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Einhorn LM, Krishnan P, Poirier C, Ingelmo P. Chronic Postsurgical Pain in Children and Adolescents: A Call for Action. J Pain Res 2024; 17:1967-1978. [PMID: 38828088 PMCID: PMC11144433 DOI: 10.2147/jpr.s464009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Chronic postsurgical pain (CPSP) affects a significant proportion of children and adolescents after major surgery and is a detriment to both short- and long-term recovery outcomes. While clinical characteristics and psychosocial risk factors for developing CPSP in children and adults are well established in the literature, there has been little progress on the prevention and management of CPSP after pediatric surgery. Limited evidence to support current pharmacologic approaches suggests a fundamentally new paradigm must be considered by clinicians to both conceptualize and address this adverse complication. This narrative review provides a comprehensive evaluation of both the known and emerging mechanisms that support our current understanding of CPSP. Additionally, we discuss the importance of optimizing perioperative analgesic strategies to mitigate CPSP based on individual patient risks. We highlight the importance of postoperative pain trajectories to identify those most at risk for developing CPSP, the early referral to multi-disciplinary pain clinics for comprehensive evaluation and treatment of CPSP, and additional work needed to differentiate CPSP characteristics from other chronic pain syndromes in children. Finally, we recognize ongoing challenges associated with the universal implementation of available knowledge about pediatric CPSP into practically useful care plans for clinicians.
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Affiliation(s)
- Lisa M Einhorn
- Department of Anesthesiology, Division of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Padmaja Krishnan
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Cassandra Poirier
- Department of Anesthesiology, University of British Columbia, Kelowna, BC, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Alan Edwards Center for Research in Pain, Montreal, QC, Canada
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Widder A, Reese L, Lock JF, Wiegering A, Germer CT, Rittner HL, Dietz UA, Schlegel N, Meir M. Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment. Hernia 2024:10.1007/s10029-024-03027-7. [PMID: 38526673 DOI: 10.1007/s10029-024-03027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Chronic postsurgical pain (CPSP) is a potential long-term problem following open incisional hernia repair which may affect the quality of life of patients despite successful anatomical repair of the hernia. The aim of this manuscript was to identify the incidence and outcome of patients following open incisional hernia repair in respect of risk factors to develop CPSP. METHODS A single-center retrospective analysis of patients who underwent open incisional hernia repair between 2015 and 2021 was performed. Pre-existing conditions (e.g., diabetes mellitus and malignancy), hernia complexity, postoperative complications, and postoperative pain medication were analyzed using the local database. Quality of life and CPSP were assessed using the EuraHS Quality of Life (QoL) questionnaire. RESULTS A total of 182 cases were retrospectively included in a detailed analysis based on the complete EuraHS (QoL) questionnaire. During the average follow-up period of 46 months, this long-term follow-up revealed a 54.4% incidence of CPSP and including a rate of 14.8% for severe CPSP (sCPSP) after open incisional hernia surgery. The complexity of the hernia and the demographic variables were not different between the group with and without CPSP. Patients with CPSP reported significantly reduced QoL. The analgesics score which includes the need of pain medication in the initial days after surgery was significantly higher in patients with CPSP than in those without (no CPSP: 2.86 vs. CPSP: 3.35; p = 0.047). CONCLUSION The presence of CPSP after open incisional hernia repair represents a frequent and underestimated long-term problem which has been not been recognized to this extent before. CPSP impairs QoL in these patients. Patients at risk to develop CPSP can be identified in the perioperative setting by the need of high doses of pain medication using the analgesics score. Possibly timely adjustment of pain medication, even in the domestic setting, could alleviate the chronicity or severity of CPSP.
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Affiliation(s)
- A Widder
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - L Reese
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - A Wiegering
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - C-T Germer
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - H L Rittner
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, Centre for Interdisciplinary Pain Medicine, University Hospital of Wuerzburg, Würzburg, Germany
| | - U A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Olten, Switzerland
| | - N Schlegel
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany
| | - M Meir
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, Centre of Operative Medicine (ZOM), University Hospital of Wuerzburg, Würzburg, Germany.
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Sun M, Chen WM, Wu SY, Zhang J. The influence of advanced age on long-term postsurgical analgesic use in patients receiving neuraxial anaesthesia for elective surgery. Eur J Pain 2024; 28:408-420. [PMID: 37830408 DOI: 10.1002/ejp.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the relationship between age and long-term postsurgical analgesic use in patients who underwent elective surgery with neuraxial anaesthesia. DESIGN Retrospective observational study using data from the National Health Insurance Research Database of Taiwan from 2015 to 2019. SETTING National Health Insurance Research Database of Taiwan. PATIENTS A total of 12,810 patients (6405 younger and 6405 older) matched using propensity score matching. INTERVENTIONS Older (≥65 years). MEASUREMENTS The use of long-term (3 or 6 months) postoperative analgesics, including opioids, as a surrogate marker of chronic postsurgical pain (CPSP) was analysed using logistic regression. MAIN RESULTS After 3 months of surgery, older adults had higher use of all analgesics (odds ratio [OR] = 1.15; 95% CI = 1.03-1.28) and opioids (OR = 1.18; 95% CI = 1.09-1.28) compared to younger patients. Similar results were observed after 6 months of surgery (all analgesic use: OR = 1.11; 95% CI = 1.03-1.20; opioid use: OR = 1.33; 95% CI = 1.07-1.81). CONCLUSION The findings from this study suggest that older adults are more likely to experience CPSP and have increased use of long-term analgesics, including opioids, after undergoing elective surgery with neuraxial anaesthesia. The study highlights the need for improved pain management strategies for older adults after surgery. SIGNIFICANCE Older age is an independent risk factor for long-term analgesic use after surgery under neuraxial anaesthesiaanesthesia, indicating an increased risk for chronic postsurgical pain.
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Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Liu W, Wang W, Wang Z, Xing Y. Ventral tegmental area dopaminergic circuits participates in stress-induced chronic postsurgical pain in male mice. BMC Neurosci 2024; 25:3. [PMID: 38195391 PMCID: PMC10775611 DOI: 10.1186/s12868-023-00842-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Chronic postsurgical pain (CPP) markedly impairs patients' quality of life. Research has shown that chronic stress may extend incisional nociception in male mice. Dopaminergic (DAergic) neurons in the ventral tegmental area (VTA) are integral to stress-related mental disorders (including major depressive disorder, anxiety disorders, and PTSD) and pain. However, the impact of chronic social defeat stress (CSDS) on mesolimbic dopamine (DA) transmission in the development of CPP is yet to be established. It remains uncertain whether the dopamine signals in the rostral anterior cingulate cortex (rACC), which regulate pain, derive from the VTA. This study aims to explore the role of VTA-rACC dopaminergic circuits in a mouse model of CPP induced by CSDS. METHODS We conducted CSDS on C57BL/6 J wild-type male mice (n = 12-16 mice/group) and DAT-cre male mice (n = 10-12 mice/group). After 10 days of CSDS, a left posterior plantar incision was made to establish a mouse model of CPP. Paw withdrawal thresholds (PWTs) were evaluated using Von-Frey fibre stimulation. The open field test (OFT) and elevated plus maze test (EPM) were used to assess pain-related negative emotions. We used immunofluorescence staining and Western Blot to analyse D1, D2, c-Fos, and TH expression. DAergic fibre projections in the VTA-rACC neural pathway were traced using retrograde tracing and immunofluorescence staining. Optogenetics and Chemogenetics were employed to manipulate DAergic neurons in the VTA and their axons in the rACC. RESULTS The ipsilateral PWTs in male C57BL/6 J mice significantly decreased after surgery, returning to baseline after seven days. Conversely, in CSDS mice, ipsilateral PWTs remained reduced for at least 30 days post-incision. A significant reduction in TH-positive neurons expressing c-Fos in the VTA of CPP mice was observed 15 days post-incision. Activating DAergic neurons significantly improved ipsilateral PWTs and locomotor performance in the OFT and EPM in CPP mice post-incision. Additionally, D1 expression in the rACC was found to decrease in CPP mice, and this reduction counteracted the increase in PWTs caused by activating DAergic neuron axon terminals in the rACC. CONCLUSION CSDS results in chronicity of postsurgical nociception and anxiety-like negative emotions, with alterations in DA transmission playing a role in CPP. Specific activation of DAergic neurons mitigates nociceptive responses and anxiety-like bahaviors, possibly mediated by D1 receptors in the rACC.
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Affiliation(s)
- Weizhen Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Wang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Ziliang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China
- The Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Ying Xing
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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Milkias M, Mekonnen S, Ahmed S, Getachew H, Adamu Y, Mola S, Gugsa T. Evidence-based guideline on chronic postsurgical pain management in adult patients in resource-restricted setting, 2023: systematic review and guideline. Ann Med Surg (Lond) 2023; 85:5593-5603. [PMID: 37915690 PMCID: PMC10617887 DOI: 10.1097/ms9.0000000000001258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 11/03/2023] Open
Abstract
Background Chronic postsurgical pain (CPSP) after tissue trauma is frequent and may have a long-lasting impact on the functioning and quality of life. The development of CPSP increases the burden on both the patient and the community. This review aims to systematically review articles and, lastly, pull an evidence-based guideline for CPSP management in adult patients in resource-limited areas. Methodology The review was reported based on preferred reporting items for the systemic review and meta-analysis (PRISMA) protocol. A literature search was conducted from the Cochrane, PubMed/Medline, and Google Scholar databases, and other gray literature from 2010 to 2022. The conclusion was made based on the level of evidence. Results A total of 3521 articles were identified through the database by searching strategies. Finally, by filtering duplicates unrelated to the topics, 22 articles (9 meta-analyses and systematic reviews, 12 systematic reviews, and one cohort study) were selected on the management of CPSP in adult patients. Filtering was made based on the intervention, outcome data of the population, and methodological quality. Conclusion Given the complexity and multidimensional nature of chronic postsurgical pain, effective assessment, and management require a comprehensive, multiaxial approach. Adequate preoperative preparation and counseling, potential risk identification and optimization, and use of a multimodal approach, and noninvasive surgical techniques are crucial in reducing the development of chronic postsurgical pain.
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Affiliation(s)
| | | | | | | | | | | | - Tesfaye Gugsa
- Surgery Department, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Paladini A, Rawal N, Coca Martinez M, Trifa M, Montero A, Pergolizzi J, Pasqualucci A, Narvaez Tamayo MA, Varrassi G, De Leon Casasola O. Advances in the Management of Acute Postsurgical Pain: A Review. Cureus 2023; 15:e42974. [PMID: 37671225 PMCID: PMC10475855 DOI: 10.7759/cureus.42974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Despite the millions of surgeries performed every year around the world, postoperative pain remains prevalent and is often addressed with inadequate or suboptimal treatments. Chronic postsurgical pain is surprisingly prevalent, and its rate varies with the type of surgery, as well as with certain patient characteristics. Thus, better clinical training is needed as well as patient education. As pain can be caused by more than one mechanism, multimodal or balanced postsurgical analgesia is appropriate. Pharmacological agents such as opioid and nonopioid pain relievers, as well as adjuvants and nonpharmacologic approaches, can be combined to provide better and opioid-sparing pain relief. Many specialty societies have guidelines for postoperative pain management that emphasize multimodal postoperative analgesia. These guidelines are particularly helpful when dealing with special populations such as pregnant patients or infants and children. Pediatric pain control, in particular, can be challenging as patients may be unable to communicate their pain levels. A variety of validated assessment tools are available for diagnosis. Related to therapy, most guidelines agree on the fact that codeine should be used with extreme caution in pediatric patients as some may be "rapid metabolizers" and its use may be life-threatening. Prehabilitation is a preoperative approach that prepares patients in advance of elective surgery with conditioning exercises and other interventions to optimize their health. Prehabilitation may have aerobic, strength-training, nutritional, and counseling components. Logistical considerations and degree of patient adherence represent barriers to effective prehabilitation programs. Notwithstanding all this, acute postoperative pain represents a clinical challenge that has not yet been well addressed.
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Affiliation(s)
- Antonella Paladini
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, ITA
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Fuller AM, Bharde S, Sikandar S. The mechanisms and management of persistent postsurgical pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1154597. [PMID: 37484030 PMCID: PMC10357043 DOI: 10.3389/fpain.2023.1154597] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
An estimated 10%-50% of patients undergoing a surgical intervention will develop persistent postsurgical pain (PPP) lasting more than 3 months despite adequate acute pain management and the availability of minimally invasive procedures. The link between early and late pain outcomes for surgical procedures remains unclear-some patients improve while others develop persistent pain. The elective nature of a surgical procedure offers a unique opportunity for prophylactic or early intervention to prevent the development of PPP and improve our understanding of its associated risk factors, such as pre-operative anxiety and the duration of severe acute postoperative pain. Current perioperative pain management strategies often include opioids, but long-term consumption can lead to tolerance, addiction, opioid-induced hyperalgesia, and death. Pre-clinical models provide the opportunity to dissect mechanisms underpinning the transition from acute to chronic, or persistent, postsurgical pain. This review highlights putative mechanisms of PPP, including sensitisation of peripheral sensory neurons, neuroplasticity in the central nervous system and nociceptive signalling along the neuro-immune axis.
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Hu JH, Shi HJ, Han ZY, Liu H, Ji FH, Peng K. Protocol for Development and Validation of Multivariable Prediction Models for Chronic Postsurgical Pain Following Video-Assisted Thoracic Surgery. J Pain Res 2023; 16:2251-2256. [PMID: 37425224 PMCID: PMC10328098 DOI: 10.2147/jpr.s416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Chronic postsurgical pain (CPSP) is a common complication after thoracic surgery and associated with long-term adverse outcomes. This study aims to develop two prediction models for CPSP after video-assisted thoracic surgery (VATS). Methods and Analysis This single-center prospective cohort study will include a total of 500 adult patients undergoing VATS lung resection (n = 350 for development and n = 150 for external validation). Patients will be enrolled continuously at The First Affiliated Hospital of Soochow University in Suzhou, China. The cohort for external validation will be recruited in another time period. The outcome is CPSP, which is defined as pain with the numerical rating scale score of 1 or higher 3 months after VATS. Univariate and multivariable logistic regression analyses will be performed to develop two CPSP prediction models based on patients' data of postoperative day 1 and day 14, respectively. For internal validation, we will use the bootstrapping validation technique. For external validation, the discrimination capability of the models will be assessed using the area under the receiver operating characteristic curve, and the calibration will be evaluated using the calibration curve and Hosmer-Lemeshow goodness-of-fit statistic. The results will be presented in model formulas and nomograms. Conclusion Based on the development and validation of the prediction models, our results contribute to early prediction and treatment of CPSP after VATS. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066122).
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Affiliation(s)
- Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hai-Jing Shi
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhen-Yu Han
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
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Szymoniuk M, Chin JH, Domagalski Ł, Biszewski M, Jóźwik K, Kamieniak P. Brain stimulation for chronic pain management: a narrative review of analgesic mechanisms and clinical evidence. Neurosurg Rev 2023; 46:127. [PMID: 37247036 PMCID: PMC10227133 DOI: 10.1007/s10143-023-02032-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
Chronic pain constitutes one of the most common chronic complaints that people experience. According to the International Association for the Study of Pain, chronic pain is defined as pain that persists or recurs longer than 3 months. Chronic pain has a significant impact on individuals' well-being and psychosocial health and the economy of healthcare systems as well. Despite the availability of numerous therapeutic modalities, treatment of chronic pain can be challenging. Only about 30% of individuals with non-cancer chronic pain achieve improvement from standard pharmacological treatment. Therefore, numerous therapeutic approaches were proposed as a potential treatment for chronic pain including non-opioid pharmacological agents, nerve blocks, acupuncture, cannabidiol, stem cells, exosomes, and neurostimulation techniques. Although some neurostimulation methods such as spinal cord stimulation were successfully introduced into clinical practice as a therapy for chronic pain, the current evidence for brain stimulation efficacy in the treatment of chronic pain remains unclear. Hence, this narrative literature review aimed to give an up-to-date overview of brain stimulation methods, including deep brain stimulation, motor cortex stimulation, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, cranial electrotherapy stimulation, and reduced impedance non-invasive cortical electrostimulation as a potential treatment for chronic pain.
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Affiliation(s)
- Michał Szymoniuk
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Jia-Hsuan Chin
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Łukasz Domagalski
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland.
| | - Mateusz Biszewski
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Jóźwik
- Student Scientific Association at the Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Piotr Kamieniak
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
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Schubert R, Song S, Everist R, Nesbitt-Hawes E, Abbott J. The impact of multimodal physiotherapy in an interdisciplinary setting for the management of women with persistent pelvic pain and pelvic floor tension myalgia. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023. [DOI: 10.1080/21679169.2023.2188901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
| | - Sophia Song
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Rebecca Everist
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Erin Nesbitt-Hawes
- Alana Healthcare for Women, Randwick, Australia
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
| | - Jason Abbott
- Alana Healthcare for Women, Randwick, Australia
- School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Group, RHW, Sydney, Australia
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11
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Development and validation of a multivariable prediction model for early prediction of chronic postsurgical pain in adults: a prospective cohort study. Comment on Br J Anaesth 2022; 129: 407-15. Br J Anaesth 2022; 129:e155. [PMID: 36207193 DOI: 10.1016/j.bja.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/18/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023] Open
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12
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Zhu Y, Sun M, Liu P, Shao W, Xiong M, Xu B. Perioperative stress prolong post-surgical pain via miR-339-5p targeting oprm1 in the amygdala. Korean J Pain 2022; 35:423-432. [PMID: 36175341 PMCID: PMC9530683 DOI: 10.3344/kjp.2022.35.4.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background The decreased expression of mu-opioid receptors (MOR) in the amygdala may be a key molecular in chronic post-surgical pain (CPSP). It is known that miR-339-5p expression in the amygdala of a stressed rat model was increased. Analyzed by RNAhybrid, miR-339-5p could target opioid receptor mu 1 (oprm1) which codes MOR directly. So, the authors hypothesized that miR-339-5p could regulate the expression of MOR via targeting oprm1 and cause the effects to CPSP. Methods To simulate perioperative short-term stress, a perioperative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception rat model was built. A pmiR-RB-REPORT™ dual luciferase assay was taken to verify whether miR-339-5p could act on oprm1 as a target. The serum glucocorticoid level of rats was test. Differential expressions of MOR, GFAP, and pERK1/2 in each group of the rats' amygdala were tested, and the expressions of miR-339-5p in each group of rats' amygdalas were also measured. Results Perioperative stress prolonged the recovery time of incision pain. The expression of MOR was down-regulated in the amygdala of rats in stress + incision (S + IN) group significantly compared with other groups (P < 0.050). miR-339-5p was up-regulated in the amygdala of rats in group S + IN significantly compared with other groups (P < 0.050). miR-339-5p acts on oprm1 3'UTR and take MOR mRNA as a target. Conclusions Perioperative stress could increase the expression of miR-339-5p, and miR-339-5p could cause the expression of MOR to decrease via targeting oprm1. This regulatory pathway maybe an important molecular mechanism of CPSP.
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Affiliation(s)
- Yi Zhu
- Department of Anesthesiology, General Hospital of The Southern Theater Command of PLA, Guangzhou, China
| | - Mei Sun
- Department of Anesthesiology, General Hospital of The Southern Theater Command of PLA, Guangzhou, China
| | - Peng Liu
- Department of Burns and Plastic Surgery, General Hospital of The Southern Theater Command of PLA, Guangzhou, China
| | - Weidong Shao
- Department of Anesthesiology, General Hospital of The Southern Theater Command of PLA, Guangzhou, China
| | - Ming Xiong
- Department of Anesthesiology and Peri-Operative Medicine, New Jersey Medical School, Newark, NJ, USA
| | - Bo Xu
- Department of Anesthesiology, General Hospital of The Southern Theater Command of PLA, Guangzhou, China
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13
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Gong C, Ding Y, Liang F, Wu S, Tang X, Ding H, Huang W, Yu X, Zhou L, Li J, Liu S. Muscarinic receptor regulation of chronic pain-induced atrial fibrillation. Front Cardiovasc Med 2022; 9:934906. [PMID: 36187006 PMCID: PMC9521049 DOI: 10.3389/fcvm.2022.934906] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
Atrial fibrillation (AF), one of the most common arrhythmias, is associated with chronic emotional disorder. Chronic pain represents a psychological instability condition related to cardiovascular diseases, but the mechanistic linkage connecting chronic pain to AF occurrence remains unknown. Wild-type C57BL/6J male mice were randomly divided into sham and chronic pain groups. Autonomic nerve remodeling was reflected by the increased atrial parasympathetic tension and muscarinic acetylcholine receptor M2 expression. AF susceptibility was assessed through transesophageal burst stimulation in combination with electrocardiogram recording and investigating AERP in Langendorff perfused hearts. Our results demonstrated the elevated protein expression of muscarinic acetylcholine receptor M2 in the atria of mice subjected to chronic pain stress. Moreover, chronic pain induced the increase of atrial PR interval, and atrial effective refractory periods as compared to the sham group, underlying the enhanced susceptibility of AF. Thus, autonomic cholinergic nerve may mediate mice AF in the setting of chronic pain.
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Affiliation(s)
- Chao Gong
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Ding
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuang Wu
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiruo Tang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongzhang Ding
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Huang
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaotong Yu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Likun Zhou
- Nanjing Medical University, Nanjing, China
| | - Jun Li
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jun Li
| | - Shaowen Liu
- Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Shaowen Liu
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Wu XD, Zeng FF, Yu XX, Yang PP, Wu JP, Xv P, Wang HT, Pei YM. Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study. J Pain Res 2022; 15:3079-3091. [PMID: 36203786 PMCID: PMC9530220 DOI: 10.2147/jpr.s368295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery. Patients and Methods This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples. Results The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients. Conclusion The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.
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Affiliation(s)
- Xiao-Dan Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Fan-Fang Zeng
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Xiao-Xuan Yu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Pan-Pan Yang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Jun-Peng Wu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Ping Xv
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, People’s Republic of China
| | - Hai-Tang Wang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
- Correspondence: Hai-Tang Wang; You-Ming Pei, Department of Anesthesiology, Nanfang Hospital, Southern medical university, 1838 Guangzhou North Road, Guangzhou, Guangdong, 510515, People’s Republic of China, Tel +86-18718911653; +86-15889942610, Fax +86 20-62787271; +86 20-62787271, Email ;
| | - You-Ming Pei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
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Does mental practice or mirror therapy help prevent functional loss after distal radius fracture? A randomized controlled trial. J Hand Ther 2022; 35:86-96. [PMID: 33308929 DOI: 10.1016/j.jht.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A randomized, single-blinded controlled trial. INTRODUCTION Therapy results after distal radius fractures (DRF) especially with older patients are often suboptimal. One possible approach for counteracting the problems are motor-cognitive training interventions such as Mental Practice (MP) or Mirror Therapy (MT), which may be applied in early rehabilitation without stressing the injured wrist. PURPOSE OF THE STUDY The aim of the study is to investigate the effects of MP and MT on wrist function after DRF. The pilot study should furthermore provide information about the feasibility of these methods. METHODS Thirty-one women were assigned either to one of the two experimental groups (MP, MT) or to a control group (relaxation intervention). The participants completed a training for six weeks, administered at their homes. Measurements were taken at four times (weeks 0, 3, 6 and 12) to document the progression in subjective function (PRWE, QuickDASH) and objective constraints of the wrist (ROM, grip strength) as well as in health-related quality of life (EQ-5D). RESULTS The results indicated that both experimental groups showed higher improvements across the intervention period compared to the control group; e.g. PRWE: MT 74.0%, MP 66.2%, CG 56.9%. While improvements in grip strength were higher for the MP group, the MT group performed better in all other measures. However, time by group interactions approached significance at best; e.g. ROM: P = .076; ηp2 = .141. CONCLUSION The superiority of MP as well as MT supports the simulation theory. Motor-cognitive intervention programs are feasible and promising therapy supplements, which may be applied in early rehabilitation to counteract the consequences of immobilization without stressing the injured wrist.
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Gómez M, Izquierdo CE, Mayoral Rojals V, Pergolizzi Jr J, Plancarte Sanchez R, Paladini A, Varrassi G. Considerations for Better Management of Postoperative Pain in Light of Chronic Postoperative Pain: A Narrative Review. Cureus 2022; 14:e23763. [PMID: 35518528 PMCID: PMC9064707 DOI: 10.7759/cureus.23763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/02/2022] [Indexed: 12/02/2022] Open
Abstract
Chronic postoperative pain (CPOP) is prevalent, with particularly high rates in breast surgery, thoracotomy, and amputation. As the world emerges from the coronavirus disease 2019 (COVID-19) lockdowns, it is expected that there will be an increase in surgical procedures, elevating the importance of preventing CPOP in the coming years. Risk factors are emerging to better stratify patients at high risk for CPOP. Perioperative analgesia plays an important role in managing acute postoperative pain and in some cases may limit its transition to CPOP. Acute postoperative pain is adaptive, normal, expected, and has a well-defined trajectory, while CPOP is maladaptive and, as a form of chronic pain, is challenging to treat. Good analgesia, early ambulation, and rehabilitation efforts may be helpful in preventing CPOP following certain surgeries. Enhanced Recovery After Surgery (ERAS) protocols present guidance to help promote recovery and prevent CPOP.
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Laigaard J, Karlsen A, Maagaard M, Rosenberg LK, Creutzburg A, Lunn TH, Mathiesen O, Overgaard S. Perioperative prevention of persistent pain after total hip and knee arthroplasty-Protocol for two systematic reviews. Acta Anaesthesiol Scand 2022; 66:772-777. [PMID: 35325472 PMCID: PMC9315006 DOI: 10.1111/aas.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
Background Between 9% and 20% of patients experience moderate to severe persistent postoperative pain after total hip or knee arthroplasty. Severe immediate postoperative pain limits rehabilitation and is associated with the development of persistent postoperative pain. Therefore, perioperative analgesic and physiotherapeutic interventions are of interest to reduce persistent pain. In two systematic reviews with identical methodology, we aim to investigate the effects of (a) perioperative analgesic interventions and (b) physiotherapeutic interventions in reducing persistent pain after total hip and knee arthroplasty. Methods We will include randomised and cluster‐randomised controlled trials on perioperative analgesic and physiotherapeutic interventions for patients undergoing elective total hip or knee arthroplasty for osteoarthritis. After contact with the authors, trials without pain data 3–24 months postoperatively will be excluded. Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and reference lists will be searched for eligible trials. Two authors will independently screen, extract data and assess the risk of bias. The primary outcome is pain scores 3–24 months postoperatively. Meta‐analyses will be performed for interventions with two or more trials. We will conduct trial sequential analyses and assign Grading of Recommendations, Assessment, Development and Evaluation (GRADE) ratings. Conclusion No previous review on reduction of persistent postoperative pain has included non‐pharmacological or invasive analgesic techniques. These two reviews with identical methodology will summarise the evidence of analgesic and physiotherapeutic perioperative interventions to prevent persistent pain. PROSPERO registration CRD42021284175.
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Affiliation(s)
- Jens Laigaard
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Anders Karlsen
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Mathias Maagaard
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Lukas Kristian Rosenberg
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Andreas Creutzburg
- Department of Anaesthesia Centre of Head and Orthopaedics, Rigshospitalet Copenhagen Denmark
| | - Troels Haxholdt Lunn
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Anesthesia and Intensive Care Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
| | - Ole Mathiesen
- Department of Anesthesiology Centre for Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology Copenhagen University Hospital Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Mayoral Rojals V, Charaja M, De Leon Casasola O, Montero A, Narvaez Tamayo MA, Varrassi G. New Insights Into the Pharmacological Management of Postoperative Pain: A Narrative Review. Cureus 2022; 14:e23037. [PMID: 35419225 PMCID: PMC8994615 DOI: 10.7759/cureus.23037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/10/2022] [Indexed: 11/05/2022] Open
Abstract
Postoperative pain is prevalent and often undertreated. There is a risk that untreated or suboptimally treated postoperative pain may transition into chronic postoperative pain, which can be challenging to treat. Clinical guidelines recommend the use of multimodal analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and, in some cases, opioids. NSAIDs are a broad class of drugs with different attributes such as cyclo-oxygenase (COX)-1 or COX-2 selectivity, onset of action, and analgesic potency. NSAIDs are associated with gastrointestinal and cardiovascular side effects and should be administered at the lowest effective dose for the shortest effective duration but can be effective in postoperative pain. The role of opioids in postoperative analgesia is long-standing but has recently come under scrutiny. Opioids are often used in multimodal analgesic combinations in such a way as to minimize the total consumption of opioids without sacrificing analgesic benefit. Special clinical considerations are required for surgical patients already on opioid regimens or with opioid use disorder. A particularly useful fixed-dose combination product for postoperative analgesia is dexketoprofen-tramadol, which confers safe and effective postoperative pain control and reduces the risk of persistent postoperative pain.
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Montero Matamala A, Hanna M, Perrot S, Varrassi G. Avoid Postoperative Pain To Prevent Its Chronification: A Narrative Review. Cureus 2022; 14:e22243. [PMID: 35340463 PMCID: PMC8930466 DOI: 10.7759/cureus.22243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022] Open
Abstract
Acute postoperative pain is a normal and expected part of the patient’s postsurgical trajectory, and its intensity, severity, and duration vary with surgery-related and patient factors. In a subset of patients, postoperative pain does not resolve as the tissue heals but instead transitions to chronic postoperative pain, a challenging condition to treat and one associated with decreased quality of life, sleep and mood disorders, and neuropathy. Promptly and adequately treating acute postoperative pain can reduce the risk that it will transition into chronic postoperative pain. Numerous agents are available that may help treat postoperative pain, including nonsteroidal anti-inflammatory drugs, opioids, antidepressants, anticonvulsants, and others. In this connection, it is also important to consider patient factors, such as mental health status and comorbidities, as well as the type and duration of surgery. A multimodal approach is recommended, which uses two or more agents with complementary mechanisms of action, working at different targets. Multimodal analgesia may also reduce adverse events and lessen opioid consumption after surgery. A particularly useful fixed-dose combination product is dexketoprofen/tramadol (DEX-TRA), which is safe and effective in numerous clinical trials. This review is based on a presentation from the Roma Pain Days scientific sessions of 2021.
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20
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Brase A, Brauchle D, Kermad A, Volk T, Morinello E, Gottschling S, Schneider SO. Postoperative Pain Therapy with Laser Acupuncture after Cesarean Section under Spinal Anesthesia: A Double-Blinded, Randomized, Placebo-Controlled Trial. Complement Med Res 2022; 29:235-241. [PMID: 35134798 DOI: 10.1159/000522470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/02/2022] [Indexed: 11/19/2022]
Abstract
Purpose The aim of our prospective, randomized, double blind, placebo-controlled study was to investigate the effect of laser acupuncture on postoperative pain in women undergoing cesarean section. Methods 80 women (mean age 32 ±5 years) scheduled for cesarean section under spinal anesthesia at Saarland University Hospital Medical Center, Homburg (Germany) were enrolled in this trial after giving written consent. Patients were randomized in two groups receiving a course of 3 treatments over 3 days with either active or placebo laser. Each acupuncture session treated Di-4 and Shen-men of both hands and ears. Primary outcome was defined as the pain severity at rest measured by Numeric Rating Scale (NRS) on the first postoperative day. Secondary outcome measures included analgesic consumption, time to mobilisation and length of stay. Treatment occurred on the operation day and on the following two days. Data were collected by a standardized questionnaire. Results No statistical difference between both groups were observed for pain severity at rest on the first postoperative day after cesarean section (Mann-Whitney U-test, p=0,850, verum group: 3.3±2.1 Vs. Placebo group: 3.2±1.9). Secondary outcome measures regarding analgesic consumption showed no difference in NSAID or opioid between treatment and placebo group. Laser acupuncture showed no effect on time to mobilisation and length of stay. Conclusion Our study could not demonstrate significant effects by the application of laser acupuncture on postoperative pain in women undergoing cesarean section.
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Affiliation(s)
- Annika Brase
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Dominik Brauchle
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Azzeddine Kermad
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Thomas Volk
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Emanuela Morinello
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Sven Gottschling
- Center for Palliative Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
| | - Sven Oliver Schneider
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Hospital Medical Center, Homburg/Saar, Germany
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Wang W, Liu WZ, Wang ZL, Duan DX, Wang XY, Liu SJ, Wang ZJ, Xing GG, Xing Y. Spinal microglial activation promotes perioperative social defeat stress-induced prolonged postoperative pain in a sex-dependent manner. Brain Behav Immun 2022; 100:88-104. [PMID: 34808295 DOI: 10.1016/j.bbi.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022] Open
Abstract
Prolonged postsurgical pain, which is associated with multiple risk factors in the perioperative stage, is a common medical and social problem worldwide. Suitable animal models should be established to elucidate the mechanisms underlying the perioperative prolonged postsurgical pain. In this study, standard and modified social defeat stress mice models, including chronic social defeat stress (CSDS), chronic nondiscriminatory social defeat stress (CNSDS) and vicarious social defeat stress (VSDS), were applied to explore the effect of perioperative social defeat stress on postsurgical pain in male and female mice. Our results showed that exposure to preoperative CSDS could induce prolonged postsurgical pain in defeated mice regardless of susceptibility or resilience differentiated by the social interaction test. Similar prolongation of incision-induced mechanical hypersensitivity was also observed in both sexes upon exposing to CNSDS or VSDS in the preoperative period. Moreover, we found that using the modified CNSDS or VSDS models at different recovery stages after surgery could still promote abnormal pain without sex differences. Further studies revealed the key role of spinal microglial activation in the stress-induced transition from acute to prolonged postoperative pain in male but not female mice. Together, these data indicate that perioperative social defeat stress is a vital risk factor for developing prolonged postoperative pain in both sexes, but the promotion of stress-induced prolonged postoperative pain by spinal microglial activation is sexually dimorphic in mice.
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Affiliation(s)
- Wang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Wei-Zhen Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Zi-Liang Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Dong-Xiao Duan
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Xue-Yun Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Shi-Jin Liu
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China; The Academy of Medical Sciences of Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Zhi-Ju Wang
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Guo-Gang Xing
- Department of Neurobiology, School of Basic Medical Sciences and Neuroscience Research Institute, Peking University, Beijing 100191, China.
| | - Ying Xing
- Department of Physiology and Neurobiology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan, China.
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22
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How Is Peripheral Injury Signaled to Satellite Glial Cells in Sensory Ganglia? Cells 2022; 11:cells11030512. [PMID: 35159321 PMCID: PMC8833977 DOI: 10.3390/cells11030512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 02/01/2023] Open
Abstract
Injury or inflammation in the peripheral branches of neurons of sensory ganglia causes changes in neuronal properties, including excessive firing, which may underlie chronic pain. The main types of glial cell in these ganglia are satellite glial cells (SGCs), which completely surround neuronal somata. SGCs undergo activation following peripheral lesions, which can enhance neuronal firing. How neuronal injury induces SGC activation has been an open question. Moreover, the mechanisms by which the injury is signaled from the periphery to the ganglia are obscure and may include electrical conduction, axonal and humoral transport, and transmission at the spinal level. We found that peripheral inflammation induced SGC activation and that the messenger between injured neurons and SGCs was nitric oxide (NO), acting by elevating cyclic guanosine monophosphate (cGMP) in SGCs. These results, together with work from other laboratories, indicate that a plausible (but not exclusive) mechanism for neuron-SGCs interactions can be formulated as follows: Firing due to peripheral injury induces NO formation in neuronal somata, which diffuses to SGCs. This stimulates cGMP synthesis in SGCs, leading to their activation and to other changes, which contribute to neuronal hyperexcitability and pain. Other mediators such as proinflammatory cytokines probably also contribute to neuron-SGC communications.
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Olausson A, Svensson CJ, Andréll P, Jildenstål P, Thörn S, Wolf A. Total opioid-free general anaesthesia can improve postoperative outcomes after surgery, without evidence of adverse effects on patient safety and pain management: A systematic review and meta-analysis. Acta Anaesthesiol Scand 2022; 66:170-185. [PMID: 34724195 DOI: 10.1111/aas.13994] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Opioid-based treatment is used to manage stress responses during surgery and postoperative pain. However, opioids have both acute and long-term side effects, calling for opioid-free anaesthetic strategies. This meta-analysis compares adverse events, postoperative recovery, discharge time from post-anaesthesia care unit, and postoperative pain, nausea, vomiting, and opioid consumption between strict opioid-free and opioid-based general anaesthesia. METHODS We conducted a systematic review and meta-analysis. We searched PubMed, Embase, Cinahl, Cochrane Library, selected reference lists, and Google Scholar. We included randomised controlled trials (RCTs) published between January 2000 and February 2021 with at least one opioid-free study arm, i.e. no opioids administered preoperatively, during anaesthesia induction, before skin closure, or before emergence from anaesthesia. RESULTS The study comprised 1934 patients from 26 RCTs. Common interventions included laparoscopic gynaecological surgery, upper gastrointestinal surgery, and breast surgery. There is firm evidence that opioid-free anaesthesia significantly reduced adverse postoperative events (OR 0.32, 95% CI 0.22 to 0.46, I2 = 56%, p < 0.00001), mainly driven by decreased nausea (OR 0.27, (0.17 to 0.42), p < 0.00001) and vomiting (OR 0.22 (0.11 to 0.41), p < 0.00001). Postoperative opioid consumption was significantly lower in the opioid-free group (-6.00 mg (-8.52 to -3.48), p < 0.00001). There was no significant difference in length of post-anaesthesia care unit stay and overall postoperative pain between groups. CONCLUSIONS Opioid-free anaesthesia can improve postoperative outcomes in several surgical settings without evidence of adverse effects on patient safety and pain management. There is a need for more evidence-based non-opioid anaesthetic protocols for different types of surgery as well as postoperative phases.
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Affiliation(s)
- Alexander Olausson
- Institute for Health and Care Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Carl Johan Svensson
- Department of Anesthesia, Operation and Intensive Care Sahlgrenska University Hospital/Östra Region Västra Götaland Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Medicine Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Paulin Andréll
- Department of Anaesthesiology and Intensive Care Medicine Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Medicine/Pain Centre Sahlgrenska University Hospital Region Västra Götaland Gothenburg Sweden
| | - Pether Jildenstål
- Institute for Health and Care Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Örebro University Hospital and School of Medical Sciences Örebro University Örebro Sweden
- Department of Anaesthesia, Operation and Intensive Care Sahlgrenska University Hospital Region Västra Götaland Gothenburg Sweden
- Department of Health Sciences Lund University Lund Sweden
| | - Sven‐Egron Thörn
- Department of Anesthesia, Operation and Intensive Care Sahlgrenska University Hospital/Östra Region Västra Götaland Gothenburg Sweden
- Department of Anaesthesiology and Intensive Care Medicine Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Axel Wolf
- Institute for Health and Care Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Anesthesia, Operation and Intensive Care Sahlgrenska University Hospital/Östra Region Västra Götaland Gothenburg Sweden
- Institute of Nursing and Health Promotion Oslo Metropolitan University Oslo Norway
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Zhang YH, Hu HY, Xiong YC, Peng C, Hu L, Kong YZ, Wang YL, Guo JB, Bi S, Li TS, Ao LJ, Wang CH, Bai YL, Fang L, Ma C, Liao LR, Liu H, Zhu Y, Zhang ZJ, Liu CL, Fang GE, Wang XQ. Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus. Front Med (Lausanne) 2021; 8:756940. [PMID: 34901069 PMCID: PMC8654102 DOI: 10.3389/fmed.2021.756940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/25/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. Design: A systematic review and expert consensus. Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five–ten years.
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Affiliation(s)
- Yong-Hui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Hao-Yu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
| | - Yuan-Chang Xiong
- Department of Pain Therapy, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Changgeng Peng
- The First Rehabilitation Hospital of Shanghai, Brain and Spinal Cord Innovation Research Center, School of Medicine, Advanced Institute of Translational Medicine, Tongji University, Shanghai, China
| | - Li Hu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Ya-Zhuo Kong
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Yu-Ling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia-Bao Guo
- The Second School of Clinical Medicine, Xuzhou Medical University, Xuzhou, China
| | - Sheng Bi
- Rehabilitation Medicine Centre, Chinese PLA General Hospital, Beijing, China
| | - Tie-Shan Li
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li-Juan Ao
- School of Rehabilitation, Kunming Medical University, Kunming, China
| | - Chu-Huai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Fang
- School of Rehabilitation Science, Shanghai University of T.C.M., Shanghai, China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin-Rong Liao
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Hao Liu
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Yi Zhu
- Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, China
| | - Chun-Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guo-En Fang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopedic Hospital, Shanghai, China
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Capsaicin 8% Patch and Chronic Postsurgical Neuropathic Pain. J Pers Med 2021; 11:jpm11100960. [PMID: 34683101 PMCID: PMC8537698 DOI: 10.3390/jpm11100960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 01/19/2023] Open
Abstract
(1) Background: Surgery is a frequent cause of persistent pain, defined chronic post-surgical pain (CPSP). The capsaicin 8% patch (Qutenza®) is approved for the treatment of postherpetic neuralgia (PHN) and for diabetic peripheral neuropathy (DPN) of the feet. We propose a review of the literature on use of the capsaicin 8% patch to treat neuropathic pain associated with surgery; (2) Methods: We identified the articles by searching electronic databases using a combination of such terms as “capsaicin 8% patch”, “Qutenza®”, and “chronic postsurgical pain”; (3) Results: We identified 14 selected studies reporting on a total of 632 CPSP cases treated with capsaicin 8% patch. Treatment with the capsaicin 8% patch significantly reduced the average pain intensity. Only 5 studies reported adverse events (AEs) after the patch application. The most common AEs were erythema, burning sensation and pain; (4) Conclusions: Our review indicate that capsaicin 8% patch treatment for CPSP is effective, safe and well tolerated, but randomized controlled trials on efficacy, safety and tolerability should be conducted.
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Brenner D, Shorten GD, O'Mahony SM. Postoperative pain and the gut microbiome. NEUROBIOLOGY OF PAIN 2021; 10:100070. [PMID: 34409198 PMCID: PMC8361255 DOI: 10.1016/j.ynpai.2021.100070] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
Poorly controlled postoperative pain remains a major unresolved challenge globally. The gut microbiome impacts on inflammatory pain and neuropathic pain. Microbiota metabolites can regulate peripheral and central sensitisation. Stress is linked to both postoperative pain and an altered gut microbiome.
In excess of 300 million surgical procedures are undertaken worldwide each year. Despite recognition of the prevalence of postoperative pain, and improvements in pain management techniques, poorly controlled postoperative pain remains a major unresolved challenge globally. An estimated 71% and 51% of patients experience moderate to severe pain after surgery in in-patient and outpatient settings, respectively. Inadequately controlled pain after surgery is associated with significant perioperative morbidity including myocardial infarction and pulmonary complications. As many as 20–56% of patients develop chronic pain after commonly performed procedures such as hernia repair, hysterectomy, and thoracotomy. Traditional analgesics and interventions are often ineffective or partially effective in the treatment of postoperative pain, resulting in a chronic pain condition with related socio-economic impacts and reduced quality of life for the patient. Such chronic pain which occurs after surgery is referred to as Persistent Post-Surgical Pain (PPSP). The complex ecosystem that is the gastrointestinal microbiota (including bacteria, fungi, viruses, phage) plays essential roles in the maintenance of the healthy state of the host. A disruption to the balance of this microbiome has been implicated not only in gastrointestinal disease but also neurological disorders including chronic pain. The influence of the gut microbiome is well documented in the context of visceral pain from the gastrointestinal tract while a greater understanding is emerging of the impact on inflammatory pain and neuropathic pain (both of which can occur during the perioperative period). The gut microbiome is an essential source for driving immune maturation and maintaining appropriate immune response. Given that inflammatory processes have been implicated in postoperative pain, aberrant microbiome profiles may play a role in the development of this type of pain. Furthermore, the microorganisms in our gut produce metabolites, neurotransmitters, and neuromodulators which interact with their receptors to regulate peripheral and central sensitisation associated with chronic pain. Microbiota-derived mediators can also regulate neuroinflammation, which is associated with activation of microglia as well as infiltration by immune cells, known to modulate the development and maintenance of central sensitisation. Moreover, risk factors for developing postoperative pain include anxiety, depression, and increased stress response. These central nervous system-related disorders have been associated with an altered gut microbiome and microbiome targeted intervention studies indicate improvements. Females are more likely to suffer from postoperative pain. As gonadal hormones are associated with a differential microbiome and pre-clinical studies show that male microbiome confers protection from inflammatory pain, it is possible that the composition of the microbiome and its by-products contribute to the increased risk for the development of postoperative pain. Very little evidence exists relating the microbiome to somatic pain. Here we discuss the potential role of the gut microbiome in the aetiology and pathophysiology of postoperative pain in the context of other somatic pain syndromes and what is known about microbe-neuron interactions. Investigations are needed to determine the specific role of the gut microbiome in this type of pain which may help inform the development of preventative interventions as well as management strategies to improve patient outcome.
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Affiliation(s)
- David Brenner
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland
| | - George D Shorten
- Department of Anesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Ireland
| | - Siobhain M O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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Speed TJ, Jung Mun C, Smith MT, Khanuja HS, Sterling RS, Letzen JE, Haythornthwaite JA, Edwards RR, Campbell CM. Temporal Association of Pain Catastrophizing and Pain Severity Across the Perioperative Period: A Cross-Lagged Panel Analysis After Total Knee Arthroplasty. PAIN MEDICINE (MALDEN, MASS.) 2021; 22:1727-1734. [PMID: 33532859 PMCID: PMC8502458 DOI: 10.1093/pm/pnab035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Although numerous studies show that preoperative pain catastrophizing is a risk factor for pain after total knee arthroplasty (TKA), little is known about the temporal course of the association between perioperative pain catastrophizing and pain severity. The present study investigated temporal changes and their dynamic associations between pain catastrophizing and pain severity before and after TKA. DESIGN A secondary data analysis of a larger observational parent study featuring prospective repeated measurement over 12 months. SETTING Dual-site academic hospital. SUBJECTS A total of 245 individuals who underwent TKA. METHODS Participants completed pain catastrophizing and pain severity questionnaires at baseline, 6 weeks, and 3, 6, and 12 months after TKA. Cross-lagged panel analysis was conducted with structural equation modeling including age, sex, race, baseline anxiety, and depressive symptoms as covariates. RESULTS Reduction in pain catastrophizing from baseline to 6 weeks after TKA was associated with lower pain severity at 3 months after TKA (standardized β = 0.14; SE = 0.07, P = 0.046), while reduction in pain severity at 6 weeks after TKA was not associated with pain catastrophizing at 3 months after TKA (P = 0.905). In the chronic postsurgical period (>3 months), pain catastrophizing at 6 months after TKA predicted pain severity at 12 months after TKA (β = 0.23, P = 0.009) with controlling for auto-correlation and covariates, but not vice versa. CONCLUSIONS We provide evidence that changes in pain catastrophizing from baseline to 6 weeks after TKA are associated with subsequent pain severity. Future studies are warranted to determine whether targeting pain catastrophizing during the perioperative period may improve clinical outcomes for individuals undergoing TKA.
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Affiliation(s)
- Traci J Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Sterling
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle E Letzen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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28
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Billet B, Hanssens K, Coster OD, Santos A, Rotte A, Minne V. High-frequency (10 kHz) spinal cord stimulation for the treatment of focal, chronic postsurgical neuropathic pain: results from a prospective study in Belgium. Pain Manag 2021; 12:75-85. [PMID: 34289734 DOI: 10.2217/pmt-2021-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: Chronic postsurgical pain (CPSP) is a common complication of surgery. This study was conducted to evaluate the efficacy and safety of paresthesia-free, 10-kHz spinal cord stimulation (SCS) as a treatment for CPSP. Patients & methods: Subjects in this prospective, single-arm study had an average pain intensity of ≥5 cm on a 10-cm visual analog scale. The subjects who had pain relief of ≥50% (response) with temporary trial stimulation were permanently implanted with 10-kHz SCS and assessed for 1 year. Results: At 12 months, 94% of subjects were responders to 10-kHz SCS, and 88% had pain remission (visual analog scale ≤2.5 cm). Conclusion: The pain relief was durable in CPSP subjects and the safety profile of 10-kHz SCS was as expected. Clinical trial registration: VT005076953 (Privacy Commission of Belgium).
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Affiliation(s)
- Bart Billet
- Pijncentrum AZ Delta, Roeselare, 8800, Belgium
| | | | | | - Angela Santos
- Department of Clinical and Regulatory Affairs, Nevro Corp., Redwood City, CA 94065, USA
| | - Anand Rotte
- Department of Clinical and Regulatory Affairs, Nevro Corp., Redwood City, CA 94065, USA
| | - Veerle Minne
- Department of Clinical and Regulatory Affairs, Nevro Corp., Redwood City, CA 94065, USA
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29
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Zhou F, Yu M. Five-in-one nursing management promotes rapid recovery of patients after thoracic surgery. Am J Transl Res 2021; 13:8049-8057. [PMID: 34377287 PMCID: PMC8340167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the application effect of five-in-one nursing management in the rapid recovery of patients undergoing thoracic surgery. METHODS This prospective study included 45 patients admitted to thoracic surgery before the implementation of five-in-one nursing as the control group and 40 patients admitted during the implementation as the test group. The patients in the control group were nursed by conventional nursing plan, whole those in the test group received the five-in-one nursing management. The perioperative indicators, mental state, postoperative rehabilitation, surgical complications, and nursing satisfaction were compared between the two groups. RESULTS Compared with the control group, the time of extubation, the time of getting out of bed for the first time, the recovery time of bowel sounds, the time of the first defecation, and the length of hospital stay in the experimental group were significantly shortened (P<0.05). At 24 h after surgery, MTL and GAS levels of patients in the test group were significantly higher than those of the control group (P<0.001). Moreover, the test group had lower visual analogue score (VAS) at different times after the operation, as well as lower the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) scores after nursing than the control group (P<0.001). The total incidence of postoperative complications in the experimental group was significantly reduced, while nursing satisfaction was significantly increased (P<0.001) when compared with the control group. CONCLUSION The five-in-one nursing management effectively promoted the rapid recovery of patients after thoracic surgery, shortened the length of hospital stay, and improved nursing satisfaction.
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Affiliation(s)
- Fen Zhou
- Department of Nursing, Hanchuan People’s HospitalHanchuan, Hubei Province, China
| | - Minghong Yu
- Department of Dermatology and Venereology, Hanchuan People’s HospitalHanchuan, Hubei Province, China
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30
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Paredes AC, Pinto JM, Almeida A, Pinto PR. Predictive value of quantitative sensory testing for acute and chronic postsurgical pain after total joint arthroplasty: a systematic review. Pain 2021; 163:e385-e400. [PMID: 34224493 DOI: 10.1097/j.pain.0000000000002385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Quantitative sensory testing (QST) can be useful to identify high-risk patients for the development of chronic postsurgical pain. This systematic review aims to assess if presurgical sensory sensitivity measured using QST is associated with acute and chronic postsurgical pain after total joint arthroplasty. A systematic search was performed in September 2020 in PubMed, EMBASE, Web of Science, and Scopus, using terms related to total joint arthroplasty and QST. Prospective studies were included if they reported an association between presurgical QST and postsurgical pain in adults with osteoarthritis undergoing primary unilateral total joint arthroplasty. From 2994 identified studies, 18 met the inclusion criteria (1869 patients). Total knee arthroplasty was the most common surgery (16 studies), and pressure pain threshold was the most common test (11 studies), followed by dynamic measures (9 studies). Postsurgical pain was assessed at acute (5 studies), subacute (2 studies), and chronic (13 studies) time points. Risk of bias was assessed using the Quality in Prognosis Studies tool and evaluated as low to moderate in most domains. Fourteen studies reported at least one statistically significant association between QST and pain (acute: 4 studies, subacute: 1 study, and chronic: 9 studies). Pressure pain threshold was associated with postsurgical pain in 6 studies (of 11, 55%), heat pain threshold in 2 studies (of 6, 33%), conditioned pain modulation in 1 study (of 6, 17%), and temporal summation of pain in 5 studies (of 8, 63%). The predictive role of presurgical QST for postarthroplasty pain remains unclear, mainly because of heterogeneous methodologies and inconsistent results.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Yu L, Li S, Wei J, Sun H, Yang C, Tan H. Association of serotonin transporter-linked polymorphic region (5-HTTLPR) with heat pain stimulation and postoperative pain in gastric cancer patients. Mol Pain 2021; 17:17448069211006606. [PMID: 33882731 PMCID: PMC8071976 DOI: 10.1177/17448069211006606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study was to assess whether the genotype of the serotonin transporter-linked polymorphic region (5-HTTLPR) in gastric cancer patients is associated with postoperative pain and pain threshold. Methods We conducted a prospective cohort study of 251 patients scheduled for gastrectomy from May to September 2019. All patients enrolled in the study were asked to complete the Hospital Anxiety and Depression Scale questionnaire. Heat pain threshold (HPT), cold pain threshold (CPT) and Pressure pain threshold (PPT) were measured for all participants one day prior to surgery. Blood samples were collected for genetic testing. All patients were connected to a patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery. After exclusion of 15 patients, the postoperative conditions of 236 patients were recorded. Results Distribution of homozygous long (L/L), heterozygous (L/S), and homozygous short (S/S) 5-HTTLPR genotypes among participants were 26 (11.0%), 91 (38.6%), and 119 (50.4%), respectively. Heat pain threshold (P = 0.038) and Numerical rating scale (NRS) in the 1st postoperative 24 h (P = 0.026) were significantly different between long (L/L) and short (S/S) genotype carriers. Conclusions In patients with gastric cancer, heat pain stimulation is associated with 5-HTTLPR polymorphism, and postoperative pain may be related to 5-HTTLPR polymorphism.
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Affiliation(s)
- Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuo Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jin Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongwei Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Caixia Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China
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32
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Deneuve S, Majoufre C, Testelin S, Barry B, Louis MY, Longis J, Bouchet J, Damecourt A, Salvan D, Atallah S, Saroul N, Nokovitch L, Bach C, Berta E, Dupret-Bories A, Julieron M. Donor site sequelae and patient satisfaction after head and neck reconstruction with a radial forearm free flap. Eur Arch Otorhinolaryngol 2021; 278:4051-4058. [PMID: 33721068 DOI: 10.1007/s00405-021-06649-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Radial forearm free flap (RFFF) being a workhorse flap in head and neck reconstruction, we investigated its donor site delayed consequences. METHODS Multicentric case series evaluating 189 patients who underwent RFFF for carcinologic reasons at least 6 months before. Patients and surgeon's appreciation regarding the aesthetic and functional consequences of the flap harvest on their daily life were evaluated by questionnaires using likert scales. Medical data were collected from patients' charts retrospectively. RESULTS Thirty percent of patients had at least one sequelae. Experiencing a graft necrosis did not worsen long-term results. Cosmetic satisfaction was significantly worst for women, according to patients' and surgeons' opinion. For 81% and 92% patients, respectively, the flap harvest had no impact on daily life nor sport practice. Ratio between the benefits of reconstruction and the sequelae at the donor site was judged "excellent" for 77% patients. CONCLUSIONS Although objectively important, RFFF morbidity has little impact in head and neck cancer patient's life.
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Affiliation(s)
- Sophie Deneuve
- Surgical Oncology Department, Centre Léon Berard, 28 rue Laennec, 69008, Lyon, France.
| | - Claire Majoufre
- Maxillofacial Surgery Department, University Hospital-Bordeaux, Bordeaux, France
| | - Sylvie Testelin
- Maxillofacial Surgery Department, University Hospital-Amiens, Amiens, France
| | - Béatrix Barry
- Head and Neck Surgery Department, University Hospital Bichat, Paris, France
| | | | - Julie Longis
- Head and Neck Surgery Department, University Hospital-Nantes, Nantes, France
| | - Justine Bouchet
- Head and Neck Surgery Department, Comprehesive Cancer Center Oscar Lambret, Lille, France
| | - Arnaud Damecourt
- Head and Neck Department, University Hospital Montpellier, Montpellier, France
| | - Didier Salvan
- ENT Department, Sud Francilien General Hospital, Corbeil, France
| | - Sarah Atallah
- ENT Department, University Hospital Tenon, Paris, France
| | - Nicolas Saroul
- ENT Department, University Hospital-Clermont-Ferrand, Clermont-Ferrand, France
| | - Lara Nokovitch
- Surgical Oncology Department, Centre Léon Berard, 28 rue Laennec, 69008, Lyon, France
| | - Christine Bach
- Head and Neck Surgery Department, Hopital Foch General Hospital, Suresnes, France
| | - Etienne Berta
- Maxilofacial Surgery Department, Annecy General Hospital, Annecy, France
| | - Agnès Dupret-Bories
- Head and Neck Surgery Department, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Morbize Julieron
- Head and Neck Surgery Department, Comprehesive Cancer Center Oscar Lambret, Lille, France
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Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit 2021; 27:e928759. [PMID: 33547269 PMCID: PMC7874529 DOI: 10.12659/msm.928759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Despite increased experience and technical developments in total knee arthroplasty (TKA), chronic postsurgical pain (CPSP) remains one of physicians’ biggest challenges. The aim of the present study was to evaluate the effectiveness of perineural injection therapy (PIT) in the management of CPSP after TKA. Material/Methods A total of 60 patients who had been surgically treated with TKA because of advanced knee osteoarthritis was included in the present study. The study included 2 groups. Group A consisted of patients who received 3 rounds of PIT combined with standard postoperative TKA protocol during the same period. Group B received standard postoperative TKA protocols (rehabilitation programs, oral and intravenous analgesics). Clinical effectiveness was evaluated via Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analog Scale (VAS) at baseline and 1-, 3-, and 6-month follow-ups. Results All repeated measures showed significant improvements (P<0.001) in both groups for VAS and WOMAC scores. These scores were significantly better in group A in all follow-up periods compared with group B (P<0.001). Twenty-nine patients (93.5%) in group A reported excellent or good outcomes compared with 26 patients (89.6%) in group B. Conclusions PIT is a promising approach in CPSP with minimal cost, simple and secure injection procedures, minimal side effects, and higher clinical efficacy.
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Affiliation(s)
- İsmail Güzel
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - Deniz Gül
- Department of Orthopedic Surgery, Bursa Kestel State Hospital, Bursa, Turkey
| | - Serkan Akpancar
- Department of Orthopedic Surgery, Malatya Training and Research Hospital, Malatya, Turkey
| | - John Lyftogt
- Private Practice (Retired), Christchurch, New Zealand
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Sasidharan S, Dhillon H. The lingering agony of chronic pain. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2021. [DOI: 10.4103/jotr.jotr_74_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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35
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Tan H, Wei J, Li S, Yu L, Sun H, Ji K, Wang Y, Li C. Pain threshold, anxiety and other factors affect intensity of postoperative pain in gastric cancer patients: A prospective cohort study. Chin J Cancer Res 2021; 33:343-351. [PMID: 34321831 PMCID: PMC8286888 DOI: 10.21147/j.issn.1000-9604.2021.03.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/24/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This prospective cohort study explored factors related to postoperative pain in gastric cancer patients. Methods A total of 236 patients who underwent gastrectomy were enrolled. All patients enrolled in the study completed the Hospital Anxiety and Depression Scale (HADS) questionnaire and Life Orientation Test-Revised (LOT-R) questionnaire on the day before surgery. Heat pain threshold (HPT), cold pain threshold (CPT) and pressure pain threshold (PPT) were measured for all patients one day prior to surgery and demographic details were collected. All patients were connected to a patient-controlled intravenous analgesia (PCIA) pump at the end of the surgery. The occurrence of postoperative pain was used as a dependent variable, and multivariate logistic regression analyses were conducted to screen for factors affecting postoperative pain. Results In total, 83 patients (35.2%) had postoperative pain. Body mass index (BMI) ≥28 kg/m2 [odds ratio (OR): 2.67; 95% confidence interval (95% CI): 1.07−6.67], total gastrectomy (OR: 2.64; 95% CI: 1.42−4.91), preoperative anxiety score ≥8 (OR: 2.37; 95% CI: 1.12−5.02), heat pain threshold ≤4.9 s (OR: 2.14; 95% CI: 1.06−4.32), pressure pain threshold ≤4 g (OR: 2.05; 95% CI: 1.05−4.03), and female gender (OR: 1.99; 95% CI: 1.04−3.83) were risk factors for postoperative pain.
Conclusions Obesity, wide range of gastrectomy, high preoperative anxiety, low HPT and PPT, and female gender are associated with increased risk for postoperative pain.
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Affiliation(s)
- Hongyu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jin Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shuo Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ling Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hongwei Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ke Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Changlong Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
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36
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Sasidharan S, Dhillon H. The psychobiology and management of chronic pain. HAMDAN MEDICAL JOURNAL 2021. [DOI: 10.4103/hmj.hmj_50_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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37
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Wylde V, Sanderson E, Peters TJ, Bertram W, Howells N, Bruce J, Eccleston C, Gooberman-Hill R. Screening to identify postoperative pain and cross-sectional associations between factors identified in this process with pain and function, three months after total knee replacement. Arthritis Care Res (Hoboken) 2020; 74:790-798. [PMID: 33207083 PMCID: PMC9311148 DOI: 10.1002/acr.24516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/06/2020] [Accepted: 11/12/2020] [Indexed: 11/09/2022]
Abstract
Objective To describe the screening and recruitment process of a randomized trial and evaluate associations with knee pain and function 3 months after total knee replacement (TKR). Methods In order to screen for a multicenter trial, a total of 5,036 patients were sent the Oxford Knee Score (OKS) questionnaire 10 weeks post‐TKR. Patients who reported pain in their replaced knee (score of ≤14 on the OKS pain component) completed a second OKS questionnaire 12 weeks post‐TKR. Those patients who were still experiencing pain 12 weeks post‐TKR completed a detailed questionnaire 13 weeks post‐TKR. These data were used to characterize pain in a cross‐sectional analysis. Multivariable regression was performed in order to identify factors associated with pain and function at 13 weeks post‐TKR. Results We received OKS questionnaires from 3,058 of 5,063 TKR patients (60%), and 907 of the 3,058 (30%) reported pain in their replaced knee 10 weeks post‐TKR. By 12 weeks, 179 of 553 patients (32%) reported improved pain (score of >14 on the OKS pain component). At 13 weeks, 192 of 363 patients (53%) who completed a detailed questionnaire reported neuropathic pain, 94 of 362 (26%) reported depression symptoms, and 95 of 363 (26%) anxiety symptoms. More severe pain at 13 weeks postoperatively was associated with poorer general health, poorer physical health, more pain worry, and lower satisfaction with surgery outcome. More severe functional limitation was associated with higher levels of depression, more pain worry, lower satisfaction with surgery outcome, and higher pain acceptance. Conclusion Screening after TKR identified individuals with pain. We identified several potential targets (physical and mental health outcomes, acceptance of pain, and quality of life) for tailored intervention to improve outcomes for patients. Future trials of multidisciplinary interventions warranted.
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Affiliation(s)
- Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, UK, Warwick
| | - Emily Sanderson
- Bristol Trials Centre (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Trials Centre (BRTC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Wendy Bertram
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | | | - Julie Bruce
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | | | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, UK, Warwick
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Esses G, Deiner S, Ko F, Khelemsky Y. Chronic Post-Surgical Pain in the Frail Older Adult. Drugs Aging 2020; 37:321-329. [PMID: 32297246 DOI: 10.1007/s40266-020-00761-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Older adults are the fastest growing segment of the population and surgical procedures in this group increase each year. Chronic post-surgical pain is an important consideration in the older adult as it affects recovery, physical functioning, and overall quality of life. It is increasingly recognized as a public health issue but there is a need to improve our understanding of the disease process as well as the appropriate treatment and prevention. Frailty, delirium, and cognition influence post-operative outcomes in older adults and have been implicated in the development of chronic post-surgical pain. Further research must be conducted to fully understand the role they play in the occurrence of chronic post-surgical pain in the older adult. Additionally, careful attention must be given to the physiologic, cognitive, and comorbidity differences between the older adult and the general population. This is critical for elucidating the proper chronic post-surgical pain treatment and prevention strategies to ensure that the older adult undergoing surgical intervention will have an appropriate and desirable post-operative outcome.
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Affiliation(s)
- Gary Esses
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA.
| | - Stacie Deiner
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
| | - Fred Ko
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yury Khelemsky
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, Box 1010, New York, NY, USA
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39
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van Helmond N, Aarts HM, Timmerman H, Olesen SS, Drewes AM, Wilder-Smith OH, Steegers MA, Vissers KC. Is Preoperative Quantitative Sensory Testing Related to Persistent Postsurgical Pain? A Systematic Literature Review. Anesth Analg 2020; 131:1146-1155. [PMID: 32925335 DOI: 10.1213/ane.0000000000004871] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Persistent postsurgical pain (PPSP) is a common complication of surgery that significantly affects quality of life. A better understanding of which patients are likely to develop PPSP would help to identify when perioperative and postoperative pain management may require specific attention. Quantitative sensory testing (QST) of a patient's preoperative pain perception is associated with acute postoperative pain, and acute postoperative pain is a risk factor for PPSP. The direct association between preoperative QST and PPSP has not been reviewed to date. In this systematic review, we assessed the relationship of preoperative QST to PPSP. We searched databases with components related to (1) preoperative QST; (2) association testing; and (3) PPSP. Two authors reviewed all titles and abstracts for inclusion. Inclusion criteria were as follows: (1) QST performed before surgery; (2) PPSP assessed ≥3 months postoperatively; and (3) the association between QST measures and PPSP is investigated. The search retrieved 905 articles; 24 studies with 2732 subjects met inclusion criteria. Most studies (22/24) had moderate to high risk of bias in multiple quality domains. Fourteen (58%) studies reported a significant association between preoperative QST and PPSP. Preoperative temporal summation of pain (4 studies), conditioned pain modulation (3 studies), and pressure pain threshold (3 studies) showed the most frequent association with PPSP. The strength of the association between preoperative QST and PPSP varied from weak to strong. Preoperative QST is variably associated with PPSP. Measurements related to central processing of pain may be most consistently associated with PPSP.
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Affiliation(s)
- Noud van Helmond
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, New Jersey
| | - Hugo M Aarts
- Department of Cardiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Hans Timmerman
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Søren S Olesen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn M Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Oliver H Wilder-Smith
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Monique A Steegers
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Anesthesiology, Vrije Universiteit (VU) Medical Center, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kris C Vissers
- From the Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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40
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Hanani M, Spray DC. Emerging importance of satellite glia in nervous system function and dysfunction. Nat Rev Neurosci 2020; 21:485-498. [PMID: 32699292 PMCID: PMC7374656 DOI: 10.1038/s41583-020-0333-z] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 02/08/2023]
Abstract
Satellite glial cells (SGCs) closely envelop cell bodies of neurons in sensory, sympathetic and parasympathetic ganglia. This unique organization is not found elsewhere in the nervous system. SGCs in sensory ganglia are activated by numerous types of nerve injury and inflammation. The activation includes upregulation of glial fibrillary acidic protein, stronger gap junction-mediated SGC-SGC and neuron-SGC coupling, increased sensitivity to ATP, downregulation of Kir4.1 potassium channels and increased cytokine synthesis and release. There is evidence that these changes in SGCs contribute to chronic pain by augmenting neuronal activity and that these changes are consistent in various rodent pain models and likely also in human pain. Therefore, understanding these changes and the resulting abnormal interactions of SGCs with sensory neurons could provide a mechanistic approach that might be exploited therapeutically in alleviation and prevention of pain. We describe how SGCs are altered in rodent models of four common types of pain: systemic inflammation (sickness behaviour), post-surgical pain, diabetic neuropathic pain and post-herpetic pain.
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Affiliation(s)
- Menachem Hanani
- Laboratory of Experimental Surgery, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - David C Spray
- Dominick Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
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41
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Abstract
Pain management for cancer patients should include pharmacologic and nonpharmacologic interventions. Integrative medicine therapies, such as mind-body practice, acupuncture, massage therapy, and music therapy, have been studied for their roles in pain management. Data from randomized controlled trials support the effect of hypnosis, acupuncture, and music therapy in reduction of pain. Mindfulness meditation, yoga, qigong, and massage therapy, although may not reduce pain per se, can relieve anxiety and mood changes, which are commonly associated with pain. In clinical practice, one should also consider burdens and risks to patients, patient preference, and the presence or absence of better alternatives when making decisions on whether an integrative medicine therapy is of clinical value.
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Tian X, Zhu H, Du S, Zhang XQ, Lin F, Ji F, Tsou YH, Li Z, Feng Y, Ticehurst K, Hannaford S, Xu X, Tao YX. Injectable PLGA-Coated Ropivacaine Produces A Long-Lasting Analgesic Effect on Incisional Pain and Neuropathic Pain. THE JOURNAL OF PAIN 2020; 22:180-195. [PMID: 32739615 DOI: 10.1016/j.jpain.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/27/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
Abstract
The management of persistent postsurgical pain and neuropathic pain remains a challenge in the clinic. Local anesthetics have been widely used as simple and effective treatment for these 2 disorders, but the duration of their analgesic effect is short. We here reported a new poly lactic-co-glycolic acid (PLGA)-coated ropivacaine that was continuously released in vitro for at least 6 days. Perisciatic nerve injection of the PLGA-coated ropivacaine attenuated paw incision-induced mechanical allodynia and heat hyperalgesia during the incisional pain period, and spared nerve injury-induced mechanical and cold allodynia for at least 7 days postinjection. This effect was dose-dependent. Perisciatic nerve injection of the PLGA-coated ropivacaine did not produce detectable inflammation, tissue irritation, or damage in the sciatic nerve and surrounding muscles at the injected site, dorsal root ganglion, spinal cord, or brain cortex, although the scores for grasping reflex were mildly and transiently reduced in the higher dosage-treated groups. PERSPECTIVE: Given that PLGA is an FDA-approved medical material, and that ropivacaine is used currently in clinical practice, the injectable PLGA-coated ropivacaine represents a new and highly promising avenue in the management of postsurgical pain and neuropathic pain.
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Affiliation(s)
- Xue Tian
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey; Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - He Zhu
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Shibin Du
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Xue-Qing Zhang
- Engineering Research Center of Cell & Therapeutic Antibody Ministry of Education, School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Fuqing Lin
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Fengtao Ji
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Yung-Hao Tsou
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Zhongyu Li
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Kathryn Ticehurst
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Stephen Hannaford
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Xiaoyang Xu
- Department of Chemical and Materials Engineering, New Jersey Institute of Technology, Newark, New Jersey; Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey
| | - Yuan-Xiang Tao
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey.
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Bae J, Shin S. [Factors Related to Persistent Postoperative Pain after Cardiac Surgery: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2020; 50:159-177. [PMID: 32376806 DOI: 10.4040/jkan.2020.50.2.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/17/2019] [Accepted: 01/21/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes. METHODS The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies. RESULTS The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53). CONCLUSION Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.
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Affiliation(s)
- Jaewon Bae
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Sujin Shin
- College of Nursing, Ewha Womans University, Seoul, Korea.
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Larsen JB, Skou ST, Arendt-Nielsen L, Simonsen O, Madeleine P. Neuromuscular exercise and pain neuroscience education compared with pain neuroscience education alone in patients with chronic pain after primary total knee arthroplasty: study protocol for the NEPNEP randomized controlled trial. Trials 2020; 21:218. [PMID: 32197629 PMCID: PMC7083002 DOI: 10.1186/s13063-020-4126-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/31/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is considered an effective treatment for pain relief and improved physical performances in end-stage knee osteoarthritis. However, several studies have reported less favorable outcomes after TKA with chronic pain rates of approximately 20%. Exercise might be an effective treatment strategy for chronic pain following TKA, but no randomized controlled trials have evaluated its effect. Therefore, the purpose of this randomized controlled trial is to investigate whether a 12-week neuromuscular exercise (NEuroMuscular EXercise training program for patients with knee or hip osteoarthritis assigned for total joint replacement; NEMEX-TJR) program combined with pain neuroscience education (PNE) provides greater pain relief and improvement in physical performances than PNE alone at 12 months follow-up in a population of patients with chronic pain after primary TKA. METHODS For this randomized controlled superiority trial, 120 patients with moderate-to-severe chronic pain after TKA are recruited from Aalborg University Hospital, Denmark. Patients are randomly assigned in a 1:1 ratio to one of two interventions: (a) NEMEX-TJR twice weekly for 12 weeks combined with two sessions of PNE or (b) two sessions of PNE given over 6 weeks. Assessment is performed at baseline before intervention and at 3, 6, and 12 months after initiation of the intervention. Outcome assessors are blinded toward group allocation. The primary outcome is the change in the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4), defined as the mean score for the KOOS subscales pain, symptoms, activities of daily living, and quality of life. Secondary outcomes include all KOOS subscale scores and scores for PainDETECT, the Fear-Avoidance Beliefs Questionnaire, Global Perceived Effect, the Pain Catastrophizing Scale, pain intensities, temporal summation, conditioned pain modulation, and pressure pain thresholds. Physical performances are measured with walking, stair climbing, and chair standing tests as well as tests of muscle strength and power. DISCUSSION The findings will be useful in establishing effective treatment strategies for chronic pain after TKA. The randomized controlled trial involves rigorous scientific methods and uses clinically applicable interventions. The study interventions are conducted in clinical settings, thereby enhancing the possibility of future implementation of the treatments in the health care systems. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03886259. Registered 22 March 2019. Ethics committee registration: N-20180046.
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Affiliation(s)
- Jesper Bie Larsen
- Translational Pain Biomarker, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark. .,Sports Sciences - Performance and Technology, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark.
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Region Zealand, Denmark
| | - Lars Arendt-Nielsen
- Translational Pain Biomarker, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Simonsen
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Pascal Madeleine
- Sports Sciences - Performance and Technology, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
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Dennis J, Wylde V, Gooberman-Hill R, Blom AW, Beswick AD. Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2020; 10:e033248. [PMID: 31964670 PMCID: PMC7045074 DOI: 10.1136/bmjopen-2019-033248] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Nearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%-34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR. DESIGN MEDLINE, Embase, CINAHL, The Cochrane Library and PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation. PRIMARY AND SECONDARY OUTCOMES Pain at 6 months or longer; adverse events. INTERVENTIONS Presurgical interventions aimed at improving TKR outcomes. RESULTS Eight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI -0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions. CONCLUSIONS We found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR. PROSPERO REGISTRATION NUMBER CRD42017041382.
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Affiliation(s)
- Jane Dennis
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - A W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Andrew David Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, University of Bristol, Bristol, UK
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46
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Wang S, Li Y, Fei M, Zhang H, Wang J. Clinical Analysis of the Effects of Different Anesthesia and Analgesia Methods on Chronic Postsurgical Pain in Patients With Uniportal Video-Assisted Lung Surgery. J Cardiothorac Vasc Anesth 2019; 34:987-991. [PMID: 31866220 DOI: 10.1053/j.jvca.2019.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/20/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To understand whether different anesthesia and analgesia methods affected the incidence of chronic postsurgical pain (CPSP) in patients who underwent uniportal video-assisted lung surgery and to explore the influence factors of CPSP. DESIGN Retrospective study. SETTING AND PARTICIPANTS A total of 120 patients, who underwent selective uniportal video-assisted lung surgery at Zhongshan Hospital from March to June 2018, were enrolled. INTERVENTIONS The visual analog scale was used to assess the degree of pain on the first and second postoperative days. At the third and sixth months after surgery, the telephone follow-up was conducted for the survey of the numerical rating scale. The incidence of acute and chronic pain in different anesthesia methods was analyzed, and the relevant factors of CPSP were statistically analyzed. RESULTS Among the 111 patients who completed follow-up, no significant difference was noted in the incidences of acute and chronic postsurgical pain between patients who received different anesthesia and analgesia methods (p > 0.05). The incidence of CPSP was 29.7% at 3 months after surgery and 9.0% at 6 months after surgery. The degree of pain within 48 hours after surgery was a risk factor for CPSP (odds ratio [OR] = 2.39, p < 0.05). CONCLUSION CPSP accounted for a specific proportion of patients after uniportal video-assisted lung surgery; however, it was significantly lower than that of patients with conventional thoracotomy. The incidence did not differ significantly among anesthesia and analgesia methods. Active and effective control of acute postsurgical pain might reduce the incidence of CPSP.
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Affiliation(s)
- Shuwei Wang
- Department of Anesthesia, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Li
- Department of Anesthesia, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
| | - Min Fei
- Department of Anesthesia, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Hong Zhang
- Department of Anesthesia, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jiaxing Wang
- Department of Anesthesia, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
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The effectiveness of physiotherapy interventions on pain and quality of life in adults with persistent post-surgical pain compared to usual care: A systematic review. PLoS One 2019; 14:e0226227. [PMID: 31834898 PMCID: PMC6910682 DOI: 10.1371/journal.pone.0226227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background Persistent post-surgical pain (PPSP) is a common condition following surgery, resulting in persistent pain and reduced quality of life (QoL). While pharmacological management is common, its effectiveness remains equivocal. This systematic review investigated the effectiveness of physiotherapy management in adults with PPSP in comparison to usual care. Methods A systematic search of six electronic databases was conducted. Studies of human adults (>18 years) with PPSP localised or directly referred from the surgical site, pain persisting for at least two months post-surgery and with physiotherapy as the intervention were included. This review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The McMaster critical review form for quantitative studies was utilised to assess the methodological quality. A descriptive synthesis was undertaken due to the heterogeneity of the included studies. Results Of the 1395 articles that were screened, eight studies met the inclusion criteria. A diverse range of physiotherapy interventions were utilised, and effectiveness was measured through diverse outcomes and measures. Summarised findings from the heterogenous evidence base indicated that physiotherapy interventions for PPSP has a positive impact across a range of outcomes, including pain, quality of life (QoL), physical function and depression. While these are encouraging findings, the current evidence base lacks uniformity with regards to participant characteristics, time periods since diagnosis, interventions delivered, and its parameters, and outcomes measured. Conclusion Due to ongoing challenges in the management of PPSP, alternate treatment strategies such as physiotherapy are being trialled. Despite a number of methodological constraints, current evidence indicates that physiotherapy could play a role in the management of PPSP. PROSPERO registration CRD42019129580
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Whale K, Wylde V, Beswick A, Rathbone J, Vedhara K, Gooberman-Hill R. Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement: a systematic review. BMJ Open 2019; 9:e029742. [PMID: 31806606 PMCID: PMC6924731 DOI: 10.1136/bmjopen-2019-029742] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR). DESIGN Medline, Embase, and PsycINFO were searched from inception to up to 9 May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short-term and long-term postoperative pain after TKR were included. Screening, data extraction, and assessment of methodological quality were performed in duplicate by two reviewers. The primary effectiveness outcome was postoperative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological well-being. Reporting standards were assessed using the Template for Intervention Description and Replication (TIDieR) checklist for intervention reporting. RESULTS 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study), progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive-behavioural therapy (two studies), and a postoperative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. CONCLUSION Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute postoperative pain and chronic postoperative pain would be of benefit. PROSPERO REGISTRATION NUMBER CRD42018095100.
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Affiliation(s)
- Katie Whale
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Vikki Wylde
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Rathbone
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, City Hospital, University of Nottingham, Nottingham, United Kingdom
| | - Kavita Vedhara
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachael Gooberman-Hill
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Therapeutic Approaches for Peripheral and Central Neuropathic Pain. Behav Neurol 2019; 2019:8685954. [PMID: 31871494 PMCID: PMC6906810 DOI: 10.1155/2019/8685954] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/20/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Neuropathic pain is a chronic secondary pain condition, which is a consequence of peripheral or central nervous (somatosensory) system lesions or diseases. It is a devastating condition, which affects around 7% of the general population. Numerous etiological factors contribute to the development of chronic neuropathic pain. It can originate from the peripheral part of the nervous system such as in the case of trigeminal or postherpetic neuralgia, peripheral nerve injury, painful polyneuropathies, or radiculopathies. Central chronic neuropathic pain can develop as a result of spinal cord or brain injury, stroke, or multiple sclerosis. As first-line pharmacological treatment options, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids are recommended. In trigeminal neuralgia, carbamazepine and oxcarbazepine are the first-choice drugs. In drug-refractory cases, interventional, physical, and psychological therapies are available. This review was structured based on a PubMed search of papers published in the field from 2010 until May 2019.
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McKay W, Lee D, Masu A, Thakore S, Tuyishime E, Niyitegeka J, Ruhato P, Twagirumugabe T, O’Brien J. Surveys of post-operative pain management in a teaching hospital in Rwanda - 2013 and 2017. Can J Pain 2019; 3:190-199. [PMID: 35005409 PMCID: PMC8730551 DOI: 10.1080/24740527.2019.1673158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/19/2019] [Indexed: 11/03/2022]
Abstract
Background: Postoperative pain management (POPM) appeared to be weak in Rwanda. Aims: The aim of this study was to compare POPM measures in a teaching hospital between 2013 and 2017. Methods: A two-phase observational study in 2013 and 2017. was conducted. Participants were recruited prior to major surgery and followed for two postoperative days. A numerical rating scale (0-10) was administered to all participants in both years, and the International Pain Outcomes questionnaire was administered in 2017. Recruitment, consent, and data collection were performed in participants' preferred language. Results: One hundred adult participants undergoing major general, gynecologic, orthopedic, or urologic surgery were recruited in 2013 and 83 were recruited in 2017. Fourteen percent of participants in 2013 and 46% in 2017 scored their worst pain as severe (>6; P < 0.001). This was despite improved preoperative recognition of patients at high risk for severe postoperative pain (those with chronic pain or preoperative pain); 27% and 0% of these patients were not documented in 2013 and 2017, respectively (P = 0.006). Other measures of improved planning included "any preoperative discussion of POPM" (P < 0.001) and "discussion of POPM options" (P = 0.002). Preemptive analgesia use increased (3% of participants in 2013 and 54% in 2017; P < 0.001). Incidence of participants having no postoperative analgesic at all decreased from 25% in 2013 to 5% in 2017 (P < 0.001). Conclusions: Though severe postoperative pain incidence did not improve from 2013 to 2017, POPM improved by a number of measures. These changes may be attributed to pain research conducted there having raised awareness.
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Affiliation(s)
- William McKay
- Department of Anesthesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Danyela Lee
- Department of Anesthesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Adolphe Masu
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Shefali Thakore
- Department of Anesthesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Eugene Tuyishime
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Joseph Niyitegeka
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Paulin Ruhato
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Theogene Twagirumugabe
- Department of Anesthesiology, Critical Care and Emergency Medicine, University of Rwanda, Kigali, Rwanda
| | - Jennifer O’Brien
- Department of Anesthesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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