMed  Google Scholar 

  19. Wylde V, Sayers A, Lenguerrand E, Gooberman-Hill R, Pyke M, Beswick AD, Dieppe P, Blom AW. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis. Pain. 2015;156(1):47–54. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.pain.0000000000000002.

    Article  PubMed  Google Scholar 

  20. Pua YH, Poon CL, Seah FJ, Thumboo J, Clark RA, Tan MH, Chong HC, Tan JW, Chew ES, Yeo SJ. Predicting individual knee range of motion, knee pain, and walking limitation outcomes following total knee arthroplasty. Acta Orthop. 2019;90(2):179–86. https://doiorg.publicaciones.saludcastillayleon.es/10.1080/17453674.2018.1560647.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Luna IE, Kehlet H, Jensen CM, Christiansen TG, Lind T, Stephensen SL, Aasvang EK. The effect of preoperative intra-articular methylprednisolone on pain after TKA: a randomized double-blinded placebo controlled trial in patients with high-pain knee osteoarthritis and sensitization. J Pain. 2017;18(12):1476–87. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jpain.2017.07.010.

    Article  CAS  PubMed  Google Scholar 

  22. Fernández-de-Las-Peñas C, Florencio LL, de-la-Llave-Rincón AI, Ortega-Santiago R, Cigarán-Méndez M, Fuensalida-Novo S, Plaza-Manzano G, Arendt-Nielsen L, Valera-Calero JA, Navarro-Santana MJ. Prognostic factors for postoperative chronic pain after knee or hip replacement in patients with knee or hip osteoarthritis: an umbrella review. J Clin Med. 2023;12(20):6624. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/jcm12206624.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Andreolotti H, Dereu D, Combescurre C, Rehberg B. A systematic review and meta-analysis of three risk factors for chronic postsurgical pain: age, sex and preoperative pain. Minerva Anestesiol. 2022;88:827–41. https://doiorg.publicaciones.saludcastillayleon.es/10.23736/S0375-9393.22.16489-8.

    Article  Google Scholar 

  24. Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jetté N, Casha S, Riva-Cambrin J. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9: e025091. https://doiorg.publicaciones.saludcastillayleon.es/10.1136/bmjopen-2018-025091.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kurien T, Arendt-Nielsen L, Petersen KK, Graven-Nielsen T, Scammell BE. Preoperative neuropathic pain-like symptoms and central pain mechanisms in knee osteoarthritis predicts poor outcome 6 months after total knee replacement surgery. J Pain. 2018;19(11):1329–41. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.jpain.2018.05.011.

    Article  PubMed  Google Scholar 

  26. Høvik LH, Winther SB, Foss OA, Gjeilo KH. Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up. BMC Musculoskelet Disord. 2016;17(17):214. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12891-016-1073-0.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yang Y, Qu JY, Guo H, Zhou HY, Ruan X, Peng YC, Shen XF, Xiong J, Wang YL. Electroacupuncture at sensitized acupoints relieves somatic referred pain in colitis rats by inhibiting sympathetic-sensory coupling to interfere with 5-HT signaling pathway. Chin J Integr Med. 2024;30(2):152–62. https://doiorg.publicaciones.saludcastillayleon.es/10.1007/s11655-023-3565-8.

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by Young Talents of the Qinglan Project in the West District of the First Affiliated Hospital of the University of Science and Technology of China (QLGC2023006).

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Authors and Affiliations

  1. Department of Pain, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China

    Tianjiao Shen, Ji Yuan, Hai Gu & Lingsuo Kong

  2. Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China

    Di Wang & Xiaoqing Chai

  3. Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, Anhui, China

    Yinghong Wang

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Contributions

Tianjiao Shen: Data collection and analysis; wrote the main manuscript text Di Wang, Xiaoqin Chai, Hai Gu: Propose research questions, design experiment scheme Ji Yuan: Data collection and analysis Lingsuo Kong; Yinghong Wang: revision of papers; Read and approve the final version of the submission.

Corresponding authors

Correspondence to Lingsuo Kong or Yinghong Wang.

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Ethics approval and consent to participate

The Ethical Committee at the first Affiliated Hospital of USTC approved this prospective trial. Written informed consent was obtained from all patients recruited to the study, in accordance with the code of the Declaration of Helsinki.

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The authors declare no competing interests.

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Shen, T., Yuan, J., Wang, D. et al. Mediating role of pain sensitization in preoperative and postoperative pain in knee osteoarthritis patients. Eur J Med Res 30, 301 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40001-025-02485-8

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s40001-025-02485-8

Keywords

European Journal of Medical Research

ISSN: 2047-783X

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