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Blom-Høgestøl IK, Aasbrenn M, Kvalem IL, Eribe I, Kristinsson JA, Mala T. Pain sensitivity after Roux-en-Y gastric bypass - associations with chronic abdominal pain and psychosocial aspects. Scand J Pain 2023; 23:511-517. [PMID: 37306001 DOI: 10.1515/sjpain-2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aims of this study were to investigate modifications in pain sensitivity after RYGB and to explore associations between pain sensitivity and weight loss, chronic abdominal pain, total body pain, anxiety, depression, and pain catastrophizing. METHODS In total, 163 patients with obesity were examined with a cold pressor test for pain sensitivity before and two years after RYGB. Two aspects of pain sensitivity were registered: Pain intensity (numeric rating scale, range 0-10) and pain tolerance (seconds). Associations between pain sensitivity and the explanatory variables were assessed with linear regression. RESULTS Two years after RYGB the pain intensity increased (mean ± SD 0.64 ± 1.9 score units, p<0.001). Pain tolerance decreased (7.2 ± 32.4 s, p=0.005). A larger reduction in body mass index was associated with increased pain intensity, β=-0.090 (95 % CI -0.15 to -0.031, p=0.003), and decreased pain tolerance β=1.1 (95 % CI 0.95 to 2.2, p=0.03). Before surgery, participants with chronic abdominal pain reported 1.2 ± 0.5 higher pain intensity (p=0.02) and had 19.2 ± 9.3 s lower pain tolerance (p=0.04) than those without abdominal pain. No differences in pain sensitivity were observed between participants who did or did not develop chronic abdominal pain after RYGB. Pain sensitivity was associated with symptoms of anxiety but not with pain catastrophizing, depression or bodily pain. CONCLUSIONS The pain sensitivity increased after RYGB and was associated with larger weight loss and anxiety symptoms. Changes in pain sensitivity were not associated with development of chronic abdominal pain after RYGB in our study.
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Affiliation(s)
- Ingvild K Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Aasbrenn
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Inger Eribe
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
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Pergolizzi JV, LeQuang JA, Magnusson P, Varrassi G. Identifying risk factors for chronic postsurgical pain and preventive measures: a comprehensive update. Expert Rev Neurother 2023; 23:1297-1310. [PMID: 37999989 DOI: 10.1080/14737175.2023.2284872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Chronic postsurgical pain (CPSP) is a prevalent condition that can diminish health-related quality of life, cause functional deficits, and lead to patient distress. Rates of CPSP are higher for certain types of surgeries than others (thoracic, breast, or lower extremity amputations) but can occur after even uncomplicated minimally invasive procedures. CPSP has multiple mechanisms, but always starts as acute postsurgical pain, which involves inflammatory processes and may encompass direct or indirect neural injury. Risk factors for CPSP are largely known but many, such as female sex, younger age, or type of surgery, are not modifiable. The best strategy against CPSP is to quickly and effectively treat acute postoperative pain using a multimodal analgesic regimen that is safe, effective, and spares opioids. AREAS COVERED This is a narrative review of the literature. EXPERT OPINION Every surgical patient is at some risk for CPSP. Control of acute postoperative pain appears to be the most effective approach, but principles of good opioid stewardship should apply. The role of regional anesthetics as analgesics is gaining interest and may be appropriate for certain patients. Finally, patients should be better informed about their relative risk for CPSP.
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Affiliation(s)
| | | | - Peter Magnusson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Cardiology, Center for Clinical Research, Falun, Sweden
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Manfuku M, Nishigami T, Mibu A, Yamashita H, Imai R, Kanamori H, Sumiyoshi K. Predictors of persistent post-surgical pain intensity and interference at 1 year after breast cancer surgery: assessing central sensitization, central sensitivity symptoms, and psychological factors. Breast Cancer 2023; 30:271-281. [PMID: 36528837 DOI: 10.1007/s12282-022-01420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Persistent post-surgical pain (PPSP) is associated with upper limb dysfunction and decreased quality of life and causes long-term suffering for breast cancer survivors after surgery. However, the predictors of PPSP remain unclear. The purpose of this study was to examine predictors of PPSP intensity and interference at 1 year postoperatively, focusing on treatment-related factors, pre- and postoperative central sensitization (CS), CS-related symptoms (e.g., muscle stiffness, fatigue, sleep disturbances), and psychological factors. METHODS Eighty-eight women with planned unilateral breast cancer surgery were included in this longitudinal study. CS, CS-related symptoms, and psychological factors were assessed preoperatively, 1 month postoperatively, and 1 year postoperatively. Analysis of covariance was used to compare the groups with and without PPSP, accounting for treatment-related factors. Multiple regression analysis was performed to identify predictors of PPSP intensity and interference at 1 year postoperatively. RESULTS Even after adjusting for covariates, preoperative and 1-month postoperative Central Sensitization Inventory scores in the PPSP group were significantly higher than scores in the group without PPSP. Multiple regression analysis showed that axillary lymph node dissection (ALND) and 1-month postoperative CS-related symptoms were independent predictors of PPSP intensity and interference at 1 year postoperatively (p < 0.01). CONCLUSION We found that ALND and 1-month postoperative CS-related symptoms were predictors of PPSP intensity and interference at 1 year postoperatively.
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Affiliation(s)
- Masahiro Manfuku
- Department of Rehabilitation, Breast Care Sensyu Clinic, Osaka, Japan.,Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Mihara , Hiroshima, Japan.
| | - Akira Mibu
- Department of Physical Therapy, Konan Women's University, Hyogo, Japan
| | - Hirofumi Yamashita
- Department of Rehabilitation, Nozomi Orthopaedic Clinic Saijo, Hiroshima, Japan
| | - Ryota Imai
- Graduate School of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka, Japan
| | - Hiroe Kanamori
- Department of Breast Surgery, Breast Care Sensyu Clinic, Osaka, Japan
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Compton P, Wang S, Fakhar C, Secreto S, Arnold OH, Ford B, Hersh EV. Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study. Anesth Prog 2023; 70:9-16. [PMID: 36995960 PMCID: PMC10069537 DOI: 10.2344/anpr-69-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/15/2022] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE Opioid-induced hyperalgesia, a paradoxical increase in pain sensitivity associated with ongoing opioid use, may worsen the postoperative pain experience. This pilot study examined the effect of chronic opioid use on pain responses in patients undergoing a standardized dental surgery. METHODS Experimental and subjective pain responses were compared prior to and immediately following planned multiple tooth extractions between patients with chronic pain on opioid therapy (≥30 mg morphine equivalents/d) and opioid-naïve patients without chronic pain matched on sex, race, age, and degree of surgical trauma. RESULTS Preoperatively, chronic opioid users rated experimental pain as more severe and appreciated less central modulation of that pain than did opioid-naïve participants. Postoperatively, chronic opioid-using patients rated their pain as more severe during the first 48 hours and used almost twice as many postoperative analgesic doses during the first 72 hours as the opioid-naïve controls. CONCLUSION These data suggest that patients with chronic pain taking opioids approach surgical interventions with heightened pain sensitivity and have a more severe postoperative pain experience, providing evidence that their complaints of postoperative pain should be taken seriously and managed appropriately.
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Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Wang
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Stacey Secreto
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian Ford
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elliot V. Hersh
- School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Lunden LK, Kleggetveit IP, Schmelz M, Jorum E. Cold allodynia is correlated to paroxysmal and evoked mechanical pain in complex regional pain syndrome (CRPS). Scand J Pain 2022; 22:533-542. [PMID: 35429156 DOI: 10.1515/sjpain-2021-0208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/09/2022] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Mechanisms of complex regional pain syndrome (CRPS) are still debated. Identifying subgroups of patients have been attempted in the hope of linking clinical findings to possible mechanisms. The aim of the present study was to investigate whether subgroups of CRPS (based on quantitative sensory testing (QST)-results) differed with respect to different characteristics of pain like spontaneous ongoing or paroxysmal pain and mechanical dynamic allodynia. METHODS 61 CRPS-patients (type 1 and 2) were examined clinically and with QST, in affected and contralateral extremity, with assessment of thresholds for warmth, cold and heat-and cold pain. RESULTS 43 patients (20 men, 23 men) were diagnosed with CRPS 1 (70.5%) and 18 patients (8 women and 10 men) with CRPS 2 (29.5%). Three subgroups were defined based on thermal thresholds; A (thermal allodynia 22.9%), B (thermal hyposensitivity 37.3%), C (thermal allodynia and hyposensitivity 39.3%). Paroxysmal pain was more prevalent in patients with thermal allodynia (merging group A + C, 25/38-65.8%) compared to patients without thermal allodynia (group B, 5/23-21.7%) (p-value=0.00085). CONCLUSIONS We suggest that cold allodynia is based on hyper-excitability of very superficial skin nociceptors. The correlation between paroxysmal pain, allodynia to light touch and cold allodynia suggests that activity in those peripheral nociceptors can drive both, paroxysmal pain and spinal sensitization leading to stroke evoked allodynia. Mechanistically, the physical cold stimulus can unmask disease-related hyperexcitability by closure of temperature-sensitive potassium channels or induction of resurgent currents. Small fiber degeneration alone may not be the crucial mechanism in CRPS, nor explain pain.
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Affiliation(s)
- Lars Kristian Lunden
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inge Petter Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Schmelz
- Department of Experimental Pain Research, MCTN, University of Heidelberg, Mannheim, Germany
| | - Ellen Jorum
- Section of Clinical Neurophysiology, Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Waller R, Smith AJ, Graven-Nielsen T, Arendt-Nielsen L, Sterling M, Karppinen JI, O'Sullivan PB, Straker LM, Slater H. Role of population-based cohorts in understanding the emergence and progression of musculoskeletal pain. Pain 2022; 163:58-63. [PMID: 33883537 DOI: 10.1097/j.pain.0000000000002316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Robert Waller
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Anne Julia Smith
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Thomas Graven-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg DK, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Faculty of Medicine, Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg DK, Denmark
| | - Michele Sterling
- RECOVER Injury Research Centre, NHMRC Centre of Research Excellence in Road Traffic Injury, The University of Queensland, Herston, Australia
| | - Jaro Ilari Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | | | - Leon Melville Straker
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Helen Slater
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Fladseth K, Lindekleiv H, Nielsen C, Øhrn A, Kristensen A, Mannsverk J, Løchen ML, Njølstad I, Wilsgaard T, Mathiesen EB, Stubhaug A, Trovik T, Rotevatn S, Forsdahl S, Schirmer H. Low Pain Tolerance Is Associated With Coronary Angiography, Coronary Artery Disease, and Mortality: The Tromsø Study. J Am Heart Assoc 2021; 10:e021291. [PMID: 34729991 PMCID: PMC8751909 DOI: 10.1161/jaha.121.021291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. Methods and Results We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Conclusions Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.
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Affiliation(s)
- Kristina Fladseth
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Haakon Lindekleiv
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Christopher Nielsen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway.,Division of Ageing and Health Norwegian Institute of Public Health Oslo Norway.,Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Andrea Øhrn
- Department of Psychology UiT The Arctic University of Norway Tromsø Norway
| | - Andreas Kristensen
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Jan Mannsverk
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Inger Njølstad
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine UiT The Arctic University of Norway Tromsø Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Department of Neurology University Hospital of North Norway Tromsø Norway
| | - Audun Stubhaug
- Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Svein Rotevatn
- Department of Cardiology Haukeland University Hospital Bergen Norway
| | - Signe Forsdahl
- Department of Radiology University Hospital North Norway Tromsø Norway
| | - Henrik Schirmer
- Cardiovascular Research Group Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.,Institute of Clinical Medicine University of Oslo Lørenskog Norway.,Department of Cardiology Akershus University Hospital Lørenskog Norway
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Olofsson IA, Hvedstrup J, Falkenberg K, Chalmer MA, Schytz HW, Pedersen MB, Ullum H, Pedersen OB, Olesen J, Hansen TF. Pain sensitivity in men who have never experienced a headache: an observer blinded case control study. J Headache Pain 2021; 22:134. [PMID: 34749638 PMCID: PMC8576972 DOI: 10.1186/s10194-021-01345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background Headache affects 90–99% of the population. Based on the question “Do you think that you never ever in your whole life have had a headache?” 4% of the population say that they have never experienced a headache. The rarity of never having had a headache suggests that distinct biological and environmental factors may be at play. We hypothesized that people who have never experienced a headache had a lower general pain sensitivity than controls. Methods We included 99 male participants, 47 headache free participants and 52 controls, in an observer blinded nested case-control study. We investigated cold pain threshold and heat pain threshold using a standardized quantitative sensory testing protocol, pericranial tenderness with total tenderness score and pain tolerance with the cold pressor test. Differences between the two groups were assessed with the unpaired Student’s t-test or Mann-Whitney U test as appropriate. Results There was no difference in age, weight or mean arterial pressure between headache free participants and controls. We found no difference in pain detection threshold, pericranial tenderness or pain tolerance between headache free participants and controls. Conclusion Our study clearly shows that freedom from headache is not caused by a lower general pain sensitivity. The results support the hypothesis that headache is caused by specific mechanisms, which are present in the primary headache disorders, rather than by a decreased general sensitivity to painful stimuli. Trial registration Registered at ClinicalTrials.gov (NCT04217616), 3rd January 2020, retrospectively registered.
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Affiliation(s)
- Isa Amalie Olofsson
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark.
| | - Jeppe Hvedstrup
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | - Katrine Falkenberg
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | - Mona Ameri Chalmer
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | - Henrik Winther Schytz
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | - Miguel Benjamin Pedersen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | | | - Ole Birger Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Koege, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
| | - Thomas Folkmann Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Valdemar Hansens Vej 5, Glostrup, Denmark
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Casale R. Capsaicin 179-mg cutaneous patch in the treatment of post-surgical neuropathic pain: a scoping review of current evidence and place in therapy. Expert Rev Neurother 2021; 21:1147-1158. [PMID: 34461799 DOI: 10.1080/14737175.2021.1974842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The use of topical agents has been suggested for post-surgical neuropathic pain. A high-concentration capsaicin 179-mg cutaneous patch (Qutenza™) is licensed in adults for chronic neuropathic pain in the EU, and neuropathic pain with post-herpetic neuralgia and neuropathic pain with diabetic peripheral neuropathy in the USA. This article aims to describe the use of a topical capsaicin 179-mg cutaneous patch in the treatment of PSNP. AREA COVERED This narrative review presents the relevant clinical aspects of the use of a topical capsaicin 179-mg cutaneous patch for the treatment of post-surgical neuropathic pain (PSNP). Randomized control trials, observational studies, case series, and reports investigating the clinical use of the capsaicin patch were searched through MEDLINE, EMBASE, AMED, Cochrane Library, CINAHL, Web of Science, and ROAD databases. Trials from citation lists of reviewed articles and hand-searching were added. The search concluded in September 2020. 10/20 articles were considered. EXPERT OPINION Some clinical studies demonstrated the efficacy of the capsaicin 179-mg patch in PSNP as monotherapy and concomitant treatment with oral treatments. This topical treatment of PSNP is better tolerated and accepted compared with systemic treatments. To maximize the effectiveness of the treatment, correct administration recommendations should be followed.
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Affiliation(s)
- Roberto Casale
- Opusmedica Persons, Care & Research - PC&R, Piacenza, Italy
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10
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Kristensen NS, Hertel E, Skadhauge CH, Kronborg SH, Petersen KK, McPhee ME. Psychophysical predictors of experimental muscle pain intensity following fatiguing calf exercise. PLoS One 2021; 16:e0253945. [PMID: 34329324 PMCID: PMC8323909 DOI: 10.1371/journal.pone.0253945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/15/2021] [Indexed: 01/11/2023] Open
Abstract
Musculoskeletal pain affects approximately 20% of the population worldwide and represents one of the leading causes of global disability. As yet, precise mechanisms underlying the development of musculoskeletal pain and transition to chronicity remain unclear, though individual factors such as sleep quality, physical activity, affective state, pain catastrophizing and psychophysical pain sensitivity have all been suggested to be involved. This study aimed to investigate whether factors at baseline could predict musculoskeletal pain intensity to an experimental delayed onset of muscle soreness (DOMS) pain model. Demographics, physical activity, pain catastrophizing, affective state, sleep quality, isometric force production, temporal summation of pain, and psychophysical pain sensitivity using handheld and cuff algometry were assessed at baseline (Day-0) and two days after (Day-2) in 28 healthy participants. DOMS was induced on Day-0 by completing eccentric calf raises on the non-dominant leg to fatigue. On Day-2, participants rated pain on muscle contraction (visual analogue scale, VAS, 0-10cm) and function (Likert scale, 0–6). DOMS resulted in non-dominant calf pain at Day-2 (3.0±2.3cm), with significantly reduced isometric force production (P<0.043) and handheld pressure pain thresholds (P<0.010) at Day-2 compared to Day-0. Linear regression models using backward selection predicted from 39.3% (P<0.003) of VAS to 57.7% (P<0.001) of Likert score variation in DOMS pain intensity and consistently included cuff pressure pain tolerance threshold (P<0.01), temporal summation of pain (P<0.04), and age (P<0.02) as independent predictive factors. The findings indicate that age, psychological and central pain mechanistic factors are consistently associated with pain following acute muscle injury.
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Affiliation(s)
| | - Emma Hertel
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | - Kristian Kjær Petersen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Megan E. McPhee
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- * E-mail:
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Atsidakou N, Matsi AE, Christakou A. The effectiveness of exercise program after lumbar discectomy surgery. J Clin Orthop Trauma 2021; 16:99-105. [PMID: 33680831 DOI: 10.1016/j.jcot.2020.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
A lumbar herniation disc appears as a major cause of lumbar pain and sciatica. The purpose of the present systematic review is to examine the effectiveness of such exercise programs on pain, disability, quality of life, strength and the assessed time required to return to work/normal activities after undergoing lumbar discectomy surgery. PubMed, MEDLINE, and Google Scholar were used for the selection of randomized controlled trials (RCTs). The PEDro scale was chosen to assess the methodological quality of the included studies. Seven RCTS met the inclusion criteria. According to the evaluation of the PEDro scale, one was considered as « high quality», five as « moderate quality» and one as « low quality». The mean score of the studies was 5.14. The results showed that after such exercise there was an improvement in pain, disability, quality of life, muscle strength and in time required to return to work. The exercise programs have a positive impact on the reduction of pain, disability, time required to return to work/normal activities as well as an increase in quality of life and muscle strength in patients with lumbar discectomy surgery.
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12
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Mustonen L, Aho T, Harno H, Kalso E. Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments. Scand J Pain 2020; 20:683-691. [PMID: 32697763 DOI: 10.1515/sjpain-2020-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/19/2020] [Indexed: 11/15/2022]
Abstract
Objectives Static mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient's daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246-56). Methods We studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test. Results SMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance. Conclusions SMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization. Implications SMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.
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Affiliation(s)
- Laura Mustonen
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Neurocenter, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Tommi Aho
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Harno
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Neurocenter, Neurology, University of Helsinki, and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Eija Kalso
- Division of Pain Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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McIntyre MH, Kless A, Hein P, Field M, Tung JY. Validity of the cold pressor test and pain sensitivity questionnaire via online self-administration. PLoS One 2020; 15:e0231697. [PMID: 32298348 PMCID: PMC7162430 DOI: 10.1371/journal.pone.0231697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/31/2020] [Indexed: 02/06/2023] Open
Abstract
To determine the feasibility of complex home-based phenotyping, 1,876 research participants from the customer base of 23andMe completed an online version of a Pain Sensitivity Questionnaire (PSQ) as well as a cold pressor test (CPT) which is used in clinical assessments of pain. Overall our online version of the PSQ performed similarly to the original pen-and-paper version. Construct validity of the PSQ total was demonstrated by internal consistency and consistent discrimination between more and less painful items. Criterion validity was demonstrated by correlation with pain sensitivity as measured by the CPT. Within the same cohort we performed a cold pressor test using a layperson description and household equipment. Comparison with published reports from controlled studies revealed similar distributions of cold pain tolerance times (i.e., time elapsed before removing the hand from the water). Of those who elected to participate in the CPT, a large majority of participants did not report issues with the test procedure or noncompliance with the instructions (97%). We confirmed a large sex difference in CPT thresholds in line with published data, such that women removed their hands from the water at a median of 54.2 seconds, with men lasting for a median time of 82.7 seconds (Kruskal-Wallis statistic, p < 0.0001), but other factors like age or current pain treatment were at most weakly associated, and inconsistently between men and women. We introduce a new paradigm for performing pain testing, called testing@home, that, in the case of cold nociception, showed comparable results to studies conducted under controlled conditions and supervision of a health care professional.
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Affiliation(s)
| | | | - Achim Kless
- Grünenthal Innovation, Grünenthal GmbH, Aachen, Germany
| | - Peter Hein
- Grünenthal Innovation, Grünenthal GmbH, Aachen, Germany
| | - Mark Field
- Grünenthal Innovation, Grünenthal GmbH, Aachen, Germany
| | - Joyce Y Tung
- 23andMe Inc., Mountain View, California, United States of America
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14
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15
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Khan J, Zusman T, Wang Q, Eliav E. Acute and chronic pain in orofacial trauma patients. Dent Traumatol 2019; 35:348-357. [PMID: 31125489 DOI: 10.1111/edt.12493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 01/07/2023]
Abstract
Trauma or injury to the dentition and supporting tissues is associated with pain and discomfort, as expected, that may present immediately, shortly afterwards, or within a few days. Pain is an essential response to injury because it allows the organism to develop avoidance behavior to potential threats and helps the organism to avoid usage of the injured organ during the healing process. Not only does external trauma induce pain, but also essential invasive dental procedures such as extractions, dental implant insertions, root canal treatments, and oral surgeries are accompanied by similar post-surgical (post-traumatic) pain. The pain intensity after trauma varies and does not always correlate with the extent of injury. Trauma to the orofacial region or the teeth may also indirectly affect and induce pain in other orofacial structures such as the masticatory muscles, the temporomandibular joint, and even the cervical spine. In most cases, the pain will resolve as soon as healing of the affected tissue occurs or after dental and routine palliative treatment. In a limited number of cases, the pain persists beyond healing and evolves into a chronic pain state. Chronic pain in the orofacial region presents diagnostic and management challenges. Misdiagnosis or delayed diagnosis of the oral chronic pain condition may lead to unnecessary dental treatment. This article will discuss diagnosis and treatment for acute and chronic pain as well as potential mechanisms involved in the undesirable transition from acute to chronic pain.
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Affiliation(s)
- Junad Khan
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Tal Zusman
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Qian Wang
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, Rochester, NY, USA
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16
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Wisløff‐Aase K, Ræder J, Månum G, Løvstad M, Schanke A, Dyb G, Ekeberg Ø, Stanghelle JK. Chronic pain among the hospitalized patients after the 22 July 2011 terror attacks in Oslo and at Utøya Island. Acta Anaesthesiol Scand 2019; 63:913-922. [PMID: 30968401 DOI: 10.1111/aas.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 01/16/2019] [Accepted: 03/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND On 22 July 2011, 48 people were hospitalized due to physical injuries from gun shots or explosion, following 2 terror attacks in the Oslo area, Norway. In this study, we have investigated the occurrence of chronic pain, the severity and consequences of chronic pain in these patients, 3 to 4 years after the incidents. METHODS Totally 43 eligible terror trauma patients were invited to participate in the study, 30 patients were included. They underwent a consultation with a psychologist and a physician; containing psychological assessment, neuropsychological screening, a standardized clinical interview, medical examination, and a pain protocol. RESULTS In 18 (60%) the injury was severe, as defined by New Injury Severity Score > 15. Twenty-four patients (80%) reported injury-related chronic pain after the trauma, in 22 with consequences on daily life. Analgesics were used by 20 patients, including 5 in need of opioids. Ten patients had unmet needs of further specialist pain care. In 12 patients, the average pain score last week was above three on a 0-10 Numeric Rating Scale. In these patients, clinical signs of neuropathic pain were evident in 10, as tested by the Douleur Neuropathique score. There were significant correlations (P < 0.05) between severity of chronic pain and presence of post-traumatic stress symptoms, reduced quality of life, reduced psychosocial and physical function; but no correlation with pre-injury patient characteristics or the degree of physical injury. CONCLUSION Chronic pain was frequent and significant, irrespective of injury severity, in these patients who obtained their physical injuries under extreme psychological conditions.
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Affiliation(s)
- Kristin Wisløff‐Aase
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Johan Ræder
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Grethe Månum
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Sunnaas Rehabilitation Hospital Nesodden Norway
| | - Marianne Løvstad
- Sunnaas Rehabilitation Hospital Nesodden Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Anne‐Kristine Schanke
- Sunnaas Rehabilitation Hospital Nesodden Norway
- Department of Psychology University of Oslo Oslo Norway
| | - Grete Dyb
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Norwegian Center for Violence and Traumatic Stress Studies Oslo Norway
| | - Øivind Ekeberg
- Division of Mental Health and Addiction Oslo University Hospital Oslo Norway
- Department of Behavioral Sciences in Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Johan Kvalvik Stanghelle
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Sunnaas Rehabilitation Hospital Nesodden Norway
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Anwar S, Cooper J, Rahman J, Sharma C, Langford R. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. Anesthesiology 2019; 131:119-31. [DOI: 10.1097/aln.0000000000002751] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.
Methods
This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg−1 · h−1. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes included acute pain, opioid use, and safety measures, as well as long-term neuropathic pain, analgesic requirement, and quality of life.
Results
In total, 150 patients were randomized, with 17 withdrawals from treatment and 2 losses to follow-up but with data analyzed for all participants on an intention-to-treat basis. The prevalence of pain was lower at 3 postoperative months for pregabalin alone (6% [3 of 50]) and in combination with ketamine (2% [1 of 50]) compared to the control group (34% [17 of 50]; odds ratio = 0.126 [0.022 to 0.5], P = 0.0008; and 0.041 [0.0009 to 0.28], P < 0.0001, respectively) and at 6 months for pregabalin alone (6% [3 of 50]) and in combination with ketamine 0% (0 of 5) compared to the control group (28% [14 of 50]; odds ratio = 0.167 [0.029 to 0.7], P = 0.006; and 0.000 [0 to 0.24], P < 0.0001). Diplopia was more common in both active arms.
Conclusions
Preoperative administration of 150 mg of pregabalin and postoperative continuation twice daily for 14 days significantly lowered the prevalence of persistent pain after cardiac surgery.
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Skrejborg P, Petersen KK, Kold S, Kappel A, Pedersen C, Østgaard SE, Simonsen O, Arendt-nielsen L. Presurgical Comorbidities as Risk Factors For Chronic Postsurgical Pain Following Total Knee Replacement. Clin J Pain 2019; 35:577-82. [DOI: 10.1097/ajp.0000000000000714] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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19
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Mustonen L, Aho T, Harno H, Sipilä R, Meretoja T, Kalso E. What makes surgical nerve injury painful? A 4-year to 9-year follow-up of patients with intercostobrachial nerve resection in women treated for breast cancer. Pain 2019; 160:246-56. [PMID: 30234699 DOI: 10.1097/j.pain.0000000000001398] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nerve injury during breast cancer surgery can cause neuropathic pain (NP). It is not known why some, but not all, patients develop chronic postsurgical neuropathic pain (CPSNP) after the same nerve injury. In this study, we examined 251 breast cancer survivors with surgeon-verified intercostobrachial nerve resection to identify factors that associate with CPSNP. The patients were recruited from a previous study of 1000 women treated for breast cancer in 2006 to 2010. This enabled us to analyze preoperative factors that associate with future CPSNP. The patients were re-examined in 2014 to 2016 to diagnose CPSNP using the revised NP diagnostic criteria. Preoperative assessments were pain in the area to be operated on, any chronic pain condition, depressive symptoms, anxiety, sleep, and experimental cold pain sensitivity using the cold pressor test (CPT). Follow-up assessments were CPT, psychological factors, sleep, any chronic pain, and basic laboratory tests. One hundred thirty-seven (55%) patients with intercostobrachial nerve resection fulfilled CPSNP diagnostic criteria after 4 to 9 years. Of them, 30 patients (22%) had moderate to severe pain in self-reports and 86 (63%) presented moderate to severe evoked pain at examination. Preoperative pain in the surgical area, other chronic pains, and breast-conserving surgery were associated with future CPSNP. Other chronic pains, increased psychological burden, and insomnia, both before surgery and at the follow-up, were associated with CPSNP. Preoperative CPT did not associate with future CPSNP. Patients with established CPSNP showed increased pain sensitivity in CPT and higher levels of inflammatory markers, suggesting that central sensitization and inflammation may associate with the maintenance of CPSNP.
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Abstract
The conceptualization of placebo has changed from inactive pills to a detailed understanding of how patients' perception of receiving a treatment influences pain processing and overall treatment outcome. Large placebo effects were recently demonstrated in chronic neuropathic pain, thereby opening the question of whether placebo effects also apply to orofacial neuropathic pain. In this article, we review the new definitions, magnitude, and social, psychological, neurobiologic, and genetic mechanisms of placebo effects in pain, especially neuropathic pain, to illustrate that placebo effects are not simply response bias but psychoneurobiological phenomena that can be measured at many levels of the neuroaxis. We use this knowledge to carefully illustrate how patients' perceptions of the treatment, the relationship with the health care provider, and the expectations and emotions toward a treatment can influence test and treatment outcome and potentially skew the results if they are not taken into consideration. Orofacial neuropathic pain is a new research area, and we review the status on definition, diagnosis, mechanisms, and pharmacologic treatment of neuropathic pain after trigeminal nerve injury, as this condition may be especially influenced by placebo factors. Finally, we have a detailed discussion of how knowledge of placebo mechanisms may help improve the understanding, diagnosis, and treatment of orofacial neuropathic pain, and we illustrate pitfalls and opportunities of applying this knowledge to the test of dental treatments.
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Affiliation(s)
- L Vase
- 1 Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - L Baad-Hansen
- 2 Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,3 Scandinavian Center of Orofacial Neurosciences, Aarhus, Denmark / Malmö, Sweden
| | - M Pigg
- 3 Scandinavian Center of Orofacial Neurosciences, Aarhus, Denmark / Malmö, Sweden.,4 Department of Endodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Freeman R, Edwards R, Baron R, Bruehl S, Cruccu G, Dworkin RH, Haroutounian S. AAPT Diagnostic Criteria for Peripheral Neuropathic Pain: Focal and Segmental Disorders. J Pain 2018; 20:369-393. [PMID: 30527971 DOI: 10.1016/j.jpain.2018.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Abstract
Peripheral neuropathic pain is among the most prevalent types of neuropathic pain. No comprehensive peripheral neuropathic pain classification system that incorporates contemporary clinical, diagnostic, biological, and psychological information exists. To address this need, this article covers the taxonomy for 4 focal or segmental peripheral neuropathic pain disorders, as part of the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public-private partnership and the American Pain Society (APS) collaborative to develop a standardized, evidence-based taxonomy initiative: the ACTTION-APS Pain Taxonomy (AAPT). The disorders-postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia-were selected because of their clinical and clinical research relevance. The multidimensional features of the taxonomy are suitable for clinical trials and can also facilitate hypothesis-driven case-control and cohort epidemiologic studies. PERSPECTIVE: The AAPT peripheral neuropathic pain taxonomy subdivides the peripheral neuropathic pain disorders into those that are generalized and symmetric and those that are focal or segmental and asymmetric. In this article, we cover the focal and segmental disorders: postherpetic neuralgia, persistent posttraumatic neuropathic pain, complex regional pain disorder, and trigeminal neuralgia. The taxonomy is evidence-based and multidimensional, with the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical and psychiatric comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors.
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Affiliation(s)
- Roy Freeman
- Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Robert Edwards
- Department of Anesthesiology, Brigham & Women's Hospital, Harvard University School of Medicine, Boston, MA
| | - Ralf Baron
- University of Kiel, Division of Neurological Pain Research and Therapy, Department of Neurology, Kiel, Germany
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Giorgio Cruccu
- Department Human Neuroscience, Sapienza University, Rome, Italy
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Simon Haroutounian
- Department of Anesthesiology and Washington University Pain Center, Washington University School of Medicine, St Louis, MO
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Rosseland R, Pallesen S, Nordhus IH, Matre D, Blågestad T. Effects of Sleep Fragmentation and Induced Mood on Pain Tolerance and Pain Sensitivity in Young Healthy Adults. Front Psychol 2018; 9:2089. [PMID: 30429815 PMCID: PMC6220068 DOI: 10.3389/fpsyg.2018.02089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Experimental research exploring the sleep/pain-relationship has typically focused on total or partial sleep deprivation, hereby failing to reproduce the mere fragmented sleep pattern typically observed in patients with chronic pain. Further, little research is done on how affect moderates the sleep–pain relationship after sleep fragmentation. The present study sought to clarify the relationship between pain, sleep and positive and negative affect. Methods: In an experimental counterbalanced crossover design, 35 healthy young adults were subjected to several pain measures after one night of fragmented sleep, compared to one control night of normal sleep, both conducted in their own homes, and respectively, positive and negative affect induction using validated film clips and facial feedback procedures. Sleep was monitored using sleep diaries. Results: Increased pain sensitivity after one night of experimentally induced sleep fragmentation was found, compared to after one control night of undisturbed sleep. No main effects of induced affect on pain were found, and sleep x induced affect interaction was not significant. Conclusion: The present study supports the adverse effect of sleep fragmentation on pain sensitivity, however, affect was not found to be a moderator in the sleep–pain relationship. The results underline the need for further research within this field.
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Affiliation(s)
- Ragna Rosseland
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Inger Hilde Nordhus
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Dagfinn Matre
- Department of Work Psychology and Physiology, National Institute of Occupational Health, Oslo, Norway
| | - Tone Blågestad
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Beloeil H, Sion B, Rousseau C, Albaladejo P, Raux M, Aubrun F, Martinez V. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol 2018; 34:652-657. [PMID: 28437260 DOI: 10.1097/eja.0000000000000634] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acute neuropathic pain can occur in the postoperative period but any link with persistent post-surgical neuropathic pain remains unclear. OBJECTIVES The objectives of this study were to prospectively describe the incidence of acute post-surgical neuropathic pain in a large population using the DN4 (clinician administered) questionnaire and to confirm the hypothetical link between acute and persistent neuropathic pain at 2 months after surgery in a large population using the DN2 (self administered) questionnaire. DESIGN A multi-centre, prospective and observational trial. SETTING Two consecutive days in 27 hospitals in France. PATIENTS Six hundred and eight patients undergoing 13 different types of surgery. Fifteen patients were excluded as data were incomplete, and 229 (38.6%) and 260 (43.8%) were not contactable for assessment at 1 and 2 months after surgery, respectively. MAIN OUTCOME MEASURES Pain was evaluated at least 2 h postoperatively on the same day (D0),on the second day (D2) and at 1 and 2 months after surgery (M1 and M2). Pain was assessed using a 10-point Numeric Rating Scale. If the Numeric Rating Scale score was greater than 0, neuropathic pain was assessed using a DN4 (clinician administered) questionnaire or using a DN2 (self-administered) questionnaire. Acute and persistent postsurgical neuropathic pain (PPSNP) were defined respectively by a DN4 score at least 4/10 on day 0 and/or day 2 and a DN2 score at least 3/7 at 2 months after surgery. RESULTS Of the 593 patients included, 41.2% were in pain before surgery and 8.2% described neuropathic pain. Early after surgery, the majority of the 593 patients (72.2% on the day of surgery and 71.3% on day 2) experienced acute pain. It was neuropathic in nature in 5.6% of patients (95% CI, 3.6 to 8.3) on the day of surgery and 12.9% (95% CI, 9.7 to 16.7) on day 2. Two months after surgery, PPSNP was present in 33.3% of the 333 patients assessed. Multivariate analysis showed that a DN4 score at least 4/10 on the day of surgery or on day 2 was a significant risk factor for PPSNP [odds ratios 4.22 (95% CI, 2.19 to 8.12)]. CONCLUSION Our results suggest that early acute postsurgical neuropathic pain significantly increases the risk of persistent post-surgical neuropathic pain. TRIAL REGISTRATION Clinicaltrials.gov identifier: NTC NCT02826317.
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Affiliation(s)
- Helene Beloeil
- From the CHU Rennes, Pôle Anesthésie et Réanimation, Inserm, UMR 991, CIC 1414 and Université de Rennes 1 (HB), CHU Rennes, Pôle Anesthésie et Réanimation (BS), CHU Rennes, Inserm CIC 1414, Rennes (CR), Pôle Anesthésie Réanimation CHU de Grenoble BP217, Grenoble Cedex 9 (PA), Département d'Anesthésie Réanimation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris (MR), Hospices civils de Lyon, Université Lyon 1, Groupement hospitalier Nord, Hôpital de la Croix Rousse, Lyon (FA), Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, AP-HP (VM); and INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Paris, France (VM)
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Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend 2018; 187:61-65. [PMID: 29627407 PMCID: PMC5991834 DOI: 10.1016/j.drugalcdep.2018.02.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Knowledge of incidence and risk factors for long-term opioid prescribing is critical for surgical patients. In this retrospective cohort study, we linked information available at the time of surgery with prescription data to ascertain characteristics associated with prolonged opioid therapy. METHODS Patients (n = 6003) with claims in the Colorado All Payer Claims Database (APCD) were matched with 20,501 encounters in a clinical database. Rates of prescription filling were defined by at least one monthly opioid claim relative to the date of surgery. Associations of variables with claims during months 2-6 post-operatively ("long-term prescription filling") were evaluated, and significant variables were jointly modeled using binomial regression. RESULTS Rates of patients filling opioid prescriptions preoperatively [month (M) relative to date of surgery] were 22%(-3 M), 24%(-2 M), and 27%(-1 M); after surgery, opioid fill rates were 62%(1 M), 28%(2 M), 24%(3), 24%(4 M), 23%(5 M), and 22%(6 M). The majority, 71-76%, of patients filling prescriptions in months 2-6 after surgery had also filled before surgery. In the binomial regression model, long-term opioid use was associated with prior opioid use (p < 0.0001), age ≥26 to <65 relative to age ≥ 65 (p < 0.0001), orthopedic surgery (p = 0.001), colorectal surgery (p = 0.003), multiple procedures (p < 0.0001), and worse physical status classification (p < 0.0001). CONCLUSIONS Patients who had filled opioid prescriptions preoperatively comprised the majority of the group who filled long-term prescriptions. Surgical procedures were associated with discontinuation of previous opioid prescribing in some patients. For others, surgery marked the initiation of prolonged opioid therapy. Surgical encounters should include interventions aimed to reduce long-term opioid use.
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Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA.
| | - Ana Fernandez-Bustamante
- Department of Anesthesiology, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Shannon K McWilliams
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Christian J Hopfer
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA
| | - Susan K Mikulich-Gilbertson
- Department of Psychiatry, Division of Substance Dependence, University of Colorado, School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA; Department of Biostatistics and Informatics, University of Colorado, School of Public Health, Anschutz Medical Campus, 13001 East 17th Place, Aurora, CO, 80045, USA
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Stubhaug A. Why are some patients with chronic pain from anterior abdominal nerve entrapment syndrome (ACNES) refractory to peripheral treatment with neurectomy? Scand J Pain 2017; 14:80-81. [PMID: 28850439 DOI: 10.1016/j.sjpain.2016.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Audun Stubhaug
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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Luna IE, Kehlet H, Petersen MA, Aasvang EK. Clinical, nociceptive and psychological profiling to predict acute pain after total knee arthroplasty. Acta Anaesthesiol Scand 2017; 61:676-687. [PMID: 28508511 DOI: 10.1111/aas.12899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Pre-operative identification of high-pain responders for acute pain after total knee arthroplasty (TKA) could lead to targeted analgesic trials and individualized analgesic strategies to improve recovery and potentially reduce the risk of persistent post-surgical pain. The aim of this study was to use simple clinical tests and questionnaires to identify predictive nociceptive and psychological factors for acute post-TKA pain. METHODS Sixty consecutive TKA patients were included in a prospective descriptive study of pain during a 5-m walk-test 24 h post-operatively as the primary outcome. Predictive variables collected prior to surgery included demographics, nociceptive testing (pressure pain threshold (PPT), cold pressor tolerance, electrical pain threshold and tolerance) and psychological profile (pain catastrophizing scale (PCS) and hospital anxiety and depression scale). The prediction of acute post-TKA pain was assessed by univariate analysis, logistic regressions and ROC curves. RESULTS Reduced PPT on the arm and increased PCS were predictive variables for moderate/severe post-TKA pain 24 h after surgery (P = 0.007 and P = 0.026, respectively, R-squared 0.21) in the logistic regression model. Odds ratios were 0.67 for a 50 kPa increased PPT and 1.36 for a 5 point increase in PCS. A predictive model with cut-off values of PPT ≤ 245 kPa and PCS≥ 8 point had a sensitivity of 71.4 and a specificity of 62.5. CONCLUSION Pre-operative widespread pressure pain hypersensitivity and pain catastrophizing are predictive of moderate severe post-TKA pain. If validated in a larger population, the clinically applicable tests should be considered in future interventions aiming to minimize post-operative pain in high-risk patients.
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Affiliation(s)
- I. E. Luna
- Section of Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- The Lundbeck Centre for fast-track Hip and Knee Arthroplasty; Copenhagen Denmark
- Department of Orthopaedics; Gentofte-Herlev Hospital; University of Copenhagen; Hellerup Denmark
| | - H. Kehlet
- Section of Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- The Lundbeck Centre for fast-track Hip and Knee Arthroplasty; Copenhagen Denmark
| | - M. A. Petersen
- The Research Unit; Department of Palliative Medicine; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - E. K. Aasvang
- Section of Surgical Pathophysiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- The Lundbeck Centre for fast-track Hip and Knee Arthroplasty; Copenhagen Denmark
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Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW. Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. J Physiother 2017; 63:144-153. [PMID: 28668558 DOI: 10.1016/j.jphys.2017.05.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 01/24/2023] Open
Abstract
QUESTION Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral? DESIGN Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis. PARTICIPANTS Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level. INTERVENTION Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge. OUTCOME MEASURES In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery. RESULTS There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95% CI 0.6 to 1.7), functional status (MD 1.5, 95% CI -3.6 to 6.7), leg pain (MD 0.1, 95% CI -0.7 to 0.8), back pain (MD 0.3, 95% CI -0.3 to 0.9), physical health (MD -3.5, 95% CI -11.3 to 4.3), and mental health (MD -4.1, 95% CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95% CI -0.02 to 0.04 points) and societal costs (MD -€527, 95% CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year. CONCLUSION Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral. TRIAL REGISTRATION Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy 63: 144-153].
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Affiliation(s)
- Teddy Oosterhuis
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam; Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden; Department of Neurosurgery, Medical Center Haaglanden, The Hague, the Netherlands
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam
| | | | - Mark P Arts
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, the Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam; the EMGO+ Institute for Health and Care Research, Amsterdam
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Samuelsen PJ, Nielsen CS, Wilsgaard T, Stubhaug A, Svendsen K, Eggen AE. Pain sensitivity and analgesic use among 10,486 adults: the Tromsø study. BMC Pharmacol Toxicol 2017; 18:45. [PMID: 28599683 DOI: 10.1186/s40360-017-0149-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/24/2017] [Indexed: 12/11/2022] Open
Abstract
Background Increased pain sensitivity is a putative risk factor for chronic pain and consequently for analgesic use. Conversely, analgesic use may be a cause of increased pain sensitivity, e.g., through opioid-induced hyperalgesia. We aimed to study the association between pain sensitivity and analgesic use in a general population, and to test the hypothesis that increased baseline pain sensitivity is a risk factor for future persistent analgesic use. Methods The Tromsø Study (2007–08), a population-based health study, was linked with eight years of prescription data from the Norwegian Prescription Database. The cold pressor test was completed in 10,486 participants aged 30+ years, and we used cold pressor endurance time as a proxy measure of pain sensitivity. Cross-sectional associations with different measures of analgesic use were assessed. Furthermore, a cohort of 9,657 persons was followed for 4.5 years. Results In the cross-sectional analysis, increased pain sensitivity was associated with analgesic use; regular users of opioids alone were more pain sensitive than regular users of non-opioid analgesics. Increased baseline pain sensitivity was a risk factor for persistent analgesic use, i.e., using non-steroidal anti-inflammatory drugs, paracetamol, or opioids for ≥ 90 days and proportion-of-days-covered ≥ 40% (HR = 1.22, 95% CI 1.06-1.40), although not statistical significant after confounder adjustment. Conclusions Increased pain sensitivity was associated with analgesic use in general, and reduced pain tolerance was found for both opioid and non-opioid analgesic users. The data suggest that hyperalgesia is an effect of analgesics, whereas pain tolerance has little impact on future analgesic use. Electronic supplementary material The online version of this article (doi:10.1186/s40360-017-0149-2) contains supplementary material, which is available to authorized users.
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29
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Yoshino A, Okamoto Y, Doi M, Otsuru N, Okada G, Takamura M, Ichikawa N, Yokoyama S, Yamashita H, Yamawaki S. Regional brain functions in the resting state indicative of potential differences between depression and chronic pain. Sci Rep 2017; 7:3003. [PMID: 28592893 PMCID: PMC5462802 DOI: 10.1038/s41598-017-03522-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 05/02/2017] [Indexed: 01/03/2023] Open
Abstract
Complex relationships between depression and chronic pain have been reported in previous studies. However, only a few neuroimaging studies have investigated similarities and differences in neural systems underlying them. We examined the brain functions in the resting state of 43 patients with depression, 41 patients with chronic pain (somatoform pain disorder) and 41 healthy controls, by using regional homogeneity (ReHo) and functional connectivity analysis. Depressive symptoms were assessed by using the Beck Depression Inventory-Second Edition (BDI-II). ReHo values for the dorsolateral prefrontal cortex (DLPFC) significantly decreased for chronic pain patients, and functional connectivity between the DLPFC and thalamus decreased only for these patients. These findings are indicative of distinct brain functions related to depression and chronic pain. Understanding these differences would further elucidate the pathophysiology of these conditions.
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Affiliation(s)
- Atsuo Yoshino
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Yasumasa Okamoto
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Mitsuru Doi
- Department of Dental Anesthesiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naofumi Otsuru
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimamichou, Kita-ku, Niigata, 950-3198, Japan
| | - Go Okada
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masahiro Takamura
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naho Ichikawa
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Satoshi Yokoyama
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hidehisa Yamashita
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shigeto Yamawaki
- Department of Psychiatry and Neurosciences, Division of Frontier Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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30
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Abstract
Background and purpose There is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. Methods Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. Results The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. Conclusion This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain.
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Affiliation(s)
- Berit Taraldsen Valeberg
- Department of Nursing and Health promotion, Oslo and Akershus University College of Applied Sciences
| | - Linda Margareth Pedersen
- Research and communication unit for musculoskeletal health (FORMI).,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Valentina Girotto
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Vivi Lycke Christensen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Werner MU, Jensen EK, Stubhaug A. Preoperative quantitative sensory testing (QST) predicting postoperative pain: Image or mirage? Scand J Pain 2017; 15:91-2. [DOI: 10.1016/j.sjpain.2017.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Schistad EI, Stubhaug A, Furberg A, Engdahl BL, Nielsen CS. C-reactive protein and cold-pressor tolerance in the general population: the Tromsø Study. Pain 2017; 158:1280-8. [DOI: 10.1097/j.pain.0000000000000912] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Meretoja TJ, Andersen KG, Bruce J, Haasio L, Sipilä R, Scott NW, Ripatti S, Kehlet H, Kalso E. Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery. J Clin Oncol 2017; 35:1660-1667. [PMID: 28524782 DOI: 10.1200/jco.2016.70.3413] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Persistent pain after breast cancer surgery is a well-recognized problem, with moderate to severe pain affecting 15% to 20% of women at 1 year from surgery. Several risk factors for persistent pain have been recognized, but tools to identify high-risk patients and preventive interventions are missing. The aim was to develop a clinically applicable risk prediction tool. Methods The prediction models were developed and tested using three prospective data sets from Finland (n = 860), Denmark (n = 453), and Scotland (n = 231). Prediction models for persistent pain of moderate to severe intensity at 1 year postoperatively were developed by logistic regression analyses in the Finnish patient cohort. The models were tested in two independent cohorts from Denmark and Scotland by assessing the areas under the receiver operating characteristics curves (ROC-AUCs). The outcome variable was moderate to severe persistent pain at 1 year from surgery in the Finnish and Danish cohorts and at 9 months in the Scottish cohort. Results Moderate to severe persistent pain occurred in 13.5%, 13.9%, and 20.3% of the patients in the three studies, respectively. Preoperative pain in the operative area ( P < .001), high body mass index ( P = .039), axillary lymph node dissection ( P = .008), and more severe acute postoperative pain intensity at the seventh postoperative day ( P = .003) predicted persistent pain in the final prediction model, which performed well in the Danish (ROC-AUC, 0.739) and Scottish (ROC-AUC, 0.740) cohorts. At the 20% risk level, the model had 32.8% and 47.4% sensitivity and 94.4% and 82.4% specificity in the Danish and Scottish cohorts, respectively. Conclusion Our validated prediction models and an online risk calculator provide clinicians and researchers with a simple tool to screen for patients at high risk of developing persistent pain after breast cancer surgery.
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Affiliation(s)
- Tuomo J Meretoja
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Kenneth Geving Andersen
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Julie Bruce
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Lassi Haasio
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Reetta Sipilä
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Neil W Scott
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Samuli Ripatti
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Henrik Kehlet
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
| | - Eija Kalso
- Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, and Eija Kalso, Helsinki University Hospital; Tuomo J. Meretoja, Lassi Haasio, Reetta Sipilä, Samuli Ripatti, and Eija Kalso, University of Helsinki, Helsinki, Finland; Kenneth Geving Andersen and Henrik Kehlet, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Julie Bruce, University of Warwick, Coventry; and Neil W. Scott, University of Aberdeen, Aberdeen, United Kingdom
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Abstract
INTRODUCTION Pain management after surgery continues to be suboptimal; there are several reasons including lack of translation of results from basic science studies and scientific clinical evidence into clinical praxis. OBJECTIVES This review presents and discusses basic science findings and scientific evidence generated within the last 2 decades in the field of acute postoperative pain. METHODS In the first part of the review, we give an overview about studies that have investigated the pathophysiology of postoperative pain by using rodent models of incisional pain up to July 2016. The second focus of the review lies on treatment recommendations based on guidelines and clinical evidence, eg, by using the fourth edition of the "Acute Pain Management: Scientific Evidence" of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. RESULTS Preclinical studies in rodent models characterized responses of primary afferent nociceptors and dorsal horn neurons as one neural basis for pain behavior including resting pain, hyperalgesia, movement-evoked pain or anxiety- and depression-like behaviors after surgery. Furthermore, the role of certain receptors, mediators, and neurotransmitters involved in peripheral and central sensitization after incision were identified; many of these are very specific, relate to some modalities only, and are unique for incisional pain. Future treatment should focus on these targets to develop therapeutic agents that are effective for the treatment of postoperative pain as well as have few side effects. Furthermore, basic science findings translate well into results from clinical studies. Scientific evidence is able to point towards useful (and less useful) elements of multimodal analgesia able to reduce opioid consumption, improve pain management, and enhance recovery. CONCLUSION Understanding basic mechanisms of postoperative pain to identify effective treatment strategies may improve patients' outcome after surgery.
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Affiliation(s)
- Esther M. Pogatzki-Zahn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Muenster, Muenster, Germany
| | - Daniel Segelcke
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital of Muenster, Muenster, Germany
| | - Stephan A. Schug
- Pharmacology, Pharmacy and Anaesthesiology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Øhrn AM, Nielsen CS, Schirmer H, Stubhaug A, Wilsgaard T, Lindekleiv H. Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population-Based, Cross-Sectional Study. J Am Heart Assoc 2016; 5:e003846. [PMID: 28003255 PMCID: PMC5210406 DOI: 10.1161/jaha.116.003846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/26/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Unrecognized myocardial infarction (MI) is a prevalent condition associated with a similar risk of death as recognized MI. It is unknown why some persons experience MI with few or no symptoms; however, one possible explanation is attenuated pain sensitivity. To our knowledge, no previous study has examined the association between pain sensitivity and recognition of MI. METHODS AND RESULTS We conducted a population-based cross-sectional study with 4849 included participants who underwent the cold pressor test (a common experimental pain assay) and ECG. Unrecognized MI was present in 387 (8%) and recognized MI in 227 (4.7%) participants. Participants with unrecognized MI endured the cold pressor test significantly longer than participants with recognized MI (hazard ratio for aborting the cold pressor test, 0.64; CI, 0.47-0.88), adjusted for age and sex. The association was attenuated and borderline significant after multivariable adjustment. The association between unrecognized MI and lower pain sensitivity was stronger in women than in men, and statistically significant in women only, but interaction testing was not statistically significant (P for interaction=0.14). CONCLUSIONS Our findings suggest that persons who experience unrecognized MI have reduced pain sensitivity compared with persons who experience recognized MI. This may partially explain the lack of symptoms associated with unrecognized MI.
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Affiliation(s)
- Andrea Milde Øhrn
- Faculty of Health Sciences, University of Tromsø, Norway
- Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | - Henrik Schirmer
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Tom Wilsgaard
- Faculty of Health Sciences, University of Tromsø, Norway
| | - Haakon Lindekleiv
- Faculty of Health Sciences, University of Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
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36
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Abstract
In this longitudinal population study, the aims were to study associations of mode of delivery with new onset of pelvic pain and changes in pelvic pain scores up to 7 to 18 months after childbirth. We included 20,248 participants enrolled in the Norwegian Mother and Child Cohort Study (1999-2008) without preexisting pelvic pain in pregnancy. Data were obtained by 4 self-administered questionnaires and linked to the Medical Birth Registry of Norway. A total of 4.5% of the women reported new onset of pelvic pain 0 to 3 months postpartum. Compared to unassisted vaginal delivery, operative vaginal delivery was associated with increased odds of pelvic pain (adjusted odds ratio [OR]: 1.30; 95% confidence interval [CI]: 1.06-1.59). Planned and emergency cesarean deliveries were associated with reduced odds of pelvic pain (adjusted OR: 0.48; 95% CI: 0.31-0.74 and adjusted OR: 0.65; 95% CI: 0.49-0.87, respectively). Planned cesarean delivery, young maternal age, and low Symptom Checklist-8 scores were associated with low pelvic pain scores after childbirth. A history of pain was the only factor associated with increased pelvic pain scores over time (P = 0.047). We conclude that new onset of pelvic pain after childbirth was not commonly reported, particularly following cesarean delivery. Overall, pelvic pain scores were rather low at all time points and women with a history of pain reported increased pelvic pain scores over time. Hence, clinicians should follow up women with pelvic pain after a difficult childbirth experience, particularly if they have a history of pain.
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Affiliation(s)
- Elisabeth Krefting Bjelland
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway Domain for Mental and Physical Health, Norwegian Institute of Public Health, Norway Department of Public Health and Caring Sciences, Uppsala University, Sweden Norwegian National Advisory Unit on Women's Health, Division of Women and Children, Oslo University Hospital Rikshospitalet, Norway Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway
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Tham SW, Palermo TM, Holley AL, Zhou C, Stubhaug A, Furberg AS, Nielsen CS. A population-based study of quantitative sensory testing in adolescents with and without chronic pain. Pain 2016; 157:2807-2815. [PMID: 27780176 DOI: 10.1097/j.pain.0000000000000716] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Quantitative sensory testing (QST) has been used to characterize pain sensitivity in individuals with and without pain conditions. Research remains limited in pediatric populations, hindering the ability to expand the utility of QST toward its potential application in clinical settings and clinical predictive value. The aims of this study were to examine pain sensitivity using QST in adolescents with chronic pain compared to adolescents without chronic pain and identify predictors of pain sensitivity. A population-based study conducted from 2010 to 2011 provided data on 941 adolescents, 197 were classified as having chronic pain and 744 were classified without chronic pain. Self-reported data on pain characteristics, psychological functioning, and QST responses were examined. The findings revealed lower pressure pain threshold and tolerance on the trapezius (P's = 0.03) in adolescents with chronic pain compared to adolescents without chronic pain, but no differences on heat or cold-pressor pain tasks. Female sex (P's = 0.02) and poorer psychological functioning (P's = 0.02) emerged as significant predictors of greater pain sensitivity across all pain modalities. Exploratory analyses revealed several associations between clinical pain characteristics and QST responses within the chronic pain cohort. Findings from this large pediatric sample provide comprehensive data that could serve as normative data on QST responses in adolescents with and without chronic pain. These findings lay the groundwork toward developing future QST research and study protocols in pediatric populations, taking into consideration sex and psychological distress.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, WA, USA
| | - Amy Lewandowski Holley
- Institute of Development and Disability, Oregon Health & Science University, Portland, OR, USA
| | - Chuan Zhou
- Seattle Children's Research Institute, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, WA, USA
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Anne-Sofie Furberg
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Christopher Sivert Nielsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Department of Ageing and Health, Norwegian Institute of Public Health, Oslo, Norway
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Ruan X, Kaye AD. Disclosure without or with reservation? Contemplating the development of persistent postsurgical pain due to nocebo effect. Am J Surg 2016; 212:1029-1030. [PMID: 27416808 DOI: 10.1016/j.amjsurg.2016.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Xiulu Ruan
- Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Ave., New Orleans, LA 70112, USA
| | - Alan David Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center, 1542 Tulane Ave., New Orleans, LA 70112, USA
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Johansen A, Schirmer H, Nielsen CS, Stubhaug A. Persistent post-surgical pain and signs of nerve injury: the Tromsø Study. Acta Anaesthesiol Scand 2016; 60:380-92. [PMID: 26537886 DOI: 10.1111/aas.12653] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 06/20/2015] [Accepted: 08/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The contribution of nerve lesions and neuropathic pain to persistent post-surgical pain (PPSP) is poorly established. The aim of this study was to assess the association between PPSP and symptoms and signs of possible nerve injury in an unselected surgical sample. METHODS Eighty-one individuals with and without persistent pain after surgical procedures, were recruited from a cross-sectional study. Follow-up examination with questionnaires and quantitative sensory testing was performed 15-32 months later (21-64 months after surgery). RESULTS The median rating of maximum pain intensity among individuals with PPSP decreased from numerical rating scale 4/10 at baseline to 2/10 at follow-up, but considerable changes occurred in both directions. Individuals with PPSP at follow-up were significantly more likely to self-report sensory abnormalities than those without PPSP; however, results from sensory testing did not differ significantly between the groups. Self-report of sensory disturbances at the site of surgery was associated with increased warm detection thresholds and tactile pain thresholds. Among individuals with PPSP, 61% had positive findings on sensory testing, suggesting probable neuropathic pain. CONCLUSION In this study, associations between self-reported symptoms and PPSP were stronger than associations between self-reported symptoms and results of psychophysical tests. Fluctuations in pain intensity together with wide ranges for normal variability in sensory functions, hampers detection of significant group differences. Methodological aspects of quantitative sensory testing applied in a mixed clinical sample are discussed.
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Affiliation(s)
- A. Johansen
- Division of Surgical Medicine and Intensive Care; University Hospital of North Norway; Tromsø Norway
- Department of Community Medicine; The Arctic University of Norway; Tromsø Norway
| | - H. Schirmer
- Division of Cardiothoracic and Respiratory Medicine; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Medicine; The Arctic University of Norway; Tromsø Norway
| | - C. S. Nielsen
- Division of Mental Health; Norwegian Institute of Public Health; Oslo Norway
- Department of Pain Management and Research; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
| | - A. Stubhaug
- Department of Pain Management and Research; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
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Shabes P, Schloss N, Magerl W, Schmahl C, Treede RD, Baumgärtner U. A novel human surrogate model of noninjurious sharp mechanical pain. Pain 2016; 157:214-224. [DOI: 10.1097/j.pain.0000000000000352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pokkinen SM, Nieminen K, Yli-Hankala A, Kalliomäki ML. Characterization of persistent pain after hysterectomy based on gynaecological and sensory examination. Scand J Pain 2015; 11:42-48. [PMID: 28850468 DOI: 10.1016/j.sjpain.2015.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/22/2015] [Accepted: 11/18/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Previous studies have shown that pelvic pain is common after hysterectomy. It is stated that only a minor part of that pain can be defined as persistent postsurgical pain. Our primary aim was to find out if the pelvic pain after hysterectomy may be classified as postsurgical. Secondary aims were to characterize the nature of the pain and its consequences on the health related quality of life. METHODS We contacted the 56 women, who had reported having persistent pelvic pain six months after hysterectomy in a previously sent questionnaire. Sixteen women participated. Clinical examinations included gynaecological examination and clinical sensory testing. Patients also filled in quality of life (SF-36) and pain questionnaires. RESULTS Ten out of sixteen patients still had pain at the time of examination. In nine patients, pain was regarded as persistent postsurgical pain and assessed probable neuropathic for five patients. There were declines in all scales of the SF-36 compared with the Finnish female population cohort. CONCLUSIONS In this study persistent pelvic pain after vaginal or laparoscopic hysterectomy could be defined as persistent postsurgical pain in most cases and it was neuropathic in five out of nine patients. Pain had consequences on the health related quality of life. IMPLICATIONS Because persistent postsurgical pain seems to be the main cause of pelvic pain after hysterectomy, the decision of surgery has to be considered carefully. The management of posthysterectomy pain should be based on the nature of pain and the possibility of neuropathic pain should be taken into account at an early postoperative stage.
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Affiliation(s)
- Satu M Pokkinen
- Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland. Pokkinen.Satu.M.@student.uta.fi
| | - Kari Nieminen
- Department of Obstetrics and Gynaecology, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
| | - Arvi Yli-Hankala
- Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland; University of Tampere, School of Medicine, FI-33014 University of Tampere, Finland
| | - Maija-Liisa Kalliomäki
- Department of Anaesthesia, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
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Pereira MP, Donahue RR, Dahl JB, Werner M, Taylor BK, Werner MU. Endogenous Opioid-Masked Latent Pain Sensitization: Studies from Mouse to Human. PLoS One 2015; 10:e0134441. [PMID: 26305798 PMCID: PMC4549112 DOI: 10.1371/journal.pone.0134441] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 06/08/2015] [Indexed: 01/20/2023] Open
Abstract
Following the resolution of a severe inflammatory injury in rodents, administration of mu-opioid receptor inverse agonists leads to reinstatement of pain hypersensitivity. The mechanisms underlying this form of latent pain sensitization (LS) likely contribute to the development of chronic pain, but LS has not yet been demonstrated in humans. Using a C57BL/6 mouse model of cutaneous mild heat injury (MHI) we demonstrated a dose-dependent reinstatement of pain sensitization, assessed as primary (P < 0.001) and secondary hyperalgesia (P < 0.001) by naloxone (0.3–10 mg/kg), 168 hrs after the induction of MHI. Forward-translating the dose data to a human MHI model (n = 12) we could show that LS does indeed occur after naloxone 2 mg/kg, 168 hrs after a MHI. Our previous unsuccessful efforts to demonstrate unmasking of LS in humans are thus likely explained by an insufficient naloxone dose (0.021 mg/kg). However, while LS was consistently demonstrated in 21/24 mice, LS was only seen in 4/12 subjects. This difference is likely due to selection bias since the C57BL/6 mouse strain exhibits markedly enhanced pain sensitivity in assays of acute thermal nociception. Future exploratory studies in humans should prioritize inclusion of “high-sensitizers” prone to develop LS and use post-surgical models to elucidate markers of vulnerability to chronic postsurgical pain.
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Affiliation(s)
- Manuel P. Pereira
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Renee R. Donahue
- Department of Physiology, University of Kentucky, Lexington, KY, United States of America
| | - Jørgen B. Dahl
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Werner
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Bradley K. Taylor
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
| | - Mads U. Werner
- Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
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de Kruijf M, Peters MJ, C. Jacobs L, Tiemeier H, Nijsten T, Hofman A, Uitterlinden AG, Huygen FJPM, van Meurs JBJ. Determinants for Quantitative Sensory Testing and the Association with Chronic Musculoskeletal Pain in the General Elderly Population. Pain Pract 2015. [DOI: 10.1111/papr.12335] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Marjolein de Kruijf
- Department of Internal Medicine; Erasmus MC Rotterdam; Rotterdam The Netherlands
- Department of Anesthesiology; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Marjolein J. Peters
- Department of Internal Medicine; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Leonie C. Jacobs
- Department of Dermatology; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Henning Tiemeier
- Department of Psychiatry; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Tamar Nijsten
- Department of Dermatology; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Albert Hofman
- Department of Epidemiology; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | - Andre G. Uitterlinden
- Department of Internal Medicine; Erasmus MC Rotterdam; Rotterdam The Netherlands
- Department of Epidemiology; Erasmus MC Rotterdam; Rotterdam The Netherlands
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Hetmann F, Kongsgaard UE, Sandvik L, Schou-Bredal I. Prevalence and predictors of persistent post-surgical pain 12 months after thoracotomy. Acta Anaesthesiol Scand 2015; 59:740-8. [PMID: 25907109 DOI: 10.1111/aas.12532] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/09/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Persistent post-surgical pain is recognised as a major problem. Prevalence after different surgical procedures has been reported to range from 5% up to 85%. Limb amputation and thoracotomy have the highest reported prevalence. Prediction of persistent post-surgical pain has over the last decade caught attention. Several factors have been investigated, but in-depth knowledge is still scarce. The purpose of this study was to investigate the prevalence of persistent post-surgical pain, and predictive factors for persistent post-surgical pain 12 months after thoracotomy. METHODS A prospective longitudinal study was conducted. One-hundred and seventy patients were recruited before scheduled thoracotomy, and asked to answer a questionnaire. One-hundred and six patients completed the same questionnaire at 12-month follow-up. Regression analysis was performed to explore variables assumed predictive of persistent post-surgical pain. RESULTS One-hundred and six patients (62%) filled out the questionnaire at both time points. Preoperative, 34% reported muscle-skeletal related chronic pain. At 12-month follow-up, 50% of the patients reported persistent post-surgical pain. Of the variables explored in the logistic regression model, only preoperative pain (P < 0.001) and dispositional optimism (P = 0.04) were statistically significant. In this study, preoperative pain was a predominant predictor for persistent postoperative pain (OR 6.97, CI 2.40-20.21), while dispositional optimism (OR 0.36, CI 0.14-0.96) seem to have protective properties. CONCLUSION Our results show that preoperative pain is a predominant predictor of future pain. This implies that patients presenting with a chronic pain condition prior to surgery should be assessed thoroughly preoperatively and have an individually tailored analgesic regimen.
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Affiliation(s)
- F. Hetmann
- Department of Nursing; Oslo and Akershus University College of Applied Sciences; Oslo, Norway and University of Oslo, Oslo Norway
| | - U. E. Kongsgaard
- Department of Anaesthesiology; Oslo University Hospital, Oslo, Norway and University of Oslo; Oslo Norway
| | - L. Sandvik
- Department of Biostatistics and Epidemiology; Oslo University Hospital; Oslo, Norway and University of Oslo, Oslo Norway
| | - I. Schou-Bredal
- Department of Breast and Endocrine Surgery; Oslo University Hospital, Oslo, Norway and University of Oslo; Oslo Norway
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46
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Treister R, Nielsen CS, Stubhaug A, Farrar JT, Pud D, Sawilowsky S, Oaklander AL. Experimental comparison of parametric versus nonparametric analyses of data from the cold pressor test. J Pain 2015; 16:537-48. [PMID: 25801300 DOI: 10.1016/j.jpain.2015.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED Parametric statistical methods are common in human pain research. They require normally distributed data, but this assumption is rarely tested. The current study analyzes the appropriateness of parametric testing for outcomes from the cold pressor test (CPT), a common human experimental pain test. We systematically reviewed published CPT studies to quantify how often researchers test for normality and how often they use parametric versus nonparametric tests. We then measured the normality of CPT data from 7 independent small to medium cohorts and 1 study of >10,000 subjects. We then examined the ability of 2 common mathematical transformations to normalize our skewed data sets. Lastly, we performed Monte Carlo simulations on a representative data set to compare the statistical power of the parametric t-test versus the nonparametric Wilcoxon Mann-Whitney test. We found that only 39% of published CPT studies (47/122) mentioned checking data distribution, yet 72% (88/122) used parametric statistics. Furthermore, among our 8 data sets, CPT outcomes were virtually always nonnormally distributed, and mathematical transformations were largely ineffective in normalizing them. The simulations demonstrated that the nonparametric Wilcoxon Mann-Whitney test had greater statistical power than the parametric t-test for all scenarios tested: For small effect sizes, the Wilcoxon Mann-Whitney test had up to 300% more power. PERSPECTIVE These results demonstrate that parametric analyses of CPT data are routine but incorrect and that they likely increase the chances of failing to detect significant between-group differences. They suggest that nonparametric analyses become standard for CPT studies and that assumptions of normality be routinely tested for other types of pain outcomes as well.
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Affiliation(s)
- Roi Treister
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | | | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Norway
| | - John T Farrar
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | | | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pathology (Neuropathology), Massachusetts General Hospital, Boston, Massachusetts
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Niklasson B, Georgsson Öhman S, Segerdahl M, Blanck A. Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section. Acta Obstet Gynecol Scand 2015; 94:622-8. [DOI: 10.1111/aogs.12613] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Boel Niklasson
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Obstetrics and Gynecology; Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
- Sophiahemmet University; Stockholm Sweden
| | - Susanne Georgsson Öhman
- Sophiahemmet University; Stockholm Sweden
- Department of Women's and Children's Health; Karolinska Institute; Stockholm Sweden
| | - Märta Segerdahl
- Department of Physiology and Pharmacology; Karolinska Institute; Stockholm Sweden
| | - Agneta Blanck
- Department of Clinical Science, Intervention and Technology (CLINTEC); Division of Obstetrics and Gynecology; Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
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Uddin Z, MacDermid JC, Woodhouse LJ, Triano JJ, Galea V, Gross AR. The effect of pressure pain sensitivity and patient factors on self-reported pain-disability in patients with chronic neck pain. Open Orthop J 2014; 8:302-9. [PMID: 25320651 PMCID: PMC4195173 DOI: 10.2174/1874325001408010302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 12/13/2022] Open
Abstract
The study was conducted to estimate the extent to which pressure pain sensitivity (PPS) and patient factors predict pain-related disability in patients with neck pain (NP), and to determine if PPS differs by gender. Forty-four participants with a moderate level of chronic NP were recruited for this cross sectional study. All participants were asked to complete self-reported assessments of pain, disability and comorbidity and then underwent PPS testing at 4-selected body locations. Pearson`s r w was computed to explore relationships between the PPS measures and the self-reported assessments. Regression models were built to identify predictors of pain and disability. An independent sample t-test was done to identify gender-related differences in PPS, pain-disability and comorbidity. In this study, greater PPS (threshold and tolerance) was significantly correlated to lower pain-disability (r = -.30 to -.53, p≤0.05). Age was not correlated with pain or disability but comorbidity was (r= 0.42-.43, p≤0.01). PPS at the 4-selected body locations was able to explain neck disability (R2=25-28%). Comorbidity was the strongest predictor of neck disability (R2 =30%) and pain (R2=25%). Significant mean differences for gender were found in PPS, disability and comorbidity, but not in pain intensity or rating. This study suggests that PPS may play a role in outcome measures of pain and disability but between-subject comparisons should consider gender and comorbidity issues.
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Affiliation(s)
- Zakir Uddin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada ; Department of Rehabilitation Science, Bangladesh University of Health Sciences, Dhaka, Bangladesh ; Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, South Korea
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada ; Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
| | - Linda J Woodhouse
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - John J Triano
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada ; Research Division, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Victoria Galea
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Anita R Gross
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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