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He J, Wilson JM, Fields KG, Mikayla Flowers Zachos K, Franqueiro AR, Reale SC, Farber MK, Bateman BT, Edwards RR, Rathmell JP, Soens M, Schreiber KL. Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires. Anesthesiology 2024; 140:701-714. [PMID: 38207329 PMCID: PMC10939890 DOI: 10.1097/aln.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models. METHODS In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery. RESULTS A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain. CONCLUSIONS The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Jingui He
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Jenna M. Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kara G. Fields
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - K. Mikayla Flowers Zachos
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Angelina R. Franqueiro
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Sharon C. Reale
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Michaela K. Farber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - James P. Rathmell
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Mieke Soens
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
| | - Kristin L. Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School
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Saxer F, Hollinger A, Bjurström M, Conaghan P, Neogi T, Schieker M, Berenbaum F. Pain-phenotyping in osteoarthritis: Current concepts, evidence, and considerations towards a comprehensive framework for assessment and treatment. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100433. [PMID: 38225987 PMCID: PMC10788802 DOI: 10.1016/j.ocarto.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024] Open
Abstract
Objectives Pain as central symptom of osteoarthritis (OA) needs to be addressed as part of successful treatment. The assessment of pain as feature of disease or outcome in clinical practice and drug development remains a challenge due to its multidimensionality and the plethora of confounders. This article aims at providing insights into our understanding of OA pain-phenotypes and suggests a framework for systematic and comprehensive assessments. Methods This narrative review is based on a search of current literature for various combinations of the search terms "pain-phenotype" and "knee OA" and summarizes current knowledge on OA pain-phenotypes, putting OA pain and its assessment into perspective of current research efforts. Results Pain is a complex phenomenon, not necessarily associated with tissue damage. Various pain-phenotypes have been described in knee OA. Among those, a phenotype with high pain levels not necessarily matching structural changes and a phenotype with low pain levels and impact are relatively consistent. Further subgroups can be differentiated based on patient reported outcome measures, assessments of comorbidities, anxiety and depression, sleep, activity and objective measures such as quantitative sensory testing. Conclusions The complexity of both OA as disease and pain in OA prompt the definition of a set of variables that facilitate assessments comparable across studies to maximize our understanding of pain, as central concern for the patient.
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Affiliation(s)
- F. Saxer
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, University of Basel, 4002, Basel, Switzerland
| | - A. Hollinger
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - M.F. Bjurström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - P.G. Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, UK
| | - T. Neogi
- Clinical Epidemiology Research and Training Unit and Rheumatology, Boston University School of Medicine Epidemiology, Boston University School of Public Health, United States
| | - M. Schieker
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, Ludwig-Maximilians-University, Munich, 80336, Germany
| | - F. Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hopital Saint Antoine, Paris, France
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Lirk P, Schreiber KL. Lessons learnt in evidence-based perioperative pain medicine: changing the focus from the medication and procedure to the patient. Reg Anesth Pain Med 2024:rapm-2023-105235. [PMID: 38355216 DOI: 10.1136/rapm-2023-105235] [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: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024]
Abstract
Over time, the focus of evidence-based acute pain medicine has shifted, from a focus on drugs and interventions (characterized by numbers needed to treat), to an appreciation of procedure-specific factors (characterized by guidelines and meta-analyses), and now anesthesiologists face the challenge to integrate our current approach with the concept of precision medicine. Psychometric and biopsychosocial markers can potentially guide clinicians on who may need more aggressive perioperative pain management, or who would respond particularly well to a given analgesic intervention. The challenge will be to identify an easily assessable set of parameters that will guide perioperative physicians in tailoring the analgesic strategy to procedure and patient.
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Affiliation(s)
- Philipp Lirk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Cazzaniga S, Real G, Finazzi S, Lorini LF, Forget P, Bugada D. How to Modulate Peripheral and Central Nervous System to Treat Acute Postoperative Pain and Prevent Pain Persistence. Curr Neuropharmacol 2024; 22:23-37. [PMID: 37563811 DOI: 10.2174/1570159x21666230810103508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 08/12/2023] Open
Abstract
Chronic postoperative pain (CPSP) is a major issue after surgery, which may impact on patient's quality of life. Traditionally, CPSP is believed to rely on maladaptive hyperalgesia and risk factors have been identified that predispose to CPSP, including acute postoperative pain. Despite new models of prediction are emerging, acute pain is still a modifiable factor that can be challenged with perioperative analgesic strategies. In this review we present the issue of CPSP, focusing on molecular mechanism underlying the development of acute and chronic hyperalgesia. Also, we focus on how perioperative strategies can impact directly or indirectly (by reducing postoperative pain intensity) on the development of CPSP.
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Affiliation(s)
- Sara Cazzaniga
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Giovanni Real
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Simone Finazzi
- Department of Health Sciences, University of Milan, 20122, Milan, Italy
| | - Luca F Lorini
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
| | - Patrice Forget
- School of Medicine, Medical Sciences and Nutrition, Epidemiology Group, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom
- Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, Scotland, United Kingdom
| | - Dario Bugada
- Emergency and Intensive Care Department, ASST Papa Giovanni XXIII, 24127, Bergamo, Italy
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Higa S, Oba M, Saito S, Itoh K. Effect of Catastrophic Thinking on the Analgesic Effect of Electroacupuncture. Med Acupunct 2023; 35:311-318. [PMID: 38162552 PMCID: PMC10753907 DOI: 10.1089/acu.2023.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Introduction Patients with chronic pain and high-level catastrophic thoughts often do not respond to acupuncture. This may be related to hypofunctioning of the dorsolateral prefrontal cortex and the descending pain inhibitory system. Therefore, we examined the relationship between the level of catastrophic thinking and the analgesic effect of electroacupuncture using the pain catastrophizing scale (PCS). We also evaluated the descending pain inhibitory system using conditioned pain modulation (CPM) and offset analgesia (OA). The relationship between catastrophic thinking and the descending pain inhibitory system was also examined. Materials and Methods After testing the hospital anxiety and depression scale and the PCS in 14 healthy adults, the current pain threshold (CPT), CPM, and OA were measured, in order, before the intervention. Thereafter, electroacupuncture was applied to 3 limbs (the dominant hand and both lower extremities) at 4 Hz, and to the scalp at 100 Hz, for 30 minutes, and the CPT was measured again immediately after the intervention. The difference in the CPT before and after the intervention was taken as the analgesic effect. Results The participants were divided into 2 groups, the H-PCS group (≥16 points) and the L-PCS group (≤15 points), according to the PCS score, and the analgesic effects of electroacupuncture were significantly different (P = 0.04). However, no relationship was found between the PCS score and the CPM (r = -0.02, P = 0.94) and OA effects (r = -0.19, P = 0.49). Conclusion It was suggested that people with high-level catastrophic thinking may find it difficult to obtain the analgesic effects of electroacupuncture.
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Affiliation(s)
- Shohei Higa
- Graduate School, Meiji University of Integrative Medicine, Nantan, Japan
| | - Miho Oba
- Graduate School, Meiji University of Integrative Medicine, Nantan, Japan
| | - Shingo Saito
- Department of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Japan
| | - Kazunori Itoh
- Department of Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Japan
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Rosenberger DC, Segelcke D, Pogatzki-Zahn EM. Mechanisms inherent in acute-to-chronic pain after surgery - risk, diagnostic, predictive, and prognostic factors. Curr Opin Support Palliat Care 2023; 17:324-337. [PMID: 37696259 DOI: 10.1097/spc.0000000000000673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Pain is an expected consequence of a surgery, but it is far from being well controlled. One major complication of acute pain is its risk of persistency beyond healing. This so-called chronic post-surgical pain (CPSP) is defined as new or increased pain due to surgery that lasts for at least 3 months after surgery. CPSP is frequent, underlies a complex bio-psycho-social process and constitutes an important socioeconomic challenge with significant impact on patients' quality of life. Its importance has been recognized by its inclusion in the eleventh version of the ICD (International Classification of Diseases). RECENT FINDINGS Evidence for most pharmacological and non-pharmacological interventions preventing CPSP is inconsistent. Identification of associated patient-related factors, such as psychosocial aspects, comorbidities, surgical factors, pain trajectories, or biomarkers may allow stratification and selection of treatment options based on underlying individual mechanisms. Consequently, the identification of patients at risk and implementation of individually tailored, preventive, multimodal treatment to reduce the risk of transition from acute to chronic pain is facilitated. SUMMARY This review will give an update on current knowledge on mechanism-based risk, prognostic and predictive factors for CPSP in adults, and preventive and therapeutic approaches, and how to use them for patient stratification in the future.
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Affiliation(s)
- Daniela C Rosenberger
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
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Kim A(J, Szabo E, Lunde CE, Comptdaer G, Zurakowski D, Sieberg CB, Holmes SA. Quantitative sensory testing in a magnetic resonance environment: considerations for thermal sensitivity and patient safety. FRONTIERS IN PAIN RESEARCH 2023; 4:1223239. [PMID: 37766817 PMCID: PMC10520956 DOI: 10.3389/fpain.2023.1223239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction Quantitative sensory testing (QST) is often used to understand the perceptual basis of acute and chronic conditions, including pain. As the need grows for developing a mechanistic understanding of neurological pathways underlying perception in the basic and clinical sciences, there is a greater need to adapt techniques such as QST to the magnetic resonance (MR) environment. No studies have yet evaluated the impact of the MR environment on the perception of thermal stimuli. This study aimed to evaluate the differences in temperature sensitivity outside an MR environment and during an MRI scanning session. We hypothesized that there would be a difference in how participants reported their pain sensitivity between the two environments. Methods Healthy participants underwent thermal QST outside the MR scanning environment, where they were asked to rate the temperature of a noxious stimulus at which they perceived their pain to be 7/10, using a Likert scale ranging from 0 to 10. Participants repeated this procedure inside a 3.0 T MRI approximately 30 min later. We repeated our investigation in a clinical cohort of participants with a chronic pain condition. Results There were statistically significant changes of 1.1°C in thermal sensitivity between environments. This increase in pain threshold was found in healthy participants and replicated in the clinical cohort. Discussion Findings can be applied toward improving MR safety, the resolution of brain pathways underlying pain mechanisms, and to more broadly comment on the impact of the MR environment on investigations that integrate perception-influenced processes.
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Affiliation(s)
- Ayeong (Jenny) Kim
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Edina Szabo
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Claire E. Lunde
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Nuffield Department of Women’s & Reproductive Health, Oxford University, Oxford, United Kingdom
| | - Gabriela Comptdaer
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Christine B. Sieberg
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Scott A. Holmes
- Department of Anesthesiology, Critical Care, and Pain Medicine, Pain and Affective Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Pediatric Pain Pathway Lab, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
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Harnik MA, Kesselring P, Ott A, Urman RD, Luedi MM. Complex Regional Pain Syndrome (CRPS) and the Value of Early Detection. Curr Pain Headache Rep 2023; 27:417-427. [PMID: 37410335 PMCID: PMC10462545 DOI: 10.1007/s11916-023-01124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE OF REVIEW The goal of this narrative review is to describe the current understanding of the pathology of Complex Regional Pain Syndrome (CRPS), as well as diagnostic standards and therapeutic options. We will then make the case for early recognition and management. RECENT FINDINGS CRPS remains an enigmatic pain syndrome, comprising several subtypes. Recent recommendations clarify diagnostic ambiguities and emphasize the importance of standardized assessment and therapy. Awareness of CRPS should be raised to promote prevention, early detection, and rapid escalation of therapy in refractory cases. Comorbidities and health costs (i.e., the socioeconomic impact) must also be addressed early to prevent negative consequences for patients.
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Affiliation(s)
- Michael Alexander Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Kesselring
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander Ott
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
| | - Richard D. Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Markus M. Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anaesthesiology and Pain Medicine, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland
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Chiang DLC, Rice DA, Helsby NA, Somogyi AA, Kluger MT. The incidence, impact, and risk factors for moderate to severe persistent pain after breast cancer surgery: a prospective cohort study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1023-1034. [PMID: 37184910 PMCID: PMC10655209 DOI: 10.1093/pm/pnad065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Few Australasian studies have evaluated persistent pain after breast cancer surgery. OBJECTIVE To evaluate the incidence, impact, and risk factors of moderate to severe persistent pain after breast cancer surgery in a New Zealand cohort. DESIGN Prospective cohort study. METHODS Consented patients were reviewed at 3 timepoints (preoperative, 2 weeks and 6 months postoperative). Pain incidence and interference, psychological distress and upper limb disability were assessed perioperatively. Clinical, demographic, psychological, cancer treatment-related variables, quantitative sensory testing, and patient genotype (COMT, OPRM1, GCH1, ESR1, and KCNJ6) were assessed as risk factors using multiple logistic regression. RESULTS Of the 173 patients recruited, 140 completed the 6-month follow-up. Overall, 15.0% (n = 21, 95% CI: 9.5%-22.0%) of patients reported moderate to severe persistent pain after breast cancer surgery with 42.9% (n = 9, 95% CI: 21.9%-66.0%) reporting likely neuropathic pain. Pain interference, upper limb dysfunction and psychological distress were significantly higher in patients with moderate to severe pain (P < .004). Moderate to severe preoperative pain (OR= 3.60, 95% CI: 1.13-11.44, P = .03), COMT rs6269 GA genotype (OR = 5.03, 95% CI: 1.49-17.04, P = .009) and psychological distress at postoperative day 14 (OR= 1.08, 95% CI: 1.02-1.16, P = .02) were identified as risk factors. Total intravenous anesthesia (OR= 0.31, 95% CI: 0.10 - 0.99, P = .048) was identified as protective. CONCLUSION The incidence of moderate to severe persistent pain after breast cancer surgery is high with associated pain interference, physical disability, and psychological distress. Important modifiable risk factors were identified to reduce this important condition.
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Affiliation(s)
- Daniel L C Chiang
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - David A Rice
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nuala A Helsby
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michal T Kluger
- Department of Anaesthesiology, Perioperative & Pain Medicine, Waitemata District Health Board, Auckland, New Zealand
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Danielsen AV, Andreasen JJ, Dinesen B, Hansen J, Kjær-Staal Petersen K, Simonsen C, Arendt-Nielsen L. Chronic post-thoracotomy pain after lung cancer surgery: a prospective study of preoperative risk factors. Scand J Pain 2023; 23:501-510. [PMID: 37327358 DOI: 10.1515/sjpain-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/27/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES The objective of this longitudinal cohort study was to investigate if preoperative pain mechanisms, anxiety, and depression increase risk of developing chronic post-thoracotomy pain (CPTP) after lung cancer surgery. METHODS Patients with suspected or confirmed lung cancer undergoing surgery by either video-assisted thoracoscopic surgery or anterior thoracotomy were recruited consecutively. Preoperative assessments were conducted by: quantitative sensory testing (QST) (brush, pinprick, cuff pressure pain detection threshold, cuff pressure tolerance pain threshold, temporal summation and conditioned pain modulation), neuropathic pain symptom inventory (NPSI), and the Hospital Anxiety and Depression Scale (HADS). Clinical parameters in relation to surgery were also collected. Presence of CPTP was determined after six months and defined as pain of any intensity in relation to the operation area on a numeric rating scale form 0 (no pain) to 10 (worst pain imaginable). RESULTS A total of 121 patients (60.2 %) completed follow-up and 56 patients (46.3 %) reported CPTP. Development of CPTP was associated with higher preoperative HADS score (p=0.025), higher preoperative NPSI score (p=0.009) and acute postoperative pain (p=0.042). No differences were observed in relation to preoperative QST assessment by cuff algometry and HADS anxiety and depression sub-scores. CONCLUSIONS High preoperative HADS score preoperative pain, acute postoperative pain intensity, and preoperative neuropathic symptoms were was associated with CPTP after lung cancer surgery. No differences in values of preoperative QST assessments were found. Preoperative assessment and identification of patients at higher risk of postoperative pain will offer opportunity for further exploration and development of preventive measures and individualised pain management depending on patient risk profile.
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Affiliation(s)
- Allan Vestergaard Danielsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Birthe Dinesen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Laboratory of Welfare Technologies - Digital Health & Rehabilitation, Aalborg, Denmark
| | - John Hansen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, CardioTech Research Group, Aalborg, Denmark
| | - Kristian Kjær-Staal Petersen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark
| | - Carsten Simonsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg, Denmark
- Department of Clinical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Årnes AP, Nielsen CS, Stubhaug A, Fjeld MK, Johansen A, Morseth B, Strand BH, Wilsgaard T, Steingrímsdóttir ÓA. Longitudinal relationships between habitual physical activity and pain tolerance in the general population. PLoS One 2023; 18:e0285041. [PMID: 37224163 DOI: 10.1371/journal.pone.0285041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/13/2023] [Indexed: 05/26/2023] Open
Abstract
Physical activity (PA) might influence the risk or progression of chronic pain through pain tolerance. Hence, we aimed to assess whether habitual leisure-time PA level and PA change affects pain tolerance longitudinally in the population. Our sample (n = 10,732; 51% women) was gathered from the sixth (Tromsø6, 2007-08) and seventh (Tromsø7, 2015-16) waves of the prospective population-based Tromsø Study, Norway. Level of leisure-time PA (sedentary, light, moderate, or vigorous) was derived from questionnaires; experimental pain tolerance was measured by the cold-pressor test (CPT). We used ordinary, and multiple-adjusted mixed, Tobit regression to assess 1) the effect of longitudinal PA change on CPT tolerance at follow-up, and 2) whether a change in pain tolerance over time varied with level of LTPA. We found that participants with high consistent PA levels over the two surveys (Tromsø6 and Tromsø7) had significantly higher tolerance than those staying sedentary (20.4 s. (95% CI: 13.7, 27.1)). Repeated measurements show that light (6.7 s. (CI 3.4, 10.0)), moderate (CI 14.1 s. (9.9, 18.3)), and vigorous (16.3 s. (CI 6.0, 26.5)) PA groups had higher pain tolerance than sedentary, with non-significant interaction showed slightly falling effects of PA over time. In conclusion, being physically active at either of two time points measured 7-8 years apart was associated with higher pain tolerance compared to being sedentary at both time-points. Pain tolerance increased with higher total activity levels, and more for those who increased their activity level during follow-up. This indicates that not only total PA amount matters but also the direction of change. PA did not significantly moderate pain tolerance change over time, though estimates suggested a slightly falling effect possibly due to ageing. These results support increased PA levels as a possible non-pharmacological pathway towards reducing or preventing chronic pain.
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Affiliation(s)
| | - Christopher Sievert Nielsen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Audun Stubhaug
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats Kirkeby Fjeld
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aslak Johansen
- Department of Pain, University Hospital of North Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Heine Strand
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust Norway, Tønsberg, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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12
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Tan HS, Plichta JK, Kong A, Tan CW, Hwang S, Sultana R, Wright MC, Sia ATH, Sng BL, Habib AS. Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study. Anaesthesia 2023; 78:432-441. [PMID: 36639918 DOI: 10.1111/anae.15958] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/15/2023]
Abstract
Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4 months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC = 0.807, with five independent associations: age (OR 0.85 95%CI 0.74-0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03-21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11-1.96); previous mastitis (OR 4.90, 95%CI 1.31-18.34); and perceived stress scale (OR 1.35, 95%CI 1.01-1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk.
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Affiliation(s)
- H S Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - J K Plichta
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - A Kong
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - C W Tan
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - S Hwang
- Division of Surgical Oncology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - R Sultana
- Centre for Quantitative Medicine, Singapore
| | - M C Wright
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - A T H Sia
- KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - B L Sng
- Department of Women's Anaesthesia, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - A S Habib
- Division of Women's Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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13
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Edwards RR, Schreiber KL, Dworkin RH, Turk DC, Baron R, Freeman R, Jensen TS, Latremoliere A, Markman JD, Rice ASC, Rowbotham M, Staud R, Tate S, Woolf CJ, Andrews NA, Carr DB, Colloca L, Cosma-Roman D, Cowan P, Diatchenko L, Farrar J, Gewandter JS, Gilron I, Kerns RD, Marchand S, Niebler G, Patel KV, Simon LS, Tockarshewsky T, Vanhove GF, Vardeh D, Walco GA, Wasan AD, Wesselmann U. Optimizing and Accelerating the Development of Precision Pain Treatments for Chronic Pain: IMMPACT Review and Recommendations. THE JOURNAL OF PAIN 2023; 24:204-225. [PMID: 36198371 PMCID: PMC10868532 DOI: 10.1016/j.jpain.2022.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
Large variability in the individual response to even the most-efficacious pain treatments is observed clinically, which has led to calls for a more personalized, tailored approach to treating patients with pain (ie, "precision pain medicine"). Precision pain medicine, currently an aspirational goal, would consist of empirically based algorithms that determine the optimal treatments, or treatment combinations, for specific patients (ie, targeting the right treatment, in the right dose, to the right patient, at the right time). Answering this question of "what works for whom" will certainly improve the clinical care of patients with pain. It may also support the success of novel drug development in pain, making it easier to identify novel treatments that work for certain patients and more accurately identify the magnitude of the treatment effect for those subgroups. Significant preliminary work has been done in this area, and analgesic trials are beginning to utilize precision pain medicine approaches such as stratified allocation on the basis of prespecified patient phenotypes using assessment methodologies such as quantitative sensory testing. Current major challenges within the field include: 1) identifying optimal measurement approaches to assessing patient characteristics that are most robustly and consistently predictive of inter-patient variation in specific analgesic treatment outcomes, 2) designing clinical trials that can identify treatment-by-phenotype interactions, and 3) selecting the most promising therapeutics to be tested in this way. This review surveys the current state of precision pain medicine, with a focus on drug treatments (which have been most-studied in a precision pain medicine context). It further presents a set of evidence-based recommendations for accelerating the application of precision pain methods in chronic pain research. PERSPECTIVE: Given the considerable variability in treatment outcomes for chronic pain, progress in precision pain treatment is critical for the field. An array of phenotypes and mechanisms contribute to chronic pain; this review summarizes current knowledge regarding which treatments are most effective for patients with specific biopsychosocial characteristics.
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Affiliation(s)
| | | | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, House D, 24105 Kiel, Germany
| | - Roy Freeman
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | - Nick A Andrews
- Salk Institute for Biological Studies, San Diego, California
| | | | | | | | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Luda Diatchenko
- Department of Anesthesia and Faculty of Dentistry, McGill University, Montreal, California
| | - John Farrar
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Robert D Kerns
- Yale University, Departments of Psychiatry, Neurology, and Psychology, New Haven, Connecticut
| | | | | | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | | | | | | | | | - Gary A Walco
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Ajay D Wasan
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ursula Wesselmann
- Department of Anesthesiology/Division of Pain Medicine, Neurology and Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
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14
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Suzuki H, Tahara S, Mitsuda M, Izumi H, Ikeda S, Seki K, Nishida N, Funaba M, Imajo Y, Yukata K, Sakai T. Current Concept of Quantitative Sensory Testing and Pressure Pain Threshold in Neck/Shoulder and Low Back Pain. Healthcare (Basel) 2022; 10:healthcare10081485. [PMID: 36011141 PMCID: PMC9408781 DOI: 10.3390/healthcare10081485] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022] Open
Abstract
In recent years, several published articles have shown that quantitative sensory testing (QST) and pressure pain threshold (PPT) are useful in the analysis of neck/shoulder and low back pain. A valid reference for normal PPT values might be helpful for the clinical diagnosis of abnormal tenderness or muscle pain. However, there have been no reliable references for PPT values of neck/shoulder and back pain because the data vary depending on the devices used, the measurement units, and the area examined. In this article, we review previously published PPT articles on neck/shoulder and low back pain, discuss the measurement properties of PPT, and summarize the current data on PPT values in patients with chronic pain and healthy volunteers. We also reveal previous issues related to PPT evaluation and discuss the future of PPT assessment for widespread use in general clinics. We outline QST and PPT measurements and what kinds of perceptions can be quantified with the PPT. Ninety-seven articles were selected in the present review, in which we focused on the normative values and abnormal values in volunteers/patients with neck/shoulder and low back pain. We conducted our search of articles using PubMed and Medline, a medical database. We used a combination of “Pressure pain threshold” and “Neck shoulder pain” or “Back pain” as search terms and searched articles from 1 January 2000 to 1 June 2022. From the data extracted, we revealed the PPT values in healthy control subjects and patients with neck/shoulder and low back pain. This database could serve as a benchmark for future research with pressure algometers for the wide use of PPT assessment in clinics.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Correspondence: ; Tel.: +81-836-22-2268
| | - Shu Tahara
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Mao Mitsuda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Hironori Izumi
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Satoshi Ikeda
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Kazushige Seki
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Norihiro Nishida
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Masahiro Funaba
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
| | - Yasuaki Imajo
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
| | - Kiminori Yukata
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopaedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan
- Pain Management Research Institute, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
- Department of Rehabilitation, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
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15
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Lorenzo-Gallego L, Arranz-Martín B, Romay-Barrero H, Prieto-Gómez V, Lluch E, Torres-Lacomba M. Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074055. [PMID: 35409738 PMCID: PMC8998435 DOI: 10.3390/ijerph19074055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate changes in the pain sensory profile of women with breast cancer. Five women with unilateral breast cancer were enrolled. Participants were assessed with direct (quantitative sensory testing, QST) and indirect measures of pain sensitization (self-reported central sensitization inventory, CSI) at baseline (before surgery), 1 week after surgery, and at 1, 6, 9, and 12 months post-surgery. In the event of pain occurrence, the Leeds Assessment of Neuropathic Symptoms and Signs was also used. Nociceptive pain was the predominant pain mechanism in the postoperative period, while an increase in sensitization predominated one year after breast cancer surgery, especially in those participants who had received more treatment procedures. The participants who received more therapies for breast cancer experienced persistent pain and a higher level of sensitization. An assessment protocol including direct measurements (QST) and indirect measurement (self-reported CSI) allows for detecting changes in pain sensitivity, which can be useful for characterizing and/or predicting pain before, during, and up to one year following surgical interventions for breast cancer.
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Affiliation(s)
- Laura Lorenzo-Gallego
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Beatriz Arranz-Martín
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
- Correspondence:
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain;
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
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16
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Dams L, Van der Gucht E, Haenen V, Lauwers M, De Pauw S, Steurs T, Devoogdt N, Smeets A, Bernar K, De Vrieze T, De Groef A, Meeus M. Biopsychosocial risk factors for pain and pain-related disability 1 year after surgery for breast cancer. Support Care Cancer 2022; 30:4465-4475. [PMID: 35112213 DOI: 10.1007/s00520-022-06805-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Knowledge regarding risk factors for pain in the long term after surgery for breast cancer may be of great value in preventing this prevalent and debilitating side effect. Despite the biopsychosocial nature of pain, the predictive value of both pre- and postoperative biopsychosocial functioning for long-term pain intensity and pain-related disability has not yet been studied. METHODS One hundred sixty-six women planned for unilateral breast cancer surgery were included in this prospective cohort study. Pre- and postoperative outcomes related to pain, psychosocial, and somatosensory functioning (questionnaires and quantitative sensory testing) were evaluated as risk factors for pain intensity (visual analog scale) and pain-related disability (pain disability index) 1 year after surgery for breast cancer. Both bivariable and stepwise linear regression analyses were performed. RESULTS The most consistent biopsychosocial risk factors were symptoms related to altered central somatosensory functioning (central sensitization inventory), psychological symptoms, and social support (psychological symptoms and support subscale of McGill Quality of Life Questionnaire). Results also showed that a pre- and postoperative disturbed functioning of the somatosensory nervous system in the surgical area could provide additional information regarding pain intensity or pain-related disability in the long term after surgery for breast cancer. CONCLUSION This study revealed several biopsychosocial characteristics that might be used to identify women more vulnerable to have pain and pain-related disability in the long term after surgery for breast cancer, allowing for more effective pain management and prevention.
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Affiliation(s)
- Lore Dams
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium. .,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium. .,Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium
| | - Vincent Haenen
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium
| | - Magalie Lauwers
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium
| | - Sofie De Pauw
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium
| | - Tinne Steurs
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Center for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Bernar
- The Leuven Centre for Algology and Pain Management, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - An De Groef
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium.,Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium
| | - Mira Meeus
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, MOVANT, University of Antwerp, Campus Drie Eiken - Universiteitsplein 1, R.315, 2610 Wilrijk, Antwerp, Belgium.,Pain In Motion International Research Group, http://www.paininmotion.be, Brussels, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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17
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Schuttert I, Timmerman H, Groen GJ, Petersen KK, Arendt-Nielsen L, Wolff AP. Human assumed central sensitisation (HACS) in patients with chronic low back pain radiating to the leg (CLaSSICO study). BMJ Open 2022; 12:e052703. [PMID: 35027419 PMCID: PMC8762136 DOI: 10.1136/bmjopen-2021-052703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patients with chronic low back pain radiating to the leg (CLBPr) are sometimes referred to a specialised pain clinic for a precise diagnosis based, for example, on a diagnostic selective nerve root block. Possible interventions are therapeutic selective nerve root block or pulsed radiofrequency. Central pain sensitisation is not directly assessable in humans and therefore the term 'human assumed central sensitisation' (HACS) is proposed. The possible existence and degree of sensitisation associated with pain mechanisms assumed present in the human central nervous system, its role in the chronification of pain and its interaction with diagnostic and therapeutic interventions are largely unknown in patients with CLBPr. The aim of quantitative sensory testing (QST) is to estimate quantitatively the presence of HACS and accumulating evidence suggest that a subset of patients with CLBPr have facilitated responses to a range of QST tests.The aims of this study are to identify HACS in patients with CLBPr, to determine associations with the effect of selective nerve root blocks and compare outcomes of HACS in patients to healthy volunteers. METHODS AND ANALYSIS A prospective observational study including 50 patients with CLBPr. Measurements are performed before diagnostic and therapeutic nerve root block interventions and at 4 weeks follow-up. Data from patients will be compared with those of 50 sex-matched and age-matched healthy volunteers. The primary study parameters are the outcomes of QST and the Central Sensitisation Inventory. Statistical analyses to be performed will be analysis of variance. ETHICS AND DISSEMINATION The Medical Research Ethics Committee of the University Medical Center Groningen, Groningen, the Netherlands, approved this study (dossier NL60439.042.17). The results will be disseminated via publications in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER NTR NL6765.
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Affiliation(s)
- Ingrid Schuttert
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hans Timmerman
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gerbrand J Groen
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Aalborg Universitet, Aalborg, Denmark
- Department of Medical Gastroenterology (Mech-Sense), Aalborg University Hospital, Aalborg, Denmark
| | - Andre P Wolff
- Department of Anesthesiology, Pain Center, University Medical Centre Groningen, Groningen, The Netherlands
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18
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Lukas P, Gerdle B, Nilsson L, Wodlin NB, Fredrikson M, Arendt-Nielsen L, Kjølhede P. Association Between Experimental Pain Thresholds and Trajectories of Postoperative Recovery Measures After Benign Hysterectomy. J Pain Res 2022; 15:3657-3674. [PMID: 36447527 PMCID: PMC9701515 DOI: 10.2147/jpr.s383795] [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: 07/31/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Quantitative sensory testing (QST) can be applied to quantify the sensitivity to different painful stimuli. This study aims to evaluate the association between preoperative pressure and thermal pain thresholds and trajectories of measurements of postoperative recovery (patient-reported daily maximum and average pain intensity, sum score of symptoms, and analgesic consumption) after benign hysterectomy. Patients and Methods A prospective, longitudinal single-blinded, observational multicenter study was conducted in five hospitals in the southeast of Sweden between 2011 and 2017. A total of 406 women scheduled for abdominal or vaginal hysterectomy for benign conditions were enrolled in the study. QST measuring pressure (PPT), heat (HPT), and cold pain thresholds (CPT) were performed preoperatively. The cut-off levels for dichotomizing the pain thresholds (low/high) were set at the 25-percentile for PPT and HPT and the 75-percentile for CPT. The Swedish Postoperative Symptom Questionnaire was used to measure postoperative pain and other symptoms of discomfort (symptom sum score) on 13 occasions for six weeks postoperatively. Daily analgesic consumption of opioids and non-opioids was registered. Results A CPT above the 75-percentile was associated with high postoperative maximum pain intensity (p = 0.04), high symptom sum score (p = 0.03) and greater consumption of non-opioids (p = 0.03). A HPT below the 25-percentile was only associated with greater consumption of non-opioids (p = 0.02). PPT was not associated with any of the outcome measures. Conclusion CPT seemed to be predictive for postoperative pain and symptoms of discomfort after benign hysterectomy. Preoperative QST may be used to individualize the management of postoperative recovery for low pain threshold individuals.
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Affiliation(s)
- Peter Lukas
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Department of Anesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Fredrikson
- Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Occupational and Environmental Medicine, Department of Experimental and Clinical Medicine, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden
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19
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Yaari L, Dolev A, Kittani M, Yassin M, Gbaren M, Feicht E, Haviv B. Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:4198-4204. [PMID: 33704517 DOI: 10.1007/s00167-021-06438-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees. METHODS Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction. RESULTS There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p < 0.001). Mean final KOOS pain scores were 76.1 ± 15.2 for the betamethasone group, 70.8 ± 12.6 for the celecoxib group and 78.7 ± 11.6 for the control group. No differences in scores were observed among groups (n.s.). In the control group, a negative correlation was observed between PSQ score and KOOS-pain scores at the end of the follow-up in addition to a positive correlation between PSQ score and rescue analgesia consumption at the first postoperative week. The optimal cutoff value for PSQ score to predict insufficient improvement in KOOS-pain subscale was 5.0 points. CONCLUSIONS A cutoff value of pain sensitivity questionnaire score above 5.0 points was determined to identify patients with higher sensitivity to pain who underwent arthroscopic partial meniscectomy. These patients reported relatively increased pain and consumed more rescue analgesics postoperatively unless treated with a single intraoperative corticosteroids injection or oral non-steroidal anti-inflammatories. Therefore, surgeons can use pain sensitivity questionnaire score as a preoperative tool to identify patients with high sensitivity to pain and customize their postoperative analgesics protocol to better fit their pain levels. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Amir Dolev
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mahmod Gbaren
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Elia Feicht
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel.
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel.
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20
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Mishra P, Edwards D, Huntoon M, Sobey C, Polkowski G, Corey J, Mishra KL, Shinar A, Engstrom S, Palmer C, Bruehl S. Is preoperative genicular radiofrequency ablation effective for reducing pain following total knee arthroplasty? A pilot randomized clinical trial. Reg Anesth Pain Med 2021; 46:752-756. [PMID: 34215667 DOI: 10.1136/rapm-2021-102501] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE Although total knee arthroplasty (TKA) is an effective treatment for severe knee osteoarthritis (OA), a subset of patients experience significant postoperative pain and dissatisfaction. Several clinical trials support the analgesic benefits of genicular nerve radiofrequency ablation (GN-RFA) for non-operative knee OA, but only one prior trial has examined the effects of this intervention given preoperatively on postoperative outcomes following TKA, showing no analgesic benefit of cooled GN-RFA. The current study evaluated whether conventional thermal GN-RFA performed preoperatively resulted in significant improvements in pain and function following TKA. METHODS This was a single-center, prospective, randomized, sham-controlled, double-blinded pilot trial in which patients received either conventional GN-RFA (n=30) or sham (n=30) between 2 and 4 weeks prior to their TKA. Baseline measures were obtained preprocedurally on the day of intervention, with follow-up outcomes obtained preoperatively on the day of surgery, and at 2 and 6 weeks postoperatively. RESULTS Patients receiving GN-RFA showed no significant improvements relative to sham controls in the primary outcome, pain intensity at rest at 6-week follow-up. Secondary outcomes, including pain with ambulation and physical function, also showed no significant differences between groups at any follow-up assessment. CONCLUSIONS Conventional GN-RFA of the superior lateral, superior medial, and inferior medial genicular nerves when performed prior to TKA did not provide clinically significant pain relief or improvement in functional status at 2 or 6 weeks postoperatively. TRIAL REGISTRATION NUMBER NCT02947321.
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Affiliation(s)
- Puneet Mishra
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Edwards
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marc Huntoon
- Anesthesiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Christopher Sobey
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory Polkowski
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John Corey
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelly Louise Mishra
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew Shinar
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Engstrom
- Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassandra Palmer
- University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
| | - Stephen Bruehl
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Paredes AC, Pinto JM, Almeida A, Pinto PR. Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review. Pain 2021; 163:e385-e400. [PMID: 34224493 DOI: 10.1097/j.pain.0000000000002385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.
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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
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22
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Luedi MM, Schober P, Hammoud B, Andereggen L, Hoenemann C, Doll D. Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study. Anesth Analg 2021; 132:656-662. [PMID: 32675636 PMCID: PMC7870038 DOI: 10.1213/ane.0000000000005072] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Postoperative pain management is key for patient satisfaction. Pressure pain threshold (PPT) has been studied in some surgical cohorts but has not been studied in relationship to acute postoperative pain in short-stay patients undergoing anorectal surgery. We hypothesized that preoperative finger PPT measurements can identify respective patients with higher postoperative pain. Aiming to understand the relationship with subjective postoperative pain perception, we tested the hypotheses that preoperative PPT is associated with postoperative Visual Analog Scale (VAS) pain scores and correlates with postoperative analgesic consumption in short-stay patients undergoing anorectal surgery. METHODS: We prospectively assessed preoperative PPT in a cohort undergoing anorectal surgery, known as a moderately to severely painful procedure. Linear mixed-effects models were used to assess the relationship with postoperative VAS pain scores at 1 and 3 days as well as 4 weeks postoperatively. Logistic regression was used to study the relationship with additional postoperative analgesic consumption. RESULTS: We studied 128 patients and found that preoperative PPT is significantly associated with postoperative pain (P value for interaction = .025). Logistic regression modeling additionally revealed an association between the preoperative PPT and the need for additional postoperative analgesics, with odds of requiring additional analgesia decreasing by about 10% for each 1-point increase in PPT (odds ratio [OR] = 0.90; 95% confidence interval [CI], 00.81–0.98; P = .012). CONCLUSIONS: Preoperative finger PPT is associated with postoperative pain and might help identify patients who are at risk of developing more severe postoperative pain on anorectal surgery. Especially in ambulatory and short-stay settings, this approach can help to address patients’ high variability in pain sensitivity to facilitate appropriate postoperative analgesia, timely discharge, and prevent readmission.
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Affiliation(s)
- Markus M Luedi
- From the Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Schober
- Department of Anaesthesiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Bassam Hammoud
- Department of Colorectal Surgery, St Marien-Krankenhaus, Vechta, Germany
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Dietrich Doll
- Department of Colorectal Surgery, St Marien-Krankenhaus, Vechta, Germany
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Abstract
Purpose of Review We review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges. Recent Findings Predicting the occurrence of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic procedures. Summary Current evidence underlines the potential of preoperative QST to predict postoperative pain in patients undergoing elective surgery. Implementing QST in routine preoperative screening can help advancing traditional pain therapy toward personalized perioperative pain medicine.
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Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020; 62:103124. [PMID: 33248373 PMCID: PMC7704400 DOI: 10.1016/j.ebiom.2020.103124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and associated with significant pain-related disability. Recognition based on clinical history and sensory descriptors is challenging in young children, and screening tools require further validation at older ages. Confirmatory tests can identify the disease or lesion of the somatosensory nervous system resulting in neuropathic pain, but feasibility and interpretation may be influenced by age- and sex-dependent changes throughout development. Quantitative sensory testing identifies specific mechanism-related sensory profiles; brain imaging is a potential biomarker of alterations in central processing and modulation of both sensory and affective components of pain; and genetic analysis can reveal known and new causes of neuropathic pain. Alongside existing patient- and parent-reported outcome measures, somatosensory system research methodologies and validation of mechanism-based standardised end-points may inform individualised therapy and stratification for clinical trials that will improve evidence-based management of neuropathic pain in children.
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