Pain Mechanisms and Psychosocial Variables in Patients With Chronic Pain After Total Knee Arthroplasty: Secondary Analysis From a Randomised Controlled Trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(21):3 Eur J Pain . 2025 Jul;29(6):e70064.What this means for my practice?
Adding neuromuscular exercise to PNE reduced temporal summation (central amplification) at the operated knee versus PNE alone, while improvements in catastrophizing—seen across groups—were most strongly associated with better pain/function (KOOS4). Clinically, pairing high-quality education with exercise may address both central sensitization and maladaptive cognitions to improve outcomes in chronic post-TKA pain. Key limitations include an exploratory secondary analysis not powered for mechanistic outcomes, median-reported (often non-normal) data, and inability to blind patients.
Study Summary
Sixty-nine patients with chronic post-TKA pain were randomized to neuromuscular exercise+pain neuroscience education (PNE) (n=36) or PNE alone (n=33). The primary outcome of interest for this secondary analysis was temporal summation of pain (TSP) at the index knee. Secondary outcomes included TSP extra-segmentally, pressure pain thresholds (PPT) locally and extra-segmentally, conditioned pain modulation (CPM), PainDETECT, fear-avoidance beliefs (FABQ-PA), and pain catastrophizing (PCS). Outcomes were assessed at baseline, 3, 6, and 12 months. Overall, the results of the study revealed a significant between-group improvement favoring exercise+PNE for TSP at the index knee (mean difference −1.45, 95% CI −2.48 to −0.42; p=0.006), with no between-group differences for other mechanistic or psychosocial outcomes. In addition, both groups showed within-group improvements in PainDETECT, FABQ-PA, and PCS, and change in PCS was associated with better KOOS4. These findings suggest exercise+PNE can attenuate central pain amplification (TSP) whereas broader clinical gains may relate to reducing catastrophizing.
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