Diagnosis and management of neuropathic pain post-total knee replacement: A systematic review

Figure 2 Forest plot. A: Calculated the standardized mean difference of pain Visual Analogue Scale as reported between 6 months and 12 months after intervention. One randomized controlled trial and three retrospective studies are assessed. We have not meta-analyzed this data. Two studies report no effect, or very small effects of the intervention investigated. Two studies report good effects, but these were of poorer quality and had significant bias. For two single arm studies (Kretzschmar[15], Clendenen et al[20]), we calculated the mean difference in Visual Analogue Scale using the highest and lowest values for the control arm in other studies to provide a possible range of mean difference; B: Demonstrates the log odds ratio of patients with and without neuropathic pain after total knee replacement. The first study reports a clear effect of peri-operative oral pregabalin postulating a lasting effect on central sensitization, while the second is a comparative study of pulsed radiofrequency (radio-frequency) dorsal root ganglion ablation for neuropathic pain also reporting a sustained and substantial effect. CI: Confidence interval; REML: Residual maximum likelihood.