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Üstünel F, Tura İ, Akçam AT, Erden S. The Effect of Preoperative Fear of Pain on Postoperative Pain Levels and the Amount of Analgesic Consumption. Pain Manag Nurs 2023; 24:617-621. [PMID: 37302944 DOI: 10.1016/j.pmn.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Preoperative fear of pain can increase the surgical stress response along with anxiety, increasing postoperative pain and the amount of analgesia consumption. AIMS To determine the effect of preoperative fear of pain on postoperative pain level and analgesic consumption. DESIGN A descriptive, cross-sectional design was used. METHODS A total of 532 patients who were scheduled for a variety of surgical procedures in a tertiary hospital were included in the study. Data were collected using Patient Identification Information Form and Fear of Pain Questionnaire-III. RESULTS 86.1% of the patients thought that they would experience postoperative pain, and 70% of the patients reported moderate-to-severe postoperative pain. The examination of the postoperative first 24-hour pain levels indicated that there was a significant positive correlation between patients' pain levels within 0-2 hours and their mean scores on the fear of severe and minor pain sub-dimensions and the total scale and between pain experienced within 3-8 hours and their scores on the fear of severe pain sub-dimension (p <.05). Also, a significant positive correlation was found between patients' mean scores on the total fear of pain scale and the amount of nonopioid (diclofenac sodium) consumption (p <0.05). CONCLUSIONS The fear of pain increased patients' postoperative pain levels, and thus the amount of analgesic consumption. Therefore, patients' fear of pain should be determined in the preoperative period, and pain management practices should be initiated in this period. As a matter of fact, effective pain management will positively affect patient outcomes by reducing the amount of analgesic consumption.
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Affiliation(s)
- Fatmagül Üstünel
- Cukurova University, Balcalı Hospital Health Practice Center, Nephrology Clinic, Balcalı Campus, Adana, Turkey
| | - İlknur Tura
- Cukurova University, Department of Nursing (RN, MsN)
| | - Atılgan Tolga Akçam
- Cukurova University, Balcalı Hospital Health Practice Center, Surgical Sciences, Department of General Surgery, Balcalı Campus, Adana, Turkey
| | - Sevilay Erden
- Cukurova University, Balcalı Hospital Health Practice Center, Nephrology Clinic, Balcalı Campus, Adana, Turkey.
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Kang JH, Lee KA, Heo YR, Kim WY, Paik ES. Efficacy of a continuous wound infiltration system for postoperative pain management in gynecologic patients who underwent single-port access laparoscopy for adnexal disease. Front Med (Lausanne) 2023; 10:1199428. [PMID: 37476613 PMCID: PMC10354268 DOI: 10.3389/fmed.2023.1199428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction Single-port access (SPA) laparoscopy requires only one incision, unlike conventional laparoscopy. However, its umbilical incision is larger than that of conventional laparoscopy and can be vulnerable to postoperative pain. This study aimed to evaluate whether simultaneous use of a continuous wound infiltration (CWI) system and intravenous patient-controlled analgesia (IV PCA) effectively decreases surgical site pain in patients who underwent SPA laparoscopy due to gynecologic adnexal disease. Methods A total of 371 patients who underwent SPA laparoscopy and who received IV PCA or CWI was retrospectively reviewed (combined group [CWI + IV PCA, n = 159] vs. PCA group [IV PCA only, n = 212]). To evaluate postoperative pain management, the numeric rating scale (NRS) pain score after surgery, total amount of fentanyl administered via IV PCA, and additional pain killer consumption were collected. Results The NRS scores at 12 h (1.90 ± 1.11 vs. 2.70 ± 1.08, p < 0.001) and 24 h (1.82 ± 0.82 vs. 2.11 ± 1.44, p = 0.026) after surgery were significantly lower in the combined group than in the PCA group. The total amount of PCA fentanyl was significantly smaller in the combined group than in the PCA group (p < 0.001). The total quantity of rescue analgesics was smaller in the combined group than in the PCA group (p < 0.05). Conclusion Combined use of the CWI system and IV PCA is an effective postoperative pain management strategy in patient who underwent SPA laparoscopy for adnexal disease.
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Affiliation(s)
- Jun-Hyeok Kang
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Kyung A Lee
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yae Rin Heo
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woo Young Kim
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - E Sun Paik
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Pontone S, Lauriola M, Palma R, Panetta C, Tomai M, Baker R. Do difficulties in emotional processing predict procedure pain and shape the patient's colonoscopy experience? BMJ Open 2022; 12:e050544. [PMID: 35190415 PMCID: PMC8860019 DOI: 10.1136/bmjopen-2021-050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Pain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain have been found to depend on patients' maladaptive cognitions and exaggerated emotional responses. The present study investigated whether emotional processing difficulties predicted colonoscopy pain and the associated catastrophising thoughts. DESIGN Prospective, observational, blinded. METHOD A sample of 123 patients was assessed for specific emotional processing difficulties (ie, suppression of emotions, unprocessed emotions, failure to control emotions, avoidance of emotional triggers and impoverished emotional experience) and anxiety-related variables (ie, worry, anxiety and depression) before colonoscopy. A trained medical doctor rated patients' behavioural manifestations of pain during colonoscopy. After complete recovery from sedation, the patients rated the endoscopy experience using perceived pain and situation-specific pain catastrophising scales. RESULTS About half of the patients were above the cut-off for anxiety before the procedure. Notwithstanding sedation, behavioural manifestations of pain during colonoscopy indicated probable or moderate pain for about one-third of the patients. Failure to control emotions, poor emotional experience and avoiding emotional triggers were positively correlated with behavioural manifestations of pain, self-reported pain and pain catastrophising. Regression analyses, controlling for gender, age, colonoscopy experience and sedation, revealed that avoidance of emotional triggers uniquely contributed to predicting pain outcomes. CONCLUSIONS Early identification of emotional processing difficulties associated with pain catastrophising can help define personalised psychological preparation paths to manage negative emotions in patients who fear colonoscopy pain.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Roma, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Manuela Tomai
- Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, Italy
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
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Exploratory study of VVZ-149, a novel analgesic molecule, in the affective component of acute postoperative pain after laparoscopic colorectal surgery. J Clin Anesth 2021; 76:110576. [PMID: 34794108 DOI: 10.1016/j.jclinane.2021.110576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/20/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE VVZ-149 is a small molecule that inhibits the glycine transporter type 2 and the serotonin receptor 5-hydroxytryptamine 2A. In the present study, we investigated the efficacy and safety of VVZ-149 as a single-use injectable analgesic for treating moderate to severe postoperative pain after colorectal surgery. DESIGN Randomized, parallel group, double-blind Phase 2 clinical trial (NCT02489526). SETTING 3 academic institutions in the United States. PATIENTS 60 patients undergoing laparoscopic colorectal surgery. INTERVENTIONS A continuous 8-h intravenous infusion of VVZ-149 Injections (n = 40) or placebo (n = 20) administered after emergence from anesthesia. MEASUREMENTS The outcome measures included pain intensity (PI), opioid consumption via patient-controlled analgesia (PCA), and rescue dosing provided "as needed". Early rescue dosing with opioids postoperatively was associated with preoperative negative affect (anxiety, depression, and pain catastrophizing), enabling it to be used as an indirect measure of the affective component of pain. Efficacy outcomes were compared between treatment groups based on preoperative negative affect and early rescue dosing of opioids. MAIN RESULTS Postoperative PI was non-significantly lower in patients receiving VVZ-149 compared to those receiving placebo. The VVZ-149 group had a 34.2% reduction in opioid consumption for 24 h post-dose, along with fewer PCA demands. Somnolence and headache was higher in the intervention group. For patients characterized by high levels of preoperative negative affect, the VVZ-149 group experienced a significant pain reduction and 40% less opioid use compared to the placebo group. CONCLUSIONS VVZ-149 resulted in a non-significant reduction of postoperative pain during the first 8 h after surgery. Post hoc analysis indicates that VVZ-149 may benefit patients with negative affect who otherwise have higher postoperative opioid use. REGISTRATION NUMBER: www.clinicaltrials.gov, ID: NCT02489526.
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Ende HB, Landau R, Cole NM, Burns SM, Bateman BT, Bauer ME, Booth JL, Flood P, Leffert LR, Houle TT, Tsen LC. Labor prior to cesarean delivery associated with higher post-discharge opioid consumption. PLoS One 2021; 16:e0253990. [PMID: 34242277 PMCID: PMC8270408 DOI: 10.1371/journal.pone.0253990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background Severe acute post-cesarean delivery (CD) pain has been associated with an increased risk for persistent pain and postpartum depression. Identification of women at increased risk for pain can be used to optimize post-cesarean analgesia. The impact of labor prior to CD (intrapartum CD) on acute post-operative pain and opioid use is unclear. We hypothesized that intrapartum CD, which has been associated with both increased inflammation and affective distress related to an unexpected surgical procedure, would result in higher postoperative pain scores and increased opioid intake. Methods This is a secondary analysis of a prospective cohort study examining opioid use up to 2 weeks following CD. Women undergoing CD at six academic medical centers in the United States 9/2014-3/2016 were contacted by phone two weeks following discharge. Participants completed a structured interview that included questions about postoperative pain scores and opioid utilization. They were asked to retrospectively estimate their maximal pain score on an 11-point numeric rating scale at multiple time points, including day of surgery, during hospitalization, immediately after discharge, 1st week, and 2nd week following discharge. Pain scores over time were assessed utilizing a generalized linear mixed-effects model with the patient identifier being a random effect, adjusting for an a priori defined set of confounders. A multivariate negative binomial model was utilized to assess the association between intrapartum CD and opioid utilization after discharge, also adjusting for the same confounders. In the context of non-random prescription distribution, this model was constructed with an offset for the number of tablets dispensed. Results A total of 720 women were enrolled, 392 with and 328 without labor prior to CD. Patients with intrapartum CD were younger, less likely to undergo repeat CD or additional surgical procedures, and more likely to experience a complication of CD. Women with intrapartum CD consumed more opioid tablets following discharge than women without labor (median 20, IQR 10–30 versus 17, IQR 6–30; p = 0.005). This association persisted after adjustment for confounders (incidence rate ratio 1.16, 95% CI 1.05–1.29; p = 0.004). Pain scores on the day of surgery were higher in women with intrapartum CD (difference 0.91, 95% CI 0.52–1.30; adj. p = <0.001) even after adjustment for confounders. Pain scores at other time points were not meaningfully different between the two groups. Conclusion Intrapartum CD is associated with worse pain on the day of surgery but not other time points. Opioid requirements following discharge were modestly increased following intrapartum CD.
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Affiliation(s)
- Holly B. Ende
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Naida M. Cole
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sara M. Burns
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Brian T. Bateman
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa E. Bauer
- Department of Anesthesiology, Division of Obstetric Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Jessica L. Booth
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Pamela Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, United States of America
| | - Lisa R. Leffert
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Timothy T. Houle
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Lawrence C. Tsen
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Chang WS, Hsieh YT, Chen MC, Chang SC, Chen TS, Chang YC, Tsai YC, Lam CF. Characterization of self-anticipated pain score prior to elective surgery - a prospective observational study. BMC Anesthesiol 2021; 21:85. [PMID: 33740887 PMCID: PMC7977573 DOI: 10.1186/s12871-021-01303-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipated pain score before surgery, and compared the anticipated scores with the actual pain levels and analgesic requirements after surgery. Methods This prospective observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were asked to subjectively rate their highest anticipated pain level (numeric rating scale, NRS 0–10) for the scheduled surgical interventions during their preoperative anesthesia assessment. After the operation, the actual pain intensity (NRS 0–10) experienced by the patient in the post-anesthesia care unit and the total dose of opioids administered during the perioperative period were recorded. Pain scores ≥4 on NRS were regarded as being unacceptable levels for anticipated or postoperative pain that required more aggressive intervention. Results A total of 996 patients were included in the study. Most of the patients (86%) received general anesthesia and 73.9% of them had a history of previous operation. Female anticipated significantly higher overall pain intensities than the male patients (adjusted odd ratio 1.523, 95% confidence interval 1.126–2.061; P = 0.006). Patients who took regular benzodiazepine at bedtime (P = 0.037) and those scheduled to receive more invasive surgical procedures were most likely to anticipate for higher pain intensity at the preoperative period (P < 0.05). Higher anticipated pain scores (preoperative NRS ≥ 4) were associated with higher actual postoperative pain levels (P = 0.007) in the PACU and higher total equivalent opioid use (P < 0.001) for acute pain management during the perioperative period. Conclusion This observational study found that patients who are female, use regular benzodiazepines at bedtime and scheduled for more invasive surgeries anticipate significantly higher surgery-related pain. Therefore, appropriate preoperative counseling for analgesic control and the management of exaggerated pain expectation in these patients is necessary to improve the quality of anesthesia delivered and patient’s satisfaction. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-021-01303-y.
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Affiliation(s)
- Wei-Shu Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yi-Ting Hsieh
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Moa-Chu Chen
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Shu-Ching Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Tzu-Shan Chen
- Department of Medical Research, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yun-Chi Chang
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Yu-Chuan Tsai
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chen-Fuh Lam
- Department of Anesthesiology, E-Da Hospital and E-Da Cancer Hospital, Kaohsiung, Taiwan. .,School of Medicine, I-Shou University College of Medicine, Kaohsiung, Taiwan.
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Song I, Cho S, Nedeljkovic SS, Lee SR, Lee C, Kim J, Bai SJ. Role of VVZ-149, a Novel Analgesic Molecule, in the Affective Component of Pain: Results from an Exploratory Proof-of-Concept Study of Postoperative Pain following Laparoscopic and Robotic-Laparoscopic Gastrectomy. PAIN MEDICINE 2021; 22:2037-2049. [PMID: 33624798 DOI: 10.1093/pm/pnab066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE VVZ-149 is a small molecule that both inhibits the glycine transporter type 2 and the serotonin receptor 5 hydroxytryptamine 2 A. In a randomized, parallel-group, and double-blind trial (NCT02844725), we investigated the analgesic efficacy and safety of VVZ-149 Injections, which is under clinical development as a single-use injectable product for treating moderate to severe postoperative pain. METHODS Sixty patients undergoing laparoscopic and robotic-laparoscopic gastrectomy were randomly assigned to receive a 10-hour intravenous infusion of VVZ-149 Injections or placebo, initiated approximately 1 hour before completion of surgical suturing. Major outcomes included pain intensity and opioid consumption via patient-controlled analgesia and rescue analgesia provided "as needed." The treatment efficacy of VVZ-149 was further examined in a subpopulation requiring early rescue medication, previously associated with the presence of high levels of preoperative negative affect in a prior Phase 2 study (NCT02489526). RESULTS Pain intensity was lower in the VVZ-149 (n = 30) than the placebo group (n = 29), reaching statistical significance at 4 hours post-emergence (P < .05), with a 29.5% reduction in opioid consumption for 24 hours and fewer demands for patient-controlled analgesia. In the rescued subgroup, VVZ-149 further reduced pain intensity (P < .05) with 32.6% less opioid consumption for 24 hours compared to placebo patients. CONCLUSIONS VVZ-149 demonstrated effective analgesia with reduced postoperative pain and opioid requirements. Consistent with the results from the previous Phase 2 study, patients with early rescue requirement had greater benefit from VVZ-149, supporting the hypothesis that VVZ-149 may alleviate the affective component of pain and mitigate excessive use of opioids postoperatively.
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Affiliation(s)
- Inkyung Song
- Department of Global Research and Development, Vivozon, Inc, West Windsor, New Jersey
| | - Sunyoung Cho
- Department of Global Research and Development, Vivozon, Inc, West Windsor, New Jersey
| | - Srdjan S Nedeljkovic
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sang Rim Lee
- Department of Global Research and Development, Vivozon, Inc, West Windsor, New Jersey
| | - Chaewon Lee
- Department of Clinical Development, Vivozon, Inc, Seoul, Republic of Korea
| | - Jina Kim
- Department of Clinical Development, Vivozon, Inc, Seoul, Republic of Korea
| | - Sun Joon Bai
- Department of Global Research and Development, Vivozon, Inc, West Windsor, New Jersey.,Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Gynecologic Surgical Outcomes Through the Patient's Eyes: Are Physicians Looking in the Same Direction? Obstet Gynecol Surv 2019; 74:351-361. [PMID: 31216044 DOI: 10.1097/ogx.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Patient-centered care integrates the highest clinical standards with patient preferences surrounding their treatment. Increasing focus is being placed on the identification of patient-centered outcomes to optimize the impact of medical treatments on patient quality of life, as defined by patients themselves. Objective This article will review the central concepts of patient-centered outcomes in benign gynecologic surgery. This expert review will serve as a practical guide for surgeons to incorporate patient preferences into shared surgical decision making. Evidence Acquisition The current literature is examined, defining those outcomes identified by women undergoing gynecologic procedures as the most important factors in their decision making. Available literature on these patient-identified priorities is then reviewed with respect to gynecologic surgery in the preoperative, intraoperative, and postoperative periods. Results Each section of the article concludes with Clinical Pearls, where practical tools and key elements are summarized to assist providers with incorporating these concepts into practice. Conclusions and Relevance Many key outcomes have been identified by women undergoing benign gynecologic surgery in their decision-making process. Patient counseling should address clinically appropriate treatment modalities and include an exploration of patient expectations and preferences around nonclinical outcomes as well. This shared decision-making model will result in improved satisfaction with outcomes.
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Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain. Pain 2019; 159:956-967. [PMID: 29419656 DOI: 10.1097/j.pain.0000000000001170] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic postsurgical pain (CPSP) is a well-recognized potential complication with negative personal, social, and health care consequences. However, limited data exist on CPSP and on the course of pain over time after hysterectomy. Using data from a prospective cohort study on a consecutive sample assessed at 4 time points, presurgery (T1), 48 hours (T2), 4 months (T3), and 5 years postsurgery (T4), we sought to examine women's PSP trajectories using assessments of pain at T3 and T4. In addition, this study aimed to investigate presurgical and postsurgical risk factors associated with an unfavourable pain trajectory (PT). Based on pain data collected at T3 and T4, 3 distinct trajectories of PSP emerged: no CPSP (PT1; n = 88), prolonged PSP (PT2; n = 53), and CPSP (PT3; n = 29). Moreover, reported CPSP prevalence at 5 years was 17.1%. Multinomial logistic regression models controlling for age, presurgical pain, and type of hysterectomy tested for baseline and acute postsurgical predictive variables. Membership in PT2 and PT3 was predicted by presurgical anxiety (odds ratio [OR] = 1.131, P = 0.015; OR = 1.175, P = 0.009, respectively), emotional representation of the surgical disease (OR = 1.155, P = 0.034; OR = 1.213, P = 0.020, respectively), and pain catastrophizing (OR = 1.079, P = 0.043; OR = 1.143, P = 0.001, respectively). Furthermore, acute PSP intensity and frequency determined membership of women in PT3 (OR = 1.211, P = 0.033; OR = 3.000, P = 0.029, respectively), and postsurgical anxiety (OR = 1.182, P = 0.026) also played a key predictive role. This study identified factors that can be easily screened before and after surgery and are amenable to change through carefully designed timely and tailored interventions for women at risk of an unfavorable PSP trajectory posthysterectomy.
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10
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Paredes AC, Costa P, Almeida A, Pinto PR. A new measure to assess pain in people with haemophilia: The Multidimensional Haemophilia Pain Questionnaire (MHPQ). PLoS One 2018; 13:e0207939. [PMID: 30485381 PMCID: PMC6261605 DOI: 10.1371/journal.pone.0207939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
People with haemophilia (PWH) experience acute pain during joint bleeds and might develop chronic pain due to joint degeneration. However, there is a lack of standardized measures to comprehensively assess pain in PWH. This study aimed to develop a multidimensional questionnaire for haemophilia-related pain, the Multidimensional Haemophilia Pain Questionnaire (MHPQ), and to present initial validation data among adults.The questionnaire distinguishes between acute/chronic pain and queries about pain locations, duration, frequency, triggering factors, intensity, interference, strategies, specialists for pain management and satisfaction with treatment. An initial version was tested with 16 patients to ensure item comprehensibility and face validity. The final version was answered by 104 adults, with 82 (78.8%) reporting haemophilia-related pain in the previous year (mean age = 43.17; SD = 13.00). The non-response analysis revealed good item acceptability. Exploratory and confirmatory factor analysis (EFA/CFA), reliability (internal consistency, test-retest, inter-item and item-total correlations) and convergent validity were analysed for the intensity and interference dimensions of the questionnaire. A combined EFA with these two constructs supported a 2-factor structure distinguishing intensity (α = 0.88) from interference items (α = 0.91). CFA was tested for the interference dimension, demonstrating suitability for this sample. Item-total correlations were >0.30 on both dimensions and most inter-item correlations were <0.70. Test-retest reliability (n = 42) was good for intensity (r = 0.88) and interference (r = 0.73), and convergent validity was confirmed for most hypotheses (r>0.30).This questionnaire is a comprehensible tool, achieving a thorough assessment of relevant pain dimensions. The MHPQ can help guide treatment recommendations by highlighting relevant topics and contributing to more effective, integrated treatments.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS / 3B’s–PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS / 3B’s–PT Government Associate Laboratory, Braga / Guimarães, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS / 3B’s–PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS / 3B’s–PT Government Associate Laboratory, Braga / Guimarães, Portugal
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11
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Mimic A, Bantel C, Jovicic J, Mimic B, Kisic-Tepavcevic D, Durutovic O, Ladjevic N. Psychological factors as predictors of early postoperative pain after open nephrectomy. J Pain Res 2018; 11:955-966. [PMID: 29785136 PMCID: PMC5953320 DOI: 10.2147/jpr.s152282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose There is an increasing interest in the identification of predictors for individual responses to analgesics and surgical pain. In this study, we aimed to determine psychological factors that might contribute to this response. We hence investigated patients undergoing a standardized surgical intervention (open nephrectomy). Patients and methods Between May 2014 and April 2015, we conducted a prospective observational cohort study. The following psychological tests were administered preoperatively: Mini-Mental State Examination, Amsterdam Preoperative Anxiety and Information Scale (APAIS), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Pain Catastrophizing Scale. The primary outcome, postoperative pain intensity (11-point numerical rating scale, [NRS]), was assessed in the “immediate early” (first 8 hours), “early” (12 and 24 hours), and “late early” periods (48 and 72 hours). Results A total of 196 patients were assessed, and 150 were finally included in the study. NRS scores improved from 4.9 (95% confidence interval [CI]: 4.7–5.1) in the “immediate early” to 3.1 (95% CI: 2.9–3.3) in the “early” and 2.3 (95% CI: 2.1–2.5) in the “late early” postoperative period. Most (87%) patients received intravenous opioids, while 13% received analgesics epidurally. Repeated measures analysis of variance indicated better pain management with epidural analgesia in the first two postoperative periods (F=15.01, p<0.00). Postoperative pain correlated strongly with analgesic strategy and preoperative psychological assessment. Multiple linear regression analysis showed “expected pain” was the only predictor in the “immediate early” phase, and “anxiety” was most important in the “early” postoperative period. In the “late early” phase, catastrophizing was the predominant predictor, alongside “preoperative analgesic usage” and “APAIS anxiety”. Conclusion After open nephrectomy, epidural analgesia conveys a clear advantage for pain management only within the first 24 hours. Moreover, as the psychological phenotype of patients changes distinctively in the first 72 postoperative hours, psychological variables increasingly determine pain intensity, even surpassing employed analgesic strategy as its main predictor.
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Affiliation(s)
- Ana Mimic
- Department of Anaesthesia, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Carsten Bantel
- Department of Anaesthetics, Klinikum Oldenburg AöR, Oldenburg, Germany.,Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Jelena Jovicic
- Department of Anaesthesia, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Branko Mimic
- East Midlands Congenital Heart Centre, University Hospital Leicester, Leicester, UK
| | | | - Otas Durutovic
- Department of Urology, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,Department of Surgery and Anaesthesiology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nebojsa Ladjevic
- Department of Anaesthesia, Urology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,Department of Surgery and Anaesthesiology, School of Medicine, University of Belgrade, Belgrade, Serbia
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12
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Sourzac J, Berger V, Conri V. L’impact de l’hypnose conversationnelle sur l’anxiété pré et post opératoire des patientes en chirurgie gynécologique versus pratique courante : étude comparative. Rech Soins Infirm 2018:83-90. [DOI: 10.3917/rsi.135.0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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13
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Scott JE, Mathias JL, Kneebone AC. Depression and anxiety after total joint replacement among older adults: a meta-analysis. Aging Ment Health 2016; 20:1243-1254. [PMID: 26252414 DOI: 10.1080/13607863.2015.1072801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Patients usually experience good physical recovery after total joint replacement (TJR); however, it is unclear whether mood also improves. The current meta-analysis examined changes in depression and anxiety following TJR in older (≥50 years) patients in order to address this gap in the literature. METHODS Data from 26 studies (4045 TJR, 55 controls) that assessed depression and/or anxiety pre- and post-surgery in TJR patients, with or without a control group, were analyzed. Prevalence rates and Cohen's d effect sizes were used to evaluate changes in the prevalence and severity of depression/anxiety, respectively. RESULTS Approximately 23% of TJR patients had clinically significant levels of depression prior to surgery, which decreased to 13% one year later. The prevalence of anxiety could not be evaluated due to the limited available data. TJR patients did not show any clinically meaningful reductions in symptoms of depression or anxiety, following surgery. Compared to controls, there was no difference in symptom progression over time; although only one study examined this. CONCLUSIONS TJR patients appear to have higher rates of clinically significant symptoms of depression before and after surgery, compared to the general population, however more research with adequate control groups is needed to confirm this. Only a modest improvement in the severity of depression and anxiety symptoms was noted post-surgery. However, existing research is limited; preventing definite conclusions regarding the impact of TJR on mood.
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Affiliation(s)
- J E Scott
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - A C Kneebone
- a School of Psychology , University of Adelaide , Adelaide , Australia.,b Department of Clinical Psychology , Flinders Medical Centre , Bedford Park , Australia
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14
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Situational but Not Dispositional Pain Catastrophizing Correlates With Early Postoperative Pain in Pain-Free Patients Before Surgery. THE JOURNAL OF PAIN 2016; 17:549-60. [DOI: 10.1016/j.jpain.2015.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/05/2015] [Accepted: 12/28/2015] [Indexed: 12/12/2022]
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15
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Predictors of postoperative pain and analgesic requirements following abdominal hysterectomy: an observational study. J Anesth 2015; 30:72-9. [DOI: 10.1007/s00540-015-2090-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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16
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De Oliveira GS, Holl JL, McCarthy RJ, Butt ZA, Nouriel J, McCaffery K, Wolf MS. Overestimation of mortality risk and preoperative anxiety in patients undergoing elective general surgery procedures: a propensity matched analysis. Int J Surg 2014; 12:1473-7. [PMID: 25463769 DOI: 10.1016/j.ijsu.2014.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/03/2014] [Accepted: 11/12/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deficiencies in risk communication have been identified in perioperative medicine. Objective measurement of risk overestimation by general surgery patients has not been performed. In addition, it is unknown if surgical risk overestimation is associated with the development of preoperative anxiety. The main objective of the current investigation was to examine the association between overestimation of surgical mortality risk and the development of preoperative anxiety. METHODS Patients estimation of surgical morality risk was compared to the actual mortality risk obtained by the American College of Surgeons national database. Preoperative anxiety was evaluated using a validated instrument. Propensity matched analysis was performed to examine an independent association between mortality risk overestimation and preoperative anxiety. RESULTS 138 patients completed the study. 40 out of 138 (29%) patients overestimated their surgical mortality risk by at least 5%. 31 out of 138 (22%) patients estimated their surgical mortality risk by at least 10%. Patients who overestimated mortality risk (≥5%) were more likely to have postponed the surgery voluntarily, 9 out of 40 (23%) compared to patients who did not overestimate risk, 1 out of 98 (1%), P < 0.001. After propensity matching to control for covariate imbalances, overestimation of mortality risk was associated with the development of preoperative anxiety, OR (95%CI) of 9.5 (2.7-32.9). CONCLUSIONS Overestimation of perioperative mortality risk is common in patients undergoing general surgery and it is associated with preoperative anxiety and voluntarily delays of surgical treatment. Improved communication strategies are needed to minimize misleading risk perception in surgical patients.
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Affiliation(s)
- Gildasio S De Oliveira
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States.
| | - Jane L Holl
- Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, United States
| | - Robert J McCarthy
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States
| | - Zeeshan A Butt
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States
| | - Jacob Nouriel
- Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States
| | | | - Michael S Wolf
- Department of Medicine, Feinberg School of Medicine, Northwestern University, United States
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Theunissen M, Peters ML, Schouten EGW, Fiddelers AAA, Willemsen MGA, Pinto PR, Gramke HF, Marcus MAE. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One 2014; 9:e100225. [PMID: 24960025 PMCID: PMC4069058 DOI: 10.1371/journal.pone.0100225] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/23/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Because existing instruments for assessing surgical fear seem either too general or too limited, the Surgical Fear Questionnaire (SFQ) was developed. The aim of this study is to assess the validity and reliability of the SFQ. METHODS Based on existing literature and expert consultation the ten-item SFQ was composed. Data on the SFQ were obtained from 5 prospective studies (N = 3233) in inpatient or day surgery patients. These data were used for exploratory factor analysis (EFA), confirmatory factor analysis (CFA), reliability analysis and validity analysis. RESULTS EFA in Study 1 and 2 revealed a two-factor structure with one factor associated with fear of the short-term consequences of surgery (SFQ-s, item 1-4) and the other factor with fear of the long-term consequences of surgery (SFQ-l, item 5-10). However, in both studies two items of the SFQ-l had low factor loadings. Therefore in Study 3 and 4 the 2-factor structure was tested and confirmed by CFA in an eight-item version of the SFQ. Across all studies significant correlations of the SFQ with pain catastrophizing, state anxiety, and preoperative pain intensity indicated good convergent validity. Internal consistency (Cronbach's alpha) was between 0.765-0.920 (SFQ-total), 0.766-0.877 (SFQ-s), and 0.628-0.899 (SFQ-l). The SFQ proved to be sensitive to detect differences based on age, sex, education level, employment status and preoperative pain intensity. DISCUSSION The SFQ is a valid and reliable eight-item index of surgical fear consisting of two subscales: fear of the short-term consequences of surgery and fear of the long-term consequences.
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Affiliation(s)
- Maurice Theunissen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Madelon L. Peters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Erik G. W. Schouten
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Audrey A. A. Fiddelers
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mark G. A. Willemsen
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patrícia R. Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's – PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Hans-Fritz Gramke
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco A. E. Marcus
- Department of Anesthesiology and Pain Management, Maastricht University Medical Center+, Maastricht, the Netherlands
- Department of Anesthesia/ICU, Pain and Palliative Care, Hamad Medical Corporation, Doha, Qatar
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18
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Day MA, Rich MA, Thorn BE, Berbaum ML, Mangieri EA. A placebo-controlled trial of midazolam as an adjunct to morphine patient-controlled analgesia after spinal surgery. J Clin Anesth 2014; 26:300-8. [DOI: 10.1016/j.jclinane.2013.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 12/04/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
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Graham D, Becerril-Martinez G. Surgical resilience: a review of resilience biomarkers and surgical recovery. Surgeon 2014; 12:334-44. [PMID: 24742757 DOI: 10.1016/j.surge.2014.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Two distinct and large bodies of literature exist on resilience that are of potential interest for surgical outcomes. First is the literature on the impact of resilience on surgical recovery and wound-healing. Second is the literature on biomarkers for resilience, which largely focuses on neuropeptide Y (NPY), testosterone and dehydroepiandrosterone (DHEA). Despite this activity, there is a dearth of literature linking these two bodies of research by investigating biomarkers for surgical resilience and its impact on surgical recovery. This paper reviews both bodies of literature within the context of surgical recovery. METHOD Literature searches within Medline and Embase were conducted for studies and previous reviews of resilience biomarkers and for the impact of individual resilience on surgical recovery. Reference lists of the reviews were searched for additional papers. No systematic review is yet possible due to the novelty of the use of resilience biomarkers within a surgical context. RESULTS This is the first review to explore a potential link between resilience biomarkers and surgical recovery. There are a number of biomarkers that correlate with individual resilience levels and resilient individuals exhibit better recovery trajectories following surgery, suggesting a novel use of such biomarkers for the identification of "surgical resilience". CONCLUSION By identifying surgical resilience, there is potential for utilising these biomarkers as prognostic indicators of likely recovery trajectories from surgery, which in turn complement individualised peri-operative management.
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Affiliation(s)
- David Graham
- Department of Surgery, Concord Repatriation General Hospital, Australia; Faculty of Medicine, University of Sydney, Australia
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20
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Grosen K, Vase L, Pilegaard HK, Pfeiffer-Jensen M, Drewes AM. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study. PLoS One 2014; 9:e90185. [PMID: 24587268 PMCID: PMC3935997 DOI: 10.1371/journal.pone.0090185] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. RESULTS Patients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001). CONCLUSIONS Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have important implications for developing strategies to treat or prevent acute postoperative pain in selected patients. Pain may be predicted and the malfunctioning pain inhibition mechanism as tested with CPM may be treated with suitable drugs augmenting descending inhibition.
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Affiliation(s)
- Kasper Grosen
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Lene Vase
- The Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- The Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Hans K. Pilegaard
- The Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Asbjørn M. Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res 2013; 6:691-703. [PMID: 24072977 PMCID: PMC3783511 DOI: 10.2147/jpr.s45827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4-6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post-surgical pain. Future prospective studies should therefore collect TKA and THA samples wherein patients are homogeneous for demographic and presurgical clinical issues. Overall, these findings contribute to a small but growing body of literature documenting persistent post-surgical pain after major arthroplasty, conducted in different countries and across different health care settings.
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Affiliation(s)
- Patrícia R Pinto
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal ; Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal ; Health Psychology Group, Newcastle University, Newcastle, UK
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Sikandar S, Dickenson A. II. No need for translation when the same language is spoken. Br J Anaesth 2013; 111:3-6. [DOI: 10.1093/bja/aet210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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