1
|
Bavencoffe A, Lopez ER, Johnson KN, Tian J, Gorgun FM, Shen BQ, Domagala DM, Zhu MX, Dessauer CW, Walters ET. Widespread hyperexcitability of nociceptor somata outlasts enhanced avoidance behavior after incision injury. Pain 2025; 166:1088-1104. [PMID: 39432803 DOI: 10.1097/j.pain.0000000000003443] [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: 02/05/2024] [Accepted: 09/05/2024] [Indexed: 10/23/2024]
Abstract
ABSTRACT Nociceptors with somata in dorsal root ganglia (DRGs) readily switch from an electrically silent state to a hyperactive state of tonic, nonaccommodating, low-frequency, irregular discharge of action potentials (APs). Spontaneous activity (SA) during this state is present in vivo in rats months after spinal cord injury (SCI) and has been causally linked to SCI pain. Intrinsically generated SA and, more generally, ongoing activity (OA) are induced by various neuropathic conditions in rats, mice, and humans and are retained in nociceptor somata after dissociation and culturing, providing a powerful tool for investigating its mechanisms and functions. The present study shows that long-lasting hyperexcitability that can generate OA during modest depolarization in probable nociceptors dissociated from DRGs of male and female rats is induced by plantar incision injury. OA occurred when the soma was artificially depolarized to a level within the normal range of membrane potentials where large, transient depolarizing spontaneous fluctuations (DSFs) can approach AP threshold. This hyperexcitability persisted for at least 3 weeks, whereas behavioral indicators of affective pain-hind paw guarding and increased avoidance of a noxious substrate in an operant conflict test-persisted for 1 week or less. The most consistent electrophysiological alteration associated with OA was enhancement of DSFs. An unexpected discovery after plantar incisions was hyperexcitability in neurons from thoracic DRGs that innervate dermatomes distant from the injured tissue. Potential in vivo functions of widespread, low-frequency nociceptor OA consistent with these and other findings are to contribute to hyperalgesic priming and to drive anxiety-related hypervigilance.
Collapse
Affiliation(s)
- Alexis Bavencoffe
- Department of Integrative Biology and Pharmacology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Li S, Toneman MK, Mangnus JPM, Strocchi S, van Boekel RLM, Vissers KCP, ten Broek RPG, Coenen MJH. Genome-wide association study on chronic postsurgical pain after abdominal surgeries in the UK Biobank. Anaesthesia 2025; 80:499-510. [PMID: 39734325 PMCID: PMC11987778 DOI: 10.1111/anae.16528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2024] [Indexed: 12/31/2024]
Abstract
INTRODUCTION Chronic pain is one of the most common and severe complications after surgery, affecting quality of life and overall wellbeing of patients. Several risk factors have been identified but the mechanisms of chronic postsurgical pain development remain unclear. This study aimed to identify single-nucleotide polymorphisms associated with developing chronic postsurgical pain after abdominal surgery, one of the most common types of surgery. METHODS A genome-wide association study was performed on 27,603 patients from the UK Biobank who underwent abdominal surgery. The robustness of identified loci was validated by split-half validation analysis. Functionally related top loci were selected for expression validation in clinical samples of adhesions from patients with and without pain. RESULTS One locus (rs185545327) reached genome-wide significance for association with chronic postsurgical pain development, and 10 loci surpassed the suggestively significant threshold (p < 1 × 10-6). In the robustness analysis, eight loci had at least nominal significance. The loci passing the suggestively significant threshold were mapped to 15 genes, of which two loci contained pain-related genes (SRPK2, PDE4D). Although marginally approaching statistical significance in the expression validation of clinical samples, the detection rate and expression level of PDE4D were modestly higher in patients with pain compared with those in the control group. DISCUSSION This study provides preliminary evidence for genetic risk factors implicated in chronic postsurgical pain following abdominal surgery, particularly the PDE4D gene, which has been associated with pain in previous studies. The findings add to evidence suggesting potential for the future development of a clinically applicable tool for personalised risk prediction, aiding clinicians in stratifying patients and enhancing clinical decision-making through individualised risk assessments.
Collapse
Affiliation(s)
- Song Li
- Department of Human GeneticsRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Masja K. Toneman
- Department of SurgeryRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Judith P. M. Mangnus
- Department of SurgeryRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Stefano Strocchi
- Department of Human GeneticsRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Regina L. M. van Boekel
- Department of Anesthesiology, Pain and Palliative MedicineRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
- Research Department Emergency and Critical CareHAN University of Applied Sciences, School of Health StudiesNijmegenThe Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain and Palliative MedicineRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Richard P. G. ten Broek
- Department of SurgeryRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | | |
Collapse
|
3
|
Zang H, Ji X, Yao W, Wan L, Zhang C, Zhu C, Liu T. Role of efferocytosis in chronic pain -- From molecular perspective. Neurobiol Dis 2025; 207:106857. [PMID: 40015655 DOI: 10.1016/j.nbd.2025.106857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/23/2025] [Accepted: 02/24/2025] [Indexed: 03/01/2025] Open
Abstract
The complex nature of pain pathophysiology complicates the establishment of objective diagnostic criteria and targeted treatments. The heterogeneous manifestations of pain stemming from various primary diseases contribute to the complexity and diversity of underlying mechanisms, leading to challenges in treatment efficacy and undesirable side effects. Recent evidence suggests the presence of apoptotic cells at injury sites, the distal dorsal root ganglia (DRG), spinal cord, and certain brain regions, indicating a potential link between the ineffective clearance of dead cells and debris and pain persistence. This review highlights recent research findings indicating that efferocytosis plays a significant yet often overlooked role in lesion expansion while also representing a potentially reversible impairment that could be targeted therapeutically to mitigate chronic pain progression. We examine recent advances into how efferocytosis, a process by which phagocytes clear apoptotic cells without triggering inflammation, influences pain initiation and intensity in both human diseases and animal models. This review summarizes that efferocytosis contributes to pain progression from the perspective of defective and inefficient efferocytosis and its subsequent secondary necrocytosis, cascade inflammatory response, and the shift of phenotypic plasticity and metabolism. Additionally, we investigate the roles of newly discovered genetic alterations or modifications in biological signaling pathways in pain development and chronicity, providing insights into innovative treatment strategies that modulate efferocytosis, which are promising candidates and potential avenues for further research in pain management and prevention.
Collapse
Affiliation(s)
- Hu Zang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiaoyu Ji
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wenlong Yao
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Li Wan
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chuanhan Zhang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chang Zhu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Tongtong Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| |
Collapse
|
4
|
Kondo Y, Higuchi D, Tsushima K, Ashida Y, Miki T, Watanabe Y, Takebayashi T. The role of pain trajectory and sex in predicting postoperative neck pain in patients after cervical spine surgery: A retrospective cohort study. J Back Musculoskelet Rehabil 2025:10538127251328935. [PMID: 40152009 DOI: 10.1177/10538127251328935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2025]
Abstract
BackgroundPostoperative neck pain is common after cervical spine surgery, with potential progression to chronic pain.ObjectiveTo assess the role of pain trajectory in predicting postoperative neck pain following cervical spine surgery and to discern sex-based differences in this relationship.MethodsA retrospective study was conducted on 133 patients (mean age:64.1 ± 11.9 years; 86 males, 47 females) undergoing cervical spine surgery. Pain trajectory, defined by Numerical Rating Scale scores on postoperative days 1, 3, 5, and 7, was analyzed using hierarchical multiple regression to evaluate its predictive value for neck pain at two weeks, with sex as a moderator.ResultsSex (B = 0.613; p < .05), slope (B = 1.528; p < .01), and intercept (B = 0.410; p < .01) were significant predictors. Pain trajectory had a stronger association with neck pain in females (B = 2.283; p < .01) than in males (B = 0.772; p = .03).ConclusionPain trajectory is a predictor of postoperative neck pain and highlights sex-based differences. Incorporating pain trajectory monitoring into clinical practice can enable the early identification of patients at higher risk for poor pain outcomes, facilitating more targeted and effective interventions.
Collapse
Affiliation(s)
- Yu Kondo
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Daisuke Higuchi
- Department of Physical Therapy, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Keita Tsushima
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Yuzo Ashida
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | | | - Yuta Watanabe
- Department of Rehabilitation, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| | - Tsuneo Takebayashi
- Department of Orthopedic, Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan
| |
Collapse
|
5
|
Garrett JC, Wilson S, Jessup A, Brandel MG, Nerison CS, Raslan AM, Ben-Haim S, Halgren E. Opioidergic pain relief in humans is mediated by beta and high-gamma modulation in limbic regions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.03.03.25323046. [PMID: 40093233 PMCID: PMC11908309 DOI: 10.1101/2025.03.03.25323046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
The nature of the neurophysiological effects of opioids, especially those responsible for their analgesic properties, are unknown, hindering efforts to develop non-addictive alternatives. Fentanyl and hydromorphone were administered to patients experiencing semi-chronic, clinically-relevant pain after surgical implantation of electrodes for the localization of seizure onset. Opioids suppressed beta oscillations in lateral amygdala, ventral and dorsolateral prefrontal cortices, and increased beta in medial amygdala and hippocampus. Opioids also suppressed high gamma oscillations in insula and lateral amygdala, and increased high gamma in cingulate cortex and hippocampus. The amplitude of these beta effects in the ventral prefrontal cortex, medial amygdala and hippocampus, and of gamma effects in the insula, were positively correlated with the magnitude of pain relief in response to a constant dose. These findings identify electrophysiological events in a network of limbic structures that may participate in opioidergic pain relief through nociceptive gating and a decreased concerned fixation on pain, providing insights into the neural basis of pain relief and suggesting possible biomarkers for developing non-addictive opioid alternatives.
Collapse
|
6
|
González SR, Rico TL, Arauzo EA, Prieto JG, Muñoz LA. Improving post-operative pain management after total hip and knee replacement in a special care unit: a best practice implementation project. JBI Evid Implement 2025:02205615-990000000-00168. [PMID: 40094328 DOI: 10.1097/xeb.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
INTRODUCTION Post-operative pain is often underestimated (70% of surgical patients experience some degree of pain) and is insufficiently treated. This increases morbidity and mortality, mainly due to respiratory and thromboembolic complications, longer hospital stays, deterioration in quality of life, and occurrence of chronic pain. OBJECTIVES This study aimed to improve post-operative pain management in the first 4 hours after total hip and knee replacement by promoting best practices. METHODS This project used the JBI Evidence Implementation Framework. JBI's Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRiP) audit tools were used to collect data and develop implementation strategies, in line with identified barriers. The project was conducted in a special care unit in a primary hospital in Spain using a sample of 30 patients. Three phases of activity were followed: conducting a baseline audit, implementing improvement strategies, and conducting follow-up audits to assess intervention outcomes. The evaluation criteria used in the audits were derived from a JBI evidence summary on post-operative pain management. RESULTS The baseline audit identified five barriers: lack of nursing staff knowledge of appropriate pain assessment scales; lack of complete pain assessment record in the electronic nursing records; lack of staff confidence in evidence-based practice; lack of dedicated training time for staff; and low staff participation in consensus process. Strategies were formulated to address these barriers using JBI's GRiP method. Following implementation, compliance with all audit criteria significantly improved. CONCLUSION The strategies developed using the JBI Evidence Implementation Framework positively impacted compliance with best practices. SPANISH ABSTRACT http://links.lww.com/IJEBH/A339.
Collapse
Affiliation(s)
- Silvia Ruiz González
- Intensive Care Unit nurse, San Eloy Hospital, OSI Barakaldo -Sestao (Osakidetza), Barakaldo, Basque Country, Spain
- Spanish Centre for Evidence Based Healthcare: A Joanna Briggs Institute Centre of Excellence, JBI Evidence Implementation Training Program (EITP) Fellow, Madrid, Spain
| | - Tamara López Rico
- Intensive Care Unit nurse, San Eloy Hospital, OSI Barakaldo -Sestao (Osakidetza), Barakaldo, Basque Country, Spain
| | - Esperanza Arribas Arauzo
- Intensive Care Unit supervisor, San Eloy Hospital, OSI Barakaldo -Sestao (Osakidetza), Barakaldo, Basque Country, Spain
| | - Janire García Prieto
- Intensive Care Unit nurse, San Eloy Hospital, OSI Barakaldo -Sestao (Osakidetza), Barakaldo, Basque Country, Spain
| | - Laura Albornos Muñoz
- Nursing and Health Care Research Unit (Investén-isciii), Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
- Spanish Centre for Evidence Based Healthcare: A Joanna Briggs Institute Centre of Excellence
| |
Collapse
|
7
|
Moka E, Aguirre JA, Sauter AR, Lavand'homme P. Chronic postsurgical pain and transitional pain services: a narrative review highlighting European perspectives. Reg Anesth Pain Med 2025; 50:205-212. [PMID: 39909553 PMCID: PMC11877094 DOI: 10.1136/rapm-2024-105614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 10/23/2024] [Indexed: 02/07/2025]
Abstract
BACKGROUND/IMPORTANCE Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements. OBJECTIVE The acute to chronic pain transition involves complex interactions between peripheral and central mechanisms, with central sensitization playing a key role. Identifying high-risk patients is crucial for prevention, with factors such as surgical type, nerve injury, neuropathic elements in acute postoperative pain, and psychosocial conditions being significant contributors. EVIDENCE REVIEW Current pain management strategies, including multimodal therapy and regional anesthesia, show limited effectiveness in preventing CPSP. Neuromodulation interventions, though promising, are not yet established as preventive modalities. FINDINGS Transitional pain services (TPSs) offer a comprehensive, multidisciplinary approach to managing CPSP and reducing opioid dependence, addressing both physical and psychosocial aspects of functional recovery. While promising results have been seen in Canada and Finland, TPSs are not yet widely implemented in Europe. There is also growing interest in pain biomarkers, through initiatives such as the A2CPS program, aiming to improve CPSP prediction and develop targeted interventions. CONCLUSIONS Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact.
Collapse
Affiliation(s)
- Eleni Moka
- Anaesthesiology Department, Creta Interclinic Hospital, Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | | | - Axel R Sauter
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Patricia Lavand'homme
- Department of Anaesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
8
|
Schreiber KL, Wilson JM, Chen YYK. Recognizing pain phenotypes: biopsychosocial sources of variability in the transition to chronic postsurgical pain. Reg Anesth Pain Med 2025; 50:86-92. [PMID: 39909545 PMCID: PMC11804873 DOI: 10.1136/rapm-2024-105602] [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: 07/31/2024] [Accepted: 09/01/2024] [Indexed: 02/07/2025]
Abstract
Chronic postsurgical pain (CPSP) is a cause of new chronic pain, with a wide range of reported incidence. Previous longitudinal studies suggest that development of CPSP may depend more on the constellation of risk factors around a patient (pre-existing pain phenotype) rather than on the extent of surgical injury itself. The biopsychosocial model of pain outlines a broad array of factors that modulate the severity, longevity, and impact of pain. Biological variables associated with CPSP include age, sex, baseline pain sensitivity, and opioid tolerance. Psychological factors, including anxiety, depression, somatization, sleep disturbance, catastrophizing, and resilience, and social factors, like education and social support, may also importantly modulate CPSP. Prevention efforts have targeted acute pain reduction using multimodal analgesia (regional anesthesia and intraoperative analgesic adjuvant medications). However, studies that do not measure or take phenotypic risk factors into account (either using them for enrichment or statistically as effect modifiers) likely suffer from underpowering, and thus, fail to discern subgroups of patients that preventive measures may be most helpful to. Early preoperative identification of a patient's pain phenotype allows estimation of their constellation of risk factors and may greatly enhance successful, personalized prevention of postoperative pain. Effective preoperative employment of behavioral interventions like cognitive-behavioral therapy, stress reduction, and physical and mental prehabilitation may particularly require knowledge of a patient's pain phenotype. Preoperative assessment of patients' pain phenotypes will not only inform high-quality personalized perioperative care clinically, but it will enable enriched testing of novel therapies in future scientific studies.
Collapse
Affiliation(s)
- Kristin L Schreiber
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/ Harvard Medical School, Boston, Massachusetts, USA
| | - Jenna M Wilson
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/ Harvard Medical School, Boston, Massachusetts, USA
| | - Yun-Yun Kathy Chen
- Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital/ Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Mogianos K, Åkeson J, Persson AKM. Systematic Review of Methods for Individual Prediction of Postoperative Pain. Pain Res Manag 2025; 2025:1331412. [PMID: 39949726 PMCID: PMC11824487 DOI: 10.1155/prm/1331412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 12/31/2024] [Indexed: 02/16/2025]
Abstract
Background: Acute postoperative pain is a common problem in clinical practice and merits attention considering its potential long-term adverse effects. This systematic review covers current knowledge on methods for individual prediction of postoperative pain. Methods: A systematic literature search was conducted using the PubMed, EMBASE, and CINAHL databases for original studies with adult patients published in English between 2016 and 2022. Inclusion required assessment of risk factors preoperatively and assessment of postoperative pain. No reviews, meta-analyses, or study protocols were included, nor studies with outcomes other than pain or where risk factor analysis was not performed preoperatively. A two peer-reviewed system was utilized using the screening and data collection tool Covidence, with a focus on new tools for preoperative pain prediction. The results were only analyzed qualitatively. Results: The search yielded 1950 abstracts to be screened. In total, 208 articles were subjected to full-text review, and 107 articles were included in the data synthesis of this review. The evaluated scientific methods were grouped and analyzed separately. Psychometric questionnaires and methods for quantitative sensory testing are still being studied. New methods proposed include the evaluation of pain induced by tourniquet inflation, venous cannulation, or pin-prick stimulation, the analgesia/nociception index, electroencephalographic recording, and other new equipment developed for this purpose. Conclusion: Various screening methods have been proposed to identify patients prone to postoperative pain. The focus has shifted from procedure-specific to individualized strategies to improve early management of pain. However, many traditional predictive methods still have a questionable role in clinical practice. Trial Registration: ClinicalTrials.gov identifier: CRD42022298479.
Collapse
Affiliation(s)
- Krister Mogianos
- Department of Anesthesiology and Intensive Care Medicine, Halland's Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anna K. M. Persson
- Department of Anesthesiology and Intensive Care Medicine, Halland's Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| |
Collapse
|
10
|
Paredes AC, Costa P, Almeida A, Pinto PR. Presurgical anxiety and acute postsurgical pain predict worse chronic pain profiles after total knee/hip arthroplasty. Arch Orthop Trauma Surg 2025; 145:118. [PMID: 39798042 DOI: 10.1007/s00402-024-05681-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 10/07/2024] [Indexed: 01/13/2025]
Abstract
INTRODUCTION Total joint arthroplasties generally achieve good outcomes, but chronic pain and disability are a significant burden after these interventions. Acknowledging relevant risk factors can inform preventive strategies. This study aimed to identify chronic pain profiles 6 months after arthroplasty using the ICD-11 (International Classification of Diseases) classification and to find pre and postsurgical predictors of these profiles. MATERIALS AND METHODS Patients undergoing total knee/hip arthroplasty (n = 209, female = 54.5%) were assessed before surgery, 48 h and 6 months postsurgery for sociodemographic, pain-related, disability and psychological characteristics. K-means-constrained cluster analysis identified chronic pain profiles based on 6-month pain intensity, pain interference and disability. Chi-square tests or one-way ANOVA explored between-cluster differences. Multinomial regression identified predictors of cluster membership. Separate models analyzed presurgical (model 1), postsurgical (model 2) and a combination of previously significant pre and postsurgical (model 3) variables. RESULTS A three-cluster solution was selected, translating increasingly worse chronic pain severity: cluster 1 (C1, n = 129), cluster 2 (C2, n = 60) and cluster 3 (C3, n = 20). There were presurgical differences among clusters in the presence of other painful sites (p = 0.013, ϕc = 0.20), pain interference (p = 0.038, η2 = 0.031), disability (p = 0.020, η2 = 0.037), pain catastrophizing (p = 0.019, η2 = 0.060), anxiety (p < 0.001, η2 = 0.087), depression (p = 0.017; η2 = 0.039), self-efficacy (p = 0.018, η2 = 0.038) and satisfaction with life (p = 0.034, η2 = 0.032), postsurgical pain frequency (p = 0.003, ϕc = 0.243) and intensity (p < 0.001, η2 = 0.101). In model 1, disability predicted C2 (OR = 1.040) and anxiety predicted C3 (OR = 1.154) membership. In model 2, pain intensity predicted C3 (OR = 1.690) membership. In model 3, presurgical anxiety predicted C3 (OR = 1.181) and postsurgical pain intensity predicted C2 (OR = 1.234) and C3 (OR = 1.679) membership. CONCLUSIONS Most patients had low chronic pain severity at 6 months, but a relevant percentage exhibited poor outcomes. Membership to different outcome profiles was predicted by presurgical anxiety and acute postsurgical pain. These seem promising targets to prevent pain chronification that should be optimized for better surgical outcomes.
Collapse
Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Lugar de Sete Fontes, S. Victor, Braga, 4710-243, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Rua Alfredo Allen, Porto, 4200-135, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Lugar de Sete Fontes, S. Victor, Braga, 4710-243, Portugal
| | - Patrícia R Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimaraes, Portugal.
- 2CA-Braga, Clinical Academic Center, Hospital de Braga, Lugar de Sete Fontes, S. Victor, Braga, 4710-243, Portugal.
| |
Collapse
|
11
|
Lukas P, Nilsson L, Wodlin NB, Arendt-Nielsen L, Kjølhede P. Changes in spatial bodily pain distribution one year after benign hysterectomy with emphasis on prevalence and risk factors for de novo and persistent pelvic pain- a prospective longitudinal multicenter study. BMC Womens Health 2024; 24:644. [PMID: 39707275 PMCID: PMC11662711 DOI: 10.1186/s12905-024-03474-5] [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: 07/26/2024] [Accepted: 11/19/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND The objectives were to determine the prevalence of de novo and persistent pelvic pain after benign hysterectomy and to assess risk factors. METHODS A Swedish prospective multicenter study of 440 women undergoing benign hysterectomy was conducted between October 2011 and March 2017. Measures of pain, the spatial extent of bodily pain, and pain sensitivity were assessed using a self-reporting questionnaire, Margolis's patient pain drawing, and quantitative sensory testing of pain thresholds for pressure, heat, and cold, respectively. Quality of life was evaluated by EQ-5D-3L and SF-36. Psychological distress was assessed by the Hospital Anxiety and Depression Scaleand the Stress-Coping Inventory. Logistic regression models were used to assess risk factors, and the outcome was presented as an adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS Preoperatively, 18.0% of the women reported no bodily pain, 41.5% had pelvic pain, either as the only location (7.0%) or along with pain in other locations (34.5%), and 40.5% had non-pelvic pain only. Postoperatively, 6.2% developed de novo pelvic pain and 16.4% had persistent pelvic pain. De novo pelvic pain developed exclusively in women who preoperatively had non-pelvic pain only. Risk factors for de novo pelvic pain were a long hospital stay (aOR 1.50 (95%CI) 1.02-2.21)), high preoperative pain intensity (aOR 1.25 (95%CI 1.01-1.62)) and a high number of pain areas (aOR 1.15 (95%CI 1.05-1.27)), along with anxiety (aOR 10.61 (95%CI 1.84-61.03)) and low EQ-5D-3L health index (aOR 0.02 (95%CI 0.00-0.31)). Risk factors for persistent pelvic pain were lower age (aOR 0.89 (95%CI 0.81-0.97)), higher number of pain areas (aOR 1.08 (95%CI 1.02-1.14)), and a higher frequency of preoperative pain (aOR 12.75 (95%CI 2.24-72.66)). CONCLUSION Although hysterectomy appeared to be reasonably effective in curing pelvic pain, a non-negligible proportion of women developed de novo pelvic pain or had persistent pelvic pain. De novo pelvic pain seemed to affect only those who preoperatively had widespread bodily pain. Women at risk for de novo and persistent pelvic pain after hysterectomy could be identified preoperatively. TRIAL REGISTRATIONS The study was retrospectively registered in ClinicalTrial.gov (NCT01526668) on 01/27//2012.
Collapse
Grants
- FORSS-155141; FORSS-222211; FORSS-308441, and FORSS-387761 Forskningsrådet i Sydöstra Sverige
- RÖ-200641, RÖ-276871, RÖ-356651, RÖ-448391, RÖ-540551, RÖ-607891, RÖ-699021, RÖ-794531, RÖ-931528, RÖ-936208, RÖ-968764, and RÖ-987412 Region Östergötland
- FUTURUM-487481, and FUTURUM 579171 Futurum - Akademin för Hälsa och Vård, Region Jönköpings läns
- Linköping University
Collapse
Affiliation(s)
- Peter Lukas
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, S-581 85, Sweden.
| | - Lena Nilsson
- Department of Anesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, S-581 85, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, S-581 85, Sweden
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, S-581 85, Sweden
| |
Collapse
|
12
|
Doğan R, Oltuluoğlu H, Bayrakçi E. Pain Experiences and Coping Methods of Living Liver Donors Experiencing Chronic Pain After Surgery: Qualitative Study. Pain Manag Nurs 2024:S1524-9042(24)00301-1. [PMID: 39706785 DOI: 10.1016/j.pmn.2024.11.002] [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: 07/26/2023] [Revised: 11/05/2024] [Accepted: 11/05/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Living liver donors are known to experience many physical symptoms such as pain in the postoperative period. AIM This qualitative study was conducted to examine pain experiences and coping methods of living liver donors experiencing postoperative chronic pain. METHODS The study sample consisted of 16 living liver donors. Data were collected using a personal information form and a semi-structured questionnaire. Quantitative data were analyzed as number, mean, standard deviation, and percentage. Qualitative data were analyzed within the framework of thematic and content analysis methods. RESULTS The mean postoperative chronic pain rate of living liver donors was 4.5. Eight of these people reported experiencing sudden, pinprick-like pain after liver transplantation. Living liver donors stated that the greatest factor that increased their pain was exertion/spontaneous movement. Half of them stated that the pain they experienced after transplantation had no impact on their daily life activities. Most of the living liver donors stated that the pain they experienced had no impact on their social lives; however, it caused sadness and psychological deterioration. The most preferred method to cope with pain was the use of medication. CONCLUSIONS Living liver donors experienced moderate postoperative chronic pain, and a significant proportion of them reported psychological symptoms related to the pain they experienced. A multidisciplinary pain team can help with pain management by providing training conducted in transplant centers.
Collapse
Affiliation(s)
- Runida Doğan
- Department of Surgical Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey
| | - Hatice Oltuluoğlu
- Department of Fundamentals of Nursing, Faculty of Nursing, Inonu University, Malatya, Turkey.
| | - Emine Bayrakçi
- Inonu University Liver Transplant Institute, Malatya, Turkey
| |
Collapse
|
13
|
Fontes BV, de Oliveira AM, de Moraes ÉB, Antunes JDM, Salvetti MDG, do Carmo TG. Quality of nursing care in pain management in orthopedic surgical patients: a scoping review. Rev Esc Enferm USP 2024; 58:e20240110. [PMID: 39652719 PMCID: PMC11649067 DOI: 10.1590/1980-220x-reeusp-2024-0110en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 09/09/2024] [Indexed: 01/31/2025] Open
Abstract
OBJECTIVE To map the evidence on quality nursing care practices in pain management in orthopedic surgical patients. METHOD Scoping review, as per the JBI Manual recommendations. Searches were performed in the MEDLINE (PubMed), LILACS (Regional VHL), Scopus, Embase, Web of Science, Cochrane, Cinahl databases, and gray literature, regardless of language and period. Selection and extraction were performed by two independent reviewers, using inclusion/exclusion criteria, and the extracted data were organized to reflect key themes or recurring patterns related to the purpose of the review. RESULTS A total of 94 studies were included, most from the United States, corresponding to 34% of the sample, and published between 1997 and 2022. The findings were categorized into: nursing quality practices in pain management related to the organization and monitoring of units, and pre- and post-operative period. CONCLUSION The research revealed that quality nursing care practices in pain management in orthopedic surgical patients encompass a variety of approaches, from the use of nonpharmacological practices and patient education to the use of pain assessment scales, staff training, to innovative pharmacological procedures.
Collapse
Affiliation(s)
- Bárbara Ventura Fontes
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | | | - Érica Brandão de Moraes
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil
- Centro Brasileiro para o Cuidado à Saúde Informado por Evidências: Centro de Excelência do Instituto Joanna Briggs, São Paulo, SP, Brazil
| | | | - Marina de Góes Salvetti
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica. São Paulo, SP, Brazil
| | - Thalita Gomes do Carmo
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil
| |
Collapse
|
14
|
Erasmus S, Lyu Z, Zhou J, Fang J, Liang Y. Electroacupuncture Mechanisms in Managing Preoperative Anxiety and Postoperative Pain Chronification: A Review. J Pain Res 2024; 17:4089-4100. [PMID: 39650212 PMCID: PMC11625428 DOI: 10.2147/jpr.s498373] [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: 10/01/2024] [Accepted: 11/27/2024] [Indexed: 12/11/2024] Open
Abstract
Introduction Postoperative hyperalgesic priming, exacerbated by preoperative anxiety, complicates pain management and recovery. Electroacupuncture (EA), a technique that combines traditional acupuncture with electrical stimulation applied through needles to enhance therapeutic effect, offers a potential solution by targeting multiple neurobiological pathways. Objective This review investigates how EA addresses preoperative anxiety-induced postoperative hyperalgesic priming ie pain chronification, focusing on its mechanisms in three areas: preoperative anxiety, postoperative hyperalgesic priming, and the interaction between EA and these processes. Methods A literature search across PubMed, ScienceDirect, and Google Scholar identified relevant studies on EA's effects on neurobiological pathways related to anxiety and pain. The review synthesized findings to understand EA's role in these contexts. Results EA alleviates preoperative anxiety by influencing the body's neurochemical and neurophysiological responses. It reduces inflammation, regulates stress hormones, and improves autonomic function. For postoperative pain chronification, EA modulates pain pathways, reduces inflammation, and affects receptor signaling, gene expression, and neurotransmitter systems. Conclusion EA offers a promising approach to managing preoperative anxiety and postoperative pain. By addressing both the physiological and neurochemical pathways that contribute to pain and anxiety, EA has the potential to significantly improve clinical outcomes for patients undergoing surgery. Further research is needed to fully understand its mechanisms and optimize its application in clinical settings.
Collapse
Affiliation(s)
- Shannah Erasmus
- International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhengyi Lyu
- The Third Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jie Zhou
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianqiao Fang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yi Liang
- Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| |
Collapse
|
15
|
Velasco E, Flores-Cortés M, Guerra-Armas J, Flix-Díez L, Gurdiel-Álvarez F, Donado-Bermejo A, van den Broeke EN, Pérez-Cervera L, Delicado-Miralles M. Is chronic pain caused by central sensitization? A review and critical point of view. Neurosci Biobehav Rev 2024; 167:105886. [PMID: 39278607 DOI: 10.1016/j.neubiorev.2024.105886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/28/2024] [Accepted: 09/09/2024] [Indexed: 09/18/2024]
Abstract
Chronic pain causes disability and loss of health worldwide. Yet, a mechanistic explanation for it is still missing. Frequently, neural phenomena, and among them, Central Sensitization (CS), is presented as causing chronic pain. This narrative review explores the evidence substantiating the relationship between CS and chronic pain: four expert researchers were divided in two independent teams that reviewed the available evidence. Three criteria were established for a study to demonstrate a causal relationship: (1) confirm presence of CS, (2) study chronic pain, and (3) test sufficiency or necessity of CS over chronic pain symptoms. No study met those criteria, failing to demonstrate that CS can cause chronic pain. Also, no evidence reporting the occurrence of CS in humans was found. Worryingly, pain assessments are often confounded with CS measures in the literature, omitting that the latter is a neurophysiological and not a perceptual phenomenon. Future research should avoid this misconception to directly interrogate what is the causal contribution of CS to chronic pain to better comprehend this problematic condition.
Collapse
Affiliation(s)
- Enrique Velasco
- Laboratory of Ion Channel Research, VIB-KU Leuven Center for Brain & Disease Research, Leuven, Belgium. Department of Cellular and Molecular Medicine, KU Leuven, Belgium; Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain.
| | - Mar Flores-Cortés
- International Doctorate School, Faculty of Health Sciences, University of Málaga, Málaga 29071, Spain
| | - Javier Guerra-Armas
- International Doctorate School, Faculty of Health Sciences, University of Málaga, Málaga 29071, Spain
| | - Laura Flix-Díez
- Department of Otorrinolaryngology, Clínica Universidad de Navarra, University of Navarra, Madrid, Spain
| | - Francisco Gurdiel-Álvarez
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain. Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid 28032, Spain
| | - Aser Donado-Bermejo
- International Doctorate School, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain. Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid 28032, Spain
| | | | - Laura Pérez-Cervera
- Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain
| | - Miguel Delicado-Miralles
- Neuroscience in Physiotherapy (NiP), independent research group, Elche, Spain; Department of Pathology and Surgery. Physiotherapy Area. Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
| |
Collapse
|
16
|
Liu X, Zhao Y, Yang M, Ren J, Ouyang W, Wang S, Shen Y, Gao Y, Zhao L, Qin Z, Cao J, Xia J, Zhou H, Zeng H, Li J, Li Q, Jiang H, Zhou R, Yuan K, Jin S, Zhang X, Wang C, Chen Y, Dong H, Lv J, Yu S, Jiu Y, Wang Q, Su D, Yu W. Efficacy and safety of 4-hydroxy 2-methyl-N-(5-methyl-2-thiazolyl)-2H-1, 2-benzothiazin-3-carboxamide 1,1-dioxide, a fast-acting meloxicam formulation, on moderate-to-severe pain following abdominal surgery: A phase III randomized controlled trial. Clin Transl Sci 2024; 17:e70081. [PMID: 39660482 PMCID: PMC11632392 DOI: 10.1111/cts.70081] [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: 05/20/2024] [Revised: 10/10/2024] [Accepted: 11/01/2024] [Indexed: 12/12/2024] Open
Abstract
4-hydroxy 2-methyl-N-(5-methyl-2-thiazolyl)-2H-1, 2-benzothiazin-3-carboxamide 1,1-dioxide (QP001), a novel long-lasting meloxicam formulation, may provide adequate postoperative pain relief with a good safety profile. This study aimed to evaluate the efficacy and safety of QP001 for moderate-to-severe pain following abdominal surgery. This multicenter, randomized, double-blind, placebo-controlled phase III trial recruited patients undergoing abdominal surgery at 23 centers between October 30, 2022, and July 10, 2023. Patients were randomized to a QP001 or placebo group in a 2:1 ratio. Postoperative pain intensity was evaluated using the Numerical Rating Scale. The primary efficacy outcome was the area under curve (AUC) of pain intensity-time 0-24 h after awakening from anesthesia (AUC0-24). Adverse events and drug reactions were recorded to evaluate safety. A total of 258 patients underwent randomization, and 255 patients received at least one trial drug, including 170 in the QP001 group and 85 in the placebo group. Among these patients, 250 completed the study. The AUC0-24 was significantly lower in the QP001 group than in the placebo group (50.5 vs. 85.19, difference of 34.69 [40.7%], p < 0.0001). This was accompanied by a decrease in morphine use and an increase in patient satisfaction. Moreover, the overall adverse events or adverse drug reaction rates were similar between the QP001 and placebo groups. Among patients undergoing abdominal surgery, postoperative pain was significantly lower in the QP001 group than in the placebo group. QP001 has a great analgesic effect of up to 24 h and satisfactory safety in patients with moderate-to-severe abdominal pain.
Collapse
Affiliation(s)
- Xiaohua Liu
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanhua Zhao
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Mengchang Yang
- Department of Anesthesiology, Sichuan Academy of Medical SciencesSichuan Provincial People's HospitalChengduChina
| | - Jinghua Ren
- Department of AnesthesiologyThe Second People's Hospital of YibinYibinChina
| | - Wen Ouyang
- Department of AnesthesiologyThe Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Saiying Wang
- Department of AnesthesiologyThe Third Xiangya Hospital of Central South UniversityChangshaChina
| | - Yufei Shen
- Department of GynaecologyNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Yuanli Gao
- Department of AnesthesiologyMaanshan People's HospitalMaanshanChina
| | - Ling Zhao
- Department of AnesthesiologyThe First Affiliated Hospital of Xi'an Medical UniversityXi'anChina
| | - Zhong Qin
- Department of AnesthesiologyNanjing Medical University Affiliated Wuxi People's HospitalWuxiChina
| | - Jun Cao
- Department of AnesthesiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiangyan Xia
- Department of AnesthesiologyZhongda Hospital Southeast UniversityNanjingChina
| | - Hongmei Zhou
- Department of AnesthesiologyThe Second Hospital of JiaxingJiaxingChina
| | - Haihua Zeng
- Department of AnesthesiologyThe Third Hospital of ChangshaChangshaChina
| | - Jiangang Li
- Department of AnesthesiologyQujing No.1 HospitalNanjingChina
| | - Qiongcan Li
- Department of AnesthesiologyChangsha Central HospitalChangshaChina
| | - Haitao Jiang
- Department of AnesthesiologyYueyang People's HospitalYueyangChina
| | - Ruiren Zhou
- Department of AnesthesiologyThe First People's Hospital of NanningNanningChina
| | - Kaiming Yuan
- Department of AnesthesiologyThe 2nd Affiliated Hospital and Yuying Children's Hospital of WMUWenzhouChina
| | - Shu’an Jin
- Department of AnesthesiologyJinan Central HospitalJinanChina
| | - Xuanqiang Zhang
- Department of AnesthesiologyShanxi Yuncheng Central HospitalYunchengChina
| | - Chunhui Wang
- Department of AnesthesiologyAnhui Public Health Clinical CenterHefeiChina
| | - Yongquan Chen
- Department of AnesthesiologyThe First Affiliated Hospital of Wannan Medical CollegeWuhuChina
| | - Hailong Dong
- Department of AnesthesiologyXijing Hospital of Air Force Military Medical UniversityXi'anChina
| | - Jieping Lv
- Department of AnesthesiologyFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Sen Yu
- Nanjing Delova Biotech Co., LtdNanjingChina
| | | | | | - Diansan Su
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weifeng Yu
- Department of Anesthesiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| |
Collapse
|
17
|
Bejar-Chapa M, Caragher SP, Gfrerer L, Valerio IL, Colwell AS, Winograd JM. Diagnosis and Management of Neuropathic Breast Pain. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6266. [PMID: 39717719 PMCID: PMC11666212 DOI: 10.1097/gox.0000000000006266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/27/2024] [Indexed: 12/25/2024]
Abstract
Chronic postoperative pain after breast surgery is a significant concern, with studies indicating varying rates depending on the type of surgical procedure. The risk of developing neuropathic pain is notably increased with axillary lymph node dissection due to potential nerve injuries. Additionally, the method of breast reconstruction may influence postsurgical pain rates, with conflicting findings on the impact of reconstruction type. Recent advancements in techniques such as targeted muscle reinnervation, among others, show promise in addressing postoperative pain in these patients. As the prevalence of these procedures rises, future research is likely to focus on assessing and managing pain in this patient population. The development of patient-reported outcome measures specific to breast surgery pain can aid in clinical assessment and treatment planning. This review emphasizes the importance of gaining a deeper understanding of risk factors, nerve anatomy, and treatment options to enhance outcomes and quality of life for individuals undergoing breast surgery.
Collapse
Affiliation(s)
- Maria Bejar-Chapa
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Seamus P. Caragher
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Lisa Gfrerer
- Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York City, N.Y
| | - Ian L. Valerio
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Amy S. Colwell
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Jonathan M. Winograd
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
18
|
Luo D, Fan Z, Yin W. Chronic post-surgical pain after total knee arthroplasty: a narrative review. Perioper Med (Lond) 2024; 13:108. [PMID: 39501338 PMCID: PMC11536853 DOI: 10.1186/s13741-024-00466-9] [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: 09/10/2024] [Accepted: 10/28/2024] [Indexed: 11/09/2024] Open
Abstract
Total knee arthroplasty (TKA) is an efficacious treatment for end-stage knee osteoarthritis, often accompanied by severe postoperative pain. In certain patients, this pain can persist for over 3 months and is referred to as chronic post-surgical pain (CPSP). Postoperative persistent pain has emerged as a significant and noteworthy issue impacting patient quality of life following TKA. The etiology of CPSP after TKA is multifaceted. Peripheral or central sensitizations resulting from inflammatory reactions, nerve injury, and neurobiological mechanisms are the primary mechanisms contributing to chronic persistent pain after TKA. Preoperative, intraoperative, and postoperative factors can induce pain sensitization. Once CPSP occurs after TKA, it significantly hampers patient recovery with challenging treatment options. Currently, among the preventive and therapeutic strategies for chronic pain after TKA, it is widely believed that early comprehensive preventive treatment to prevent acute to chronic pain transition can substantially reduce the incidence of CPSP following TKA. In recent years, studies have investigated perioperative strategies aimed at reducing the occurrence of persistent pain after TKA. This article provides an overview of advancements in understanding the pathogenesis, high-risk factors, and preventive measures for chronic pain following TKA. We hope that this review will guide future research directions on CPSP after TKA while contributing to clinical perioperative pain management.
Collapse
Affiliation(s)
- Dan Luo
- College of Clinical Medicine, Dali University, Dali Bai Autonomous Prefecture, Yunnan Province, 671000, China
- Department of Anesthesiology, the First Affiliated Hospital of Dali University, Dali Bai Autonomous Prefecture, Yunnan Province, 671000, China
| | - Zhidong Fan
- College of Clinical Medicine, Dali University, Dali Bai Autonomous Prefecture, Yunnan Province, 671000, China.
- Department of Anesthesiology, the First Affiliated Hospital of Dali University, Dali Bai Autonomous Prefecture, Yunnan Province, 671000, China.
| | - Wenqin Yin
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Shunqing District, Nanchong, Sichuan Province, 637000, China.
| |
Collapse
|
19
|
Li D, Mai JW, Deng J, Chen L, Fan HT, Zhang WL, Xin WJ, Feng X, Xu T, Luo DX. A neural circuit from thalamic paraventricular nucleus via zona incerta to periaqueductal gray for the facilitation of neuropathic pain. Neurobiol Dis 2024; 202:106699. [PMID: 39393611 DOI: 10.1016/j.nbd.2024.106699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/30/2024] [Accepted: 10/08/2024] [Indexed: 10/13/2024] Open
Abstract
Top-down projections transmit a series of signals encoding pain sensation to the ventrolateral periaqueductal gray (vlPAG), where they converge with various incoming projections to regulate pain. Clarifying the upstream regulatory hierarchy of vlPAG can enhance our understanding of the neural circuitry involved in pain modulation. Here, we show that a in a mouse model of spared nerve injury (SNI), activation of a circuit arising from posterior paraventricular thalamic nucleus CaMKIIα-positive neurons (PVPCaMKIIα) projects to gamma-aminobutyric acid neurons in the rostral zona incerta (ZIrGABA) to facilitate the development of pain hypersensitivity behaviors. In turn, these ZIrGABA neurons project to CaMKIIα-positive neurons in the vlPAG (vlPAGCaMKIIα), a well-known neuronal population involved in pain descending modulation. In vivo calcium signal recording and whole-cell electrophysiological recordings reveal that the PVPCaMKIIα→ZIrGABA→vlPAGCaMKIIα circuit is activated in SNI models of persistent pain. Inhibition of this circuit using chemogenetics or optogenetics can alleviate the mechanical pain behaviors. Our study indicates that the PVPCaMKIIα→ZIrGABA→vlPAGCaMKIIα circuit is involved in the facilitation of neuropathic pain. This previously unrecognized circuit could be explored as a potential target for neuropathic pain treatment.
Collapse
Affiliation(s)
- Dai Li
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jing-Wen Mai
- Department of Anesthesiology, Huizhou Central People's Hospital, Huizhou, China
| | - Jie Deng
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China; Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Li Chen
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Hai-Ting Fan
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Wei-Lin Zhang
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Wen-Jun Xin
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Xia Feng
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Ting Xu
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology and Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China.
| | - De-Xing Luo
- Department of Anesthesiology, Huizhou Central People's Hospital, Huizhou, China.
| |
Collapse
|
20
|
Zhang X, Guan M, Yi W, Li X, Ding X, He Y, Han W, Wang Z, Tang Q, Liao B, Shen J, Han X, Bai D. Smart Response Biomaterials for Pain Management. Adv Healthc Mater 2024; 13:e2401555. [PMID: 39039990 DOI: 10.1002/adhm.202401555] [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: 04/27/2024] [Revised: 07/12/2024] [Indexed: 07/24/2024]
Abstract
The intricate nature of pain classification and mechanism constantly affects the recovery of diseases and the well-being of patients. Key medical challenges persist in devising effective pain management strategies. Therefore, a comprehensive review of relevant methods and research advancements in pain management is conducted. This overview covers the main categorization of pain and its developmental mechanism, followed by a review of pertinent research and techniques for managing pain. These techniques include commonly prescribed medications, invasive procedures, and noninvasive physical therapy methods used in rehabilitation medicine. Additionally, for the first time, a systematic summary of the utilization of responsive biomaterials in pain management is provided, encompassing their response to physical stimuli such as ultrasound, magnetic fields, electric fields, light, and temperature, as well as changes in the physiological environment like reactive oxygen species (ROS) and pH. Even though the application of responsive biomaterials in pain management remains limited and at a fundamental level, recent years have seen the examination and debate of relevant research findings. These profound discussions aim to provide trends and directions for future research in pain management.
Collapse
Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Mengtong Guan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Weiwei Yi
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xinhe Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xiaoqian Ding
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Yi He
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Wang Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zijie Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Qiuyu Tang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Bo Liao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jieliang Shen
- Department of Rehabilitation Medicine, Bishan Hospital of Chongqing Medical University, Bishan Hospital of Chongqing, Chongqing, 402760, P. R. China
| | - Xiaoyu Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| |
Collapse
|
21
|
Chen KY, Chan HC, Wei LY, Chan CM. Efficacy of gabapentin and pregabalin for treatment of post refractive surgery pain: a systematic review and meta-analysis. Int Ophthalmol 2024; 44:409. [PMID: 39448432 DOI: 10.1007/s10792-024-03300-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/28/2024] [Indexed: 10/26/2024]
Abstract
INTRODUCTION For ophthalmic patients, eye discomfort is a major problem that requires efficient pain treatment techniques. Pregabalin and gabapentin have surfaced as viable treatments for post-refractive surgery pain. To manage pain after refractive surgery, gabapentin and pregabalin were evaluated in this systematic review and meta-analysis. METHODOLOGY A thorough search of databases including PubMed, Embase, Cochrane Library, and CINAHL was performed until March 2024. Inclusion criteria were randomized controlled trials assessing pregabalin and/or gabapentin's effectiveness in treating pain post-PRK, LASIK, and LASEK surgeries. RESULTS Six studies met inclusion criteria, comprising a total of 391 patients undergoing various corneal surgeries. The meta-analysis revealed that pregabalin was significantly more effective than placebo in reducing pain on the first and second postoperative days (SMD day 1: -0.32, 95% CI -0.54, -0.09; SMD day 2: -0.55, 95% CI -0.85, -0.25), while gabapentin showed significant pain reduction on the second day only (SMD day 2: -0.42, 95% CI -0.71, -0.13). Combined analysis for both medications showed significant pain reduction on the first- and second-days post-surgery. No significant increase in adverse events was associated with either medication. Publication bias was minimal except for a slight asymmetry noted on day 1 effectiveness. CONCLUSION Pregabalin and gabapentin are effective in reducing postoperative pain following refractive surgeries, with pregabalin showing a greater effect. Both medications are safe, with no significant increase in adverse events. Further research with standardized methodologies and long-term follow-up is recommended to optimize postoperative pain management in ocular surgeries.
Collapse
Affiliation(s)
- Kai-Yang Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hoi-Chun Chan
- School of Pharmacy, China Medical University, Taichung, Taiwan
| | - Li-Yun Wei
- Department of Pharmacy, Cardinal Tien Hospital, New Taipei City, Taiwan.
| | - Chi-Ming Chan
- Department of Ophthalmology, Cardinal Tien Hospital, New Taipei City, Taiwan.
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| |
Collapse
|
22
|
Robinson AR, Steagall PV. Effects of training on Feline Grimace Scale scoring for acute pain assessment in cats. J Feline Med Surg 2024; 26:1098612X241275284. [PMID: 39466280 PMCID: PMC11529081 DOI: 10.1177/1098612x241275284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 10/29/2024]
Abstract
OBJECTIVES The aim of the study was to determine the effects of training on inter-rater reliability and agreement of Feline Grimace Scale (FGS) scoring by small animal practitioners. METHODS Seven small animal veterinarians were asked to score a total of 50 images of cats in varying degrees of pain before and after training in FGS scoring. Participant scores were compared with those of an expert rater. Inter-rater reliability was analyzed using the intraclass correlation coefficient (ICC) before and after training (ICC <0.50 = poor reliability, 0.50-0.75 = moderate reliability, 0.76-0.90 = good reliability and >0.90 = excellent reliability). The Bland-Altman method was used to analyze the limits of agreement (LoAs) and bias between participants and the expert rater. RESULTS After training, the ICC classification improved for each action unit (ear position, orbital tightening, muzzle tension, whiskers change and head position). The inter-rater reliability for the total FGS ratio scores before and after the FGS training session was moderate (ICC = 0.75; 95% confidence interval [CI] 0.66-0.83) and good (ICC = 0.80; 95% CI 0.73-0.87), respectively. Before training, LoAs were -0.277 to 0.310 with a bias of 0.016. After training, LoAs were -0.237 to 0.255 with a bias of 0.008. The bias was low (<0.1) both before and after training and LoAs did not span the FGS analgesic threshold (0.39). CONCLUSIONS AND RELEVANCE Training in FGS scoring improved inter-rater reliability and agreement among seven small animal veterinarians and the veterinarians' skills in pain assessment.
Collapse
Affiliation(s)
- Alexandra R Robinson
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Paulo V Steagall
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- Centre for Companion Animal Health and Welfare, City University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
23
|
Fang JY, Yamamoto H, Romman AN, Koutrouvelis A, Yamamoto S. Comparative Efficacy of Spinal Cord Stimulation in the Management of Acute Pain and Chronic Pain Related to Failed Back Surgery Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2024; 16:e71132. [PMID: 39525214 PMCID: PMC11550870 DOI: 10.7759/cureus.71132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2024] [Indexed: 11/16/2024] Open
Abstract
Spinal cord stimulation (SCS) is a well-established treatment for chronic pain. However, its potential in acute pain management requires further investigation. The goal of this review is to assess and compare the effectiveness of SCS for managing acute postoperative pain against chronic pain associated with failed back surgery syndrome (FBSS). A comprehensive search of databases identified randomized controlled trials (RCTs) that examined SCS for both acute and chronic pain associated with FBSS. Pain relief was measured using the Visual Analog Scale (VAS) and Numeric Rating Scale (NRS). Study quality was evaluated using the Jadad score and Cochrane risk of bias tool. Evidence suggests that SCS significantly reduces acute pain, achieving over a 50% reduction in VAS scores. For chronic pain associated with FBSS, SCS demonstrated substantial efficacy, with a mean reduction of -2.45 on pain scales compared to baseline. When compared to optimal medical management (OMM), SCS was more effective, showing a mean reduction of -1.17 in pain scores for FBSS. Overall, SCS offers significant benefits in managing chronic pain, particularly in FBSS, by reducing pain intensity and opioid use. While the initial findings for acute pain relief are promising, further high-quality RCTs are needed to better understand SCS's role in preventing the transition from acute to chronic pain. Continued research into optimizing patient selection and stimulation parameters will be essential to improve therapeutic outcomes in both acute and chronic pain management.
Collapse
Affiliation(s)
- Jaden Y Fang
- Anesthesiology, University of Texas Medical Branch (UTMB), Galveston, USA
| | - Hideaki Yamamoto
- Biological Sciences, University of California San Diego, San Diego, USA
| | - Adam N Romman
- Anesthesiology, University of Texas Medical Branch (UTMB), Galveston, USA
| | | | - Satoshi Yamamoto
- Anesthesiology, University of Texas Medical Branch (UTMB), Galveston, USA
| |
Collapse
|
24
|
Oweidat A, Kalagara H, Sondekoppam RV. Current concepts and targets for preventing the transition of acute to chronic postsurgical pain. Curr Opin Anaesthesiol 2024; 37:588-596. [PMID: 39087396 DOI: 10.1097/aco.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF REVIEW It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. RECENT FINDINGS From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain. SUMMARY A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.
Collapse
Affiliation(s)
- Adeeb Oweidat
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | |
Collapse
|
25
|
Yin W, Luo D, Xu W, Yang W, Jia S, Lin J. Effect of adductor canal block combined with infiltration between the popliteal artery and posterior capsular of the knee on chronic pain after total knee arthroplasty: a prospective, randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2024; 24:320. [PMID: 39256652 PMCID: PMC11385851 DOI: 10.1186/s12871-024-02707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. METHODS In this prospective, randomized, double-blind, placebo-controlled study, 100 subjects scheduled for TKA were randomly (1:1) divided into two groups: the ropivacaine group and the placebo group. Patients in each group received ultrasound-guided ACB + IPACK procedures with 0.25% ropivacaine or equal volume normal saline. All patients received multimodal analgesia. Pain intensity was assessed using the Numerical Rating Scale (NRS). The primary outcome was the incidence of chronic pain at 3 months after TKA by telephone follow-up. In addition, pain intensity in early resting and mobilized states, chronic pain intensity, the time to first rescue analgesia; opioid consumption; CRP and IL-6 after the operation; length of postoperative hospital stay; and cost of hospitalization and postoperative complications; as well as the function of the knee in the early stage after the operation, were recorded. RESULTS Ninety-one participants were included in the final analysis. At 3 months, the incidence of chronic pain was 30.4% in the ropivacaine group, significantly lower than 51.1% in the placebo group. Compared with the placebo group, the ACB + IPACK with ropivacaine group had significantly lower pain scores at 4 hours, 8 hours, 16 hours, and 24 hours after the operation; increased the knee range of motion at 8 hours and 24 hours after the operation; and a significantly decreased incidence of chronic pain at 3 months after the operation. During the follow-up period, there were no nerve block-related complications in either group. CONCLUSION In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA. TRIAL REGISTRATION This trial was registered in the China Clinical Trial Center (registration number ChiCTR2200065300) on November 1, 2022.
Collapse
Affiliation(s)
- Wenqin Yin
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Dan Luo
- Department of Anesthesiology, the First Affiliated Hospital of Dali University, Dali Bai Autonomous Prefecture, Dali, Yunnan, 671000, China
| | - Wenmei Xu
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Wanli Yang
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Shuaiying Jia
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China
| | - Jingyan Lin
- Department of Anesthesiology, the Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, China.
| |
Collapse
|
26
|
Shukla A, Chaudhary R, Nayyar N, Gupta B. Drugs used for pain management in gastrointestinal surgery and their implications. World J Gastrointest Pharmacol Ther 2024; 15:97350. [PMID: 39281265 PMCID: PMC11401020 DOI: 10.4292/wjgpt.v15.i5.97350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 09/03/2024] Open
Abstract
Pain is the predominant symptom troubling patients. Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy. Various groups of drugs are used for dealing with this; however, they have their own implications in the form of adverse effects and dependence. In this article, we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.
Collapse
Affiliation(s)
- Ankit Shukla
- Department of Surgery, Dr Rajendra Prasad Government Medical College, Kangra 176001, Himachal Pradesh, India
| | - Rajesh Chaudhary
- Department of Renal Transplant Surgery, Dr Rajendra Prasad Government Medical College, Kangra 176001, India
| | - Nishant Nayyar
- Department of Radiology, Dr Rajendra Prasad Government Medical College, Kangra 176001, Himachal Pradesh, India
| | - Bhanu Gupta
- Department of Anaesthesia, Dr Rajendra Prasad Government Medical College, Tanda, Kangra 176001, Himachal Pradesh, India
| |
Collapse
|
27
|
Sharma V, Singh C. Evaluation of Oral Pregabalin as a Preemptive Adjuvant for Postoperative Pain in Patients Undergoing Coronary Artery Bypass Grafting With General Anesthesia and High Thoracic Epidural: A Randomized Controlled Study. Cureus 2024; 16:e70142. [PMID: 39463672 PMCID: PMC11506319 DOI: 10.7759/cureus.70142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 10/29/2024] Open
Abstract
Aim This study aimed to evaluate the effectiveness of oral pregabalin as a preventive supplement in managing postoperative pain in patients undergoing coronary artery bypass grafting (CABG) with a combination of general anesthesia and high thoracic epidural anesthesia. Material and methods This 18-month randomized controlled study at a tertiary hospital's anesthesiology department included 62 American Society of Anesthesiologists (ASA) II or III patients aged 35-75 with left ventricular ejection fraction >35%. Placebo (Group B, n = 31) or pregabalin (Group A, n = 31) was randomly allocated. Group A got 150 mg of pregabalin the night before surgery and 75 mg on postoperative days 0 and 1, whereas Group B received a placebo. Postoperative pain was evaluated using the Verbal Numerical Scale and Visual Analogue Scale, while sedation was assessed with the Ramsay Sedation Scale. Statistical analysis was performed using SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago). Results In this study, pregabalin significantly reduced postoperative pain on Day 0 and Day 1 (p < 0.001) compared to the placebo. The pregabalin group exhibited higher sedation scores on Day 0 (p < 0.001), but there were no significant differences on Day 1. Inotrope requirements were similar between both groups. Conclusions CABG patients' postoperative pain was greatly reduced by pregabalin without impacting sedation or inotrope needs. These data imply that pregabalin was a useful supplementary analgesic for CABG patients' multimodal pain treatment.
Collapse
Affiliation(s)
- Vipul Sharma
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Chandipriya Singh
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| |
Collapse
|
28
|
Vittori A, Cascella M, Di Gennaro P, Marchetti G, Francia E, Mascilini I, Tarquini R, Innamorato MA, Petrucci E, Marinangeli F, Coluccia S, Picardo SG. Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:53. [PMID: 39103959 PMCID: PMC11299347 DOI: 10.1186/s44158-024-00188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Thoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population. METHODS A retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity. RESULTS Gender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week. CONCLUSIONS The study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Marco Cascella
- Department of Medicine, Surgery, and Dentistry, Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, University of Salerno, Baronissi, 84081, Salerno, Italy.
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | | | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Riccardo Tarquini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Massimo Antonio Innamorato
- Pain Unit, Department of Neuroscience, Santa Maria Delle Croci Hospital, AUSL Romagna, 48121, Ravenna, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100, L'Aquila, Coppito, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Coppito, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| |
Collapse
|
29
|
Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2024; 49:581-601. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
Collapse
Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
30
|
Periañez CAH, Castillo-Diaz MA, Barbosa MH, De Mattia AL. Pain Predictors in Patients in the Postanesthesia Care Unit. J Perianesth Nurs 2024; 39:652-658. [PMID: 38310508 DOI: 10.1016/j.jopan.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE To analyze the effects of pain-predicting factors on patients in the postanesthesia care unit (PACU). DESIGN This is an observational and prospective study. METHODS This study was conducted at a University Hospital in the state of Minas Gerais (Brazil). To collect data on demographic, clinical, and surgical factors, a collection instrument was devised. The verbal numerical scale was employed to measure pain levels before and after surgery in the PACU. A path analysis was used to assess a predictive model. FINDINGS A total of 226 patients were included in this study. The incidence of pain in the PACU was 31.9%. A model with demographic, clinical, and surgical variables was tested. The final model, after including modification indices, obtained results that indicated an acceptable data fit (comparative fit index = 0.996; root mean square error of approximation = 0.08). Age (being young), sex (being a woman), oncological diagnosis as an indication for the surgical procedure, type of surgery (surgery of the digestive system), duration of surgery (longer surgeries), and high intraoperative doses of opioids were predictive variables for pain in the PACU. CONCLUSIONS This study's findings provide support for pain management in the PACU. Furthermore, the results of this research can be used to anticipate the occurrence of acute postoperative pain and personalized perioperative analgesia needs.
Collapse
Affiliation(s)
| | - Marcio Alexander Castillo-Diaz
- Universidad Nacional Autónoma de Honduras, Vicerrectoría de Orientación y Asuntos Estudiantiles. Tegucigalpa, Francisco Morazán, Honduras
| | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar. Uberaba, Minas Gerias, Brasil
| | - Ana Lúcia De Mattia
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Básica, Belo Horizonte, Minas Gerais, Brasil
| |
Collapse
|
31
|
Ma J, Subramaniam P, Yancey JR, Farrington AA, McGlade EC, Renshaw PF, Yurgelun-Todd DA. Elevated circulating soluble interleukin-2 receptor (sCD25) level is associated with prefrontal excitatory-inhibitory imbalance in individuals with chronic pain: A proton MRS study. Brain Behav Immun 2024; 120:1-9. [PMID: 38772429 PMCID: PMC11269041 DOI: 10.1016/j.bbi.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/29/2024] [Accepted: 05/18/2024] [Indexed: 05/23/2024] Open
Abstract
Aberrant neuronal excitability in the anterior cingulate cortex (ACC) is implicated in cognitive and affective pain processing. Such excitability may be amplified by activated circulating immune cells, including T lymphocytes, that interact with the central nervous system. Here, we conducted a study of individuals with chronic pain using magnetic resonance spectroscopy (MRS) to investigate the clinical evidence for the interaction between peripheral immune activation and prefrontal excitatory-inhibitory imbalance. In thirty individuals with chronic musculoskeletal pain, we assessed markers of peripheral immune activation, including soluble interleukin-2 receptor alpha chain (sCD25) levels, as well as brain metabolites, including Glx (glutamate + glutamine) to GABA+ (γ-aminobutyric acid + macromolecules/homocarnosine) ratio in the ACC. We found that the circulating level of sCD25 was associated with prefrontal Glx/GABA+. Greater prefrontal Glx/GABA+ was associated with higher pain catastrophizing, evaluative pain ratings, and anxiodepressive symptoms. Further, the interaction effect of sCD25 and prefrontal Glx/GABA+ on pain catastrophizing was significant, indicating the joint association of these two markers with pain catastrophizing. Our results provide the first evidence suggesting that peripheral T cellular activation, as reflected by elevated circulating sCD25 levels, may be linked to prefrontal excitatory-inhibitory imbalance in individuals with chronic pain. The interaction between these two systems may play a role as a potential mechanism underlying pain catastrophizing. Further prospective and treatment studies are needed to elucidate the specific role of the immune and brain interaction in pain catastrophizing.
Collapse
Affiliation(s)
- Jiyoung Ma
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Punitha Subramaniam
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James R Yancey
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VISN 19 Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, USA
| | - Amy A Farrington
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin C McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VISN 19 Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, USA
| | - Perry F Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VISN 19 Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, USA
| | - Deborah A Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Diagnostic Neuroimaging Laboratory, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA; George E. Wahlen Department of Veterans Affairs Medical Center, VISN 19 Mental Illness Research, Education and Clinical Center, Salt Lake City, UT, USA.
| |
Collapse
|
32
|
Cáceres-Matos R, Gil-García E, Vázquez-Santiago S, Cabrera-León A. The use of healthcare services and disabling chronic pain: results from the cross-sectional population-based Andalusian Health Survey. Eur J Public Health 2024; 34:639-645. [PMID: 38750626 PMCID: PMC11293836 DOI: 10.1093/eurpub/ckae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Several factors seem to be related to the use of healthcare services, and chronic pain (CP) is among these characteristics. The objective is to describe the number of visits to a doctor's surgery or emergency rooms, and the periods of hospitalization; to identify characteristics associated with frequent healthcare use, including disabling chronic pain (DCP) and non-disabling chronic pain (n-DCP). METHODS Representative population-based cross-sectional study of 6569 people older than 16 years from southern Spain was collected. The frequency of visits to a doctor's surgery or emergency rooms and periods of hospitalization were defined as at or above the 90th percentile. Binary logistic regression analyses were conducted separately on women and men to identify characteristics associated with being frequent visitors. RESULTS People with DCP are more frequent visitors to a doctor's surgery and emergency rooms and endure longer periods of hospitalization compared to people with n-DCP and without pain. In logistic regression models, people with DCP are twice as likely to over-visit a doctor's surgery; to endure longer periods of hospitalization and more visits to an emergency room service. No relationship was found in n-DCP. CONCLUSIONS Disability seems to modulate a greater use of health services among the population with CP, doubling it when compared to n-DCP and n-CP, both in women and men. Understanding the role of disability in the use of healthcare services for individuals with CP allows for the identification of needs and strategies to optimize resources.
Collapse
Affiliation(s)
- Rocío Cáceres-Matos
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Eugenia Gil-García
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Soledad Vázquez-Santiago
- Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Virgen Macarena University Hospital, Seville, Spain
| | - Andrés Cabrera-León
- Andalusian School of Public Health, Cuesta del Observatorio, Granada, Spain
- Biomedical Research Consortium in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Institute of Biomedical Research ibs.GRANADA, Granada, Spain
| |
Collapse
|
33
|
Chen Y, Shen P, He Y, Zeng D, Li Y, Zhang Y, Chen M, Liu C. Bibliometric analysis of functional magnetic resonance imaging studies on chronic pain over the past 20 years. Acta Neurochir (Wien) 2024; 166:307. [PMID: 39060813 DOI: 10.1007/s00701-024-06204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE The utilization of functional magnetic resonance imaging (fMRI) in studying the mechanisms and treatment of chronic pain has gained significant popularity. However, there is currently a dearth of literature conducting bibliometric analysis on fMRI studies focused on chronic pain. METHODS All the literature included in this study was obtained from the Science Citation Index Expanded of Web of Science Core Collection. We used CiteSpace and VOSviewer to analyze publications, authors, countries or regions, institutions, journals, references and keywords. Additionally, we evaluated the timeline and burst analysis of keywords, as well as the timeline and burst analysis of references. The search was conducted from 2004 to 2023 and completed within a single day on October 4th, 2023. RESULTS A total of 1,327 articles were retrieved. The annual publication shows an overall increasing trend. The United States has the highest number of publications and the main contributing institution is Harvard University. The journal PAIN produces the most articles. In recent years, resting-state fMRI, the prefrontal cortex, nucleus accumbens, thalamus, and migraines have been researched hotspots of fMRI studies on chronic pain. CONCLUSIONS This study provides an in-depth perspective on fMRI for chronic pain research, revealing key points, research hotspots and research trends, which offers valuable ideas for future research activities. It concludes with a summary of advances in clinical practice in this area, pointing out the need for critical evaluation of these findings in the light of guidelines and expert recommendations. It is anticipated that further high-quality research outputs will be generated in the future, which will facilitate the utilization of fMRI in clinical decision-making for chronic pain.
Collapse
Affiliation(s)
- Yiming Chen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peifeng Shen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yanan He
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Deyi Zeng
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), 688 West Yushan Road Shatou Street, Panyu District, Guangzhou, China
| | - Yuanchao Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuting Zhang
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengtong Chen
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunlong Liu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.
| |
Collapse
|
34
|
Tomasson AM, Jakobsdóttir H, Gudnason HM, Karason S, Sigurdsson MI. Postoperative pain at Landspitali: A prospective study. Acta Anaesthesiol Scand 2024; 68:830-838. [PMID: 38462497 DOI: 10.1111/aas.14408] [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: 10/08/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Moderate or severe postoperative pain is common despite advances in surgical technique and perioperative analgesia. This study aimed to assess the prevalence and severity of postoperative pain following procedures requiring anaesthesia and identify factors associated with increased risk of postoperative pain. METHODS Surgical patients ≥18 years of age were prospectively questioned on level of current pain on a numerical rating scale (NRS) from 0 to 10 in the post-anaesthesia care unit (PACU) and on resting, active and worst pain experienced in the first 24 h postoperatively. Clinical data was obtained from medical records. Descriptive statistics were applied, and predictors of worst pain assessed as moderate/severe (NRS ≥ 5) on postoperative day one were assessed using multivariable logistic regression. RESULTS Of 438 included participants, moderate/severe pain occurred in 29% on the day of surgery and 70% described their worst pain as moderate/severe on postoperative day one. Procedures with the highest incidence of moderate/severe pain on the day of surgery were gynaecology-, plastic-, abdominal-, breast-, and orthopaedic procedures. On postoperative day one, patients undergoing vascular-, orthopaedic-, and abdominal operations most commonly rated their worst pain as moderate/severe. Female sex (OR = 2.15, 95% Cl 1.21-3.88, p = .010), chronic preoperative pain (OR = 4.20, 95% Cl 2.41-7.51, p < .001), undergoing a major procedure (OR = 2.07, 95% Cl 1.15-3.80, p = .017), and any intraoperative remifentanil administration (OR = 2.16, 95% Cl 1.20-3.94, p = .01) had increased odds of rating the worst pain as moderate/severe. Increased age (OR = 0.66 per 10 years (95% Cl 0.55-0.78, p < .001)) and undergoing breast-, gynaecology-, otolaryngology-, and neurosurgery (OR = 0.15-0.34, p < .038) was associated with lower odds of moderate/severe pain on postoperative day one. DISCUSSION In our cohort, patients rated their current pain in the PACU similarly to other studies. However, the ratio of patients rating the worst pain experienced as moderate/severe on postoperative day one was relatively high. The identified patient- and procedural-related factors associated with higher odds of postoperative pain highlight a subgroup of patients who may benefit from enhanced perioperative monitoring and pain management strategies.
Collapse
Affiliation(s)
| | | | - Haraldur M Gudnason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigurbergur Karason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Critical Care, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
35
|
Karaoğlan M, Küçükçay Karaoğlan B. PENG for chronic pain: the clinical effectiveness of pericapsular nerve group block in chronic hip pain. Hip Int 2024; 34:524-536. [PMID: 38380579 DOI: 10.1177/11207000241227542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To evaluate the efficiency and tolerability of pericapsular nerve group block (PENG) for the treatment of chronic hip pain. METHODS This is a retrospective, single-centre, 4-group study conducted over a 3-month period to find out the most typical cause of chronic hip pain. A total of 112 patients with symptomatic hip osteoarthritis (OA), Stage 2-3, greater trochanteric pain (GTPS) and chronic pain after total hip arthroplasty (cTHA), who had an ultrasound-guided PENG block, were selected. To assess the effectiveness of the treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analogue scale (VAS) scores of the patients prior to treatment were compared with their scores after the 1st week, 1st month, and 3rd month of treatment. The study also aimed to analyse the patients' initial feelings of alleviation following the block (1st VAS/2) and problems experienced both during and after the block. RESULTS The parameters studied included pain, stiffness, and results of physical activity in the 1st week, 1st month, and 3rd month following PENG block application. At the beginning of the 1st week, of the 112 patients who were administered a PENG block for hip pain, we reported a 62% improvement in pain, a 52% reduction in stiffness, and a 53% increase in physical activity. Even though these results slightly declined in the 1st and 3rd months, the rates were still higher than 45%. CONCLUSIONS Overall, the PENG block was well-tolerated by the patients in our study. No treatment-related infections or any other serious complications were observed.
Collapse
|
36
|
Carrascosa AJ, Navarrete F, Saldaña R, García-Gutiérrez MS, Montalbán B, Navarro D, Gómez-Guijarro FM, Gasparyan A, Murcia-Sánchez E, Torregrosa AB, Pérez-Doblado P, Gutiérrez L, Manzanares J. Cannabinoid Analgesia in Postoperative Pain Management: From Molecular Mechanisms to Clinical Reality. Int J Mol Sci 2024; 25:6268. [PMID: 38892456 PMCID: PMC11172912 DOI: 10.3390/ijms25116268] [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: 04/26/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Postoperative pain (POP) is a challenging clinical phenomenon that affects the majority of surgical patients and demands effective management to mitigate adverse outcomes such as persistent pain. The primary goal of POP management is to alleviate suffering and facilitate a seamless return to normal function for the patient. Despite compelling evidence of its drawbacks, opioid analgesia remains the basis of POP treatment. Novel therapeutic approaches rely on multimodal analgesia, integrating different pharmacological strategies to optimize efficacy while minimizing adverse effects. The recognition of the imperative role of the endocannabinoid system in pain regulation has prompted the investigation of cannabinoid compounds as a new therapeutic avenue. Cannabinoids may serve as adjuvants, enhancing the analgesic effects of other drugs and potentially replacing or at least reducing the dependence on other long-term analgesics in pain management. This narrative review succinctly summarizes pertinent information on the molecular mechanisms, clinical therapeutic benefits, and considerations associated with the plausible use of various cannabinoid compounds in treating POP. According to the available evidence, cannabinoid compounds modulate specific molecular mechanisms intimately involved in POP. However, only two of the eleven clinical trials that evaluated the efficacy of different cannabinoid interventions showed positive results.
Collapse
Affiliation(s)
- Antonio J. Carrascosa
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Raquel Saldaña
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - María S. García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Belinda Montalbán
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Daniela Navarro
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Fernando M. Gómez-Guijarro
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Elena Murcia-Sánchez
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Abraham B. Torregrosa
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Paloma Pérez-Doblado
- Servicio de Anestesiologia y Reanimación, Hospital Universitario 12 de Octubre, Avda. Córdoba s/n, 28041 Madrid, Spain; (A.J.C.); (R.S.); (B.M.); (F.M.G.-G.); (E.M.-S.); (P.P.-D.)
| | - Luisa Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (F.N.); (M.S.G.-G.); (D.N.); (A.G.); (A.B.T.); (L.G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| |
Collapse
|
37
|
Miclescu A, Rönngren C, Bengtsson M, Gordh T, Hedin A. Increased risk of persistent neuropathic pain after traumatic nerve injury and surgery for carriers of a human leukocyte antigen haplotype. Pain 2024; 165:1404-1412. [PMID: 38147413 PMCID: PMC11090029 DOI: 10.1097/j.pain.0000000000003143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 12/28/2023]
Abstract
ABSTRACT It is not known why some patients develop persistent pain after nerve trauma while others do not. Among multiple risk factors for the development of persistent posttrauma and postsurgical pain, a neuropathic mechanism due to iatrogenic nerve lesion has been proposed as the major cause of these conditions. Because there is some evidence that the human leukocyte antigen (HLA) system plays a role in persistent postsurgical pain, this study aimed to identify the genetic risk factors, specifically among HLA loci, associated with chronic neuropathic pain after traumatic nerve injuries and surgery in the upper extremities. Blood samples were taken to investigate the contribution of HLA alleles (ie, HLA-A, HLA-B, HLA-DRB1, HLA-DQB1, and HLA-DPB1) in a group of patients with persistent neuropathic pain (n = 70) and a group of patients with neuropathy without pain (n = 61). All subjects had intraoperatively verified nerve damage in the upper extremity. They underwent bedside clinical neurological examination to identify the neuropathic pain component according to the present grading system of neuropathic pain. Statistical analyses on the allele and haplotype were conducted using the BIGDAWG package. We found that the HLA haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 was associated with an increased risk of developing persistent neuropathic pain in the upper extremity (OR = 9.31 [95% CI 1.28-406.45], P < 0.05). No significant associations were found on an allele level when correcting for multiple testing. Further studies are needed to investigate whether this association is on a haplotypic level or if certain alleles may be causing the association.
Collapse
Affiliation(s)
| | | | - Mats Bengtsson
- Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Anders Hedin
- Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
38
|
Wangnamthip S, Euasobhon P, Thiangtham K, Jirachaipitak S, Rushatamukayanunt P, Jensen MP. Long-term pain outcomes after serial lidocaine infusion in participants with recent onset of peripheral neuropathic pain: A pilot double-blind, randomized, placebo-controlled trial. Medicine (Baltimore) 2024; 103:e38253. [PMID: 38787976 PMCID: PMC11124726 DOI: 10.1097/md.0000000000038253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND This study investigated the outcomes up to 12 weeks after serial lidocaine infusion for early-onset peripheral neuropathic pain. METHODS This pilot double-blind, randomized, 2-arm placebo-controlled trial recruited 50 participants with onset of peripheral neuropathic pain within the past 6 months and randomized them to either receive lidocaine (3 mg/kg) in normal saline (50 mL) intravenous infusion over 1 hour (lidocaine group) once a week for 4 weeks or 50 mL of normal saline infusion (placebo group) once a week for 4 weeks. Twenty-nine participants completed the protocol; 15 participants were assigned to the lidocaine group and 14 to the placebo group. The outcomes were pain intensity assessed using a numerical rating scale (NRS), quality of life assessed using EuroQol-Five Dimensions-Five Levels questionnaire (EQ-5D-5L), psychological function using the Thai version of the 21-item Depression Anxiety Stress Scales (DASS-21), pain medication use, and adverse effects, all assessed at baseline (BL) and again at 4, 8, and 12 weeks following randomization. RESULTS The reported tramadol use at 8 and 12 weeks following the first infusion was significantly lower in the lidocaine group (P = .023). No other significant between-group differences were observed at any time point or for any other outcome, and no serious adverse events were observed. CONCLUSION Multiple lidocaine infusions of 3 mg/kg once a week for 4 weeks in participants with recent onset of peripheral neuropathic pain demonstrated no significant benefits in pain intensity, quality of life, or psychological outcomes. At most, this treatment may result in less tramadol use.
Collapse
Affiliation(s)
- Suratsawadee Wangnamthip
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramote Euasobhon
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kasamabhorn Thiangtham
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sukunya Jirachaipitak
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pranee Rushatamukayanunt
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mark P. Jensen
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
39
|
Ikemoto H, Adachi N, Okumo T, Chuluunbat O, Hisamitsu T, Sunagawa M. Duration of the preemptive analgesic effects of low- and high-frequency transcutaneous electrical nerve stimulation in rats with acute inflammatory pain. Kaohsiung J Med Sci 2024; 40:456-466. [PMID: 38446546 DOI: 10.1002/kjm2.12818] [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: 07/06/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) activates various pathways to induce antinociceptive effects, based on the frequencies used. This study evaluates the preemptive analgesic effects and their duration of low- (LT: 4 Hz) and high-frequency TENS (HT: 100 Hz) using a rat model of acute inflammatory pain. Acute inflammation was induced by injecting 1% formalin into the hind paws of rats. LT or HT was applied for 30 min before formalin injection. Pain-related behaviors, such as licking, flinching, and lifting, were recorded for 60 min postinjection. Immunohistochemistry was used to assess the number of phosphorylated extracellular signal-regulated kinase (pERK)- and c-fos-positive cells in the spinal cord. Naloxone, a μ-opioid receptors (MORs) antagonist, and naltrindole, a δ-opioid receptors (DORs) antagonist, were administered before TENS application. Pain behavior duration and pERK- and c-fos-positive cell expression were then measured. LT and HT pretreatment significantly reduced both pain behaviors and the number of pERK- and c-fos-positive cells postformalin injection. Naloxone and naltrindole partially reversed the effects of LT and HT, respectively. Notably, HT's analgesic effect lasted up to 120 min whereas that of LT persisted for 90 min. LT and HT effectively exerted their preemptive analgesic effects on acute inflammatory pain by inhibiting pERK and c-fos expression in the spinal cord. HT presented a longer-lasting effect compared to LT. MOR and DOR activation may contribute to LT and HT's analgesic mechanisms, respectively.
Collapse
Affiliation(s)
- Hideshi Ikemoto
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Naoki Adachi
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki Okumo
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Oyunchimeg Chuluunbat
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Tadashi Hisamitsu
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Masataka Sunagawa
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
40
|
Ortega PM, Scholtz S, O'Donnell K, Hakky S, Purkayastha S, Tsironis C, Moorthy K, Aggarwal R, Ahmed AR. Risk Factors for Chronic Abdominal Pain After RYGB: Are Patients Adequately Selected Beforehand? Obes Surg 2024; 34:1748-1755. [PMID: 38575742 DOI: 10.1007/s11695-024-07193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Chronic abdominal pain after RYGB is a known issue. Identifying the potential patient-related and modifiable risk factors might contribute to diminish the risk for this undesirable outcome. METHODS A single-center retrospective cohort study with prospective data collection was conducted with inclusion of all patients who underwent RYGB surgery between 2015 and 2021. Data from the NBSR and medical records were used. Patients with chronic abdominal pain were defined when pain lasting or recurring for more than 3 to 6 months. RESULTS Six hundred sixty-four patients who underwent RYGB surgery were included with a median follow-up of 60.5 months. Forty-nine patients (7.3%) presented with chronic abdominal pain. Postoperative complications (OR 13.376, p = 0.020) and diagnosis of depression (OR 1.971, p = 0.037) were associated with developing abdominal pain. On the other hand, ex-smokers (OR 0.222, p = 0.040) and older age (0.959, p = 0.004) presented as protective factors. CONCLUSION Postoperative complications and diagnosis of depression are risk factors for chronic pain after RYGB. The role of the bariatric MDT remains crucial to select these patients adequately beforehand.
Collapse
Affiliation(s)
- Patricia M Ortega
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Samantha Scholtz
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- West London NHS Trust, Southall, UK
| | - Karen O'Donnell
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sherif Hakky
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sanjay Purkayastha
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Christos Tsironis
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Krishna Moorthy
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ravi Aggarwal
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ahmed R Ahmed
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| |
Collapse
|
41
|
Núñez-Cortés R, López-Bueno L, López-Bueno R, Cuenca-Martínez F, Suso-Martí L, Silvestre A, Casaña J, Cruz-Montecinos C, Andersen LL, Calatayud J. Acute Effects of In-Hospital Resistance Training on Clinical Outcomes in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial. Am J Phys Med Rehabil 2024; 103:401-409. [PMID: 38063321 DOI: 10.1097/phm.0000000000002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate the acute responses, in the in-hospital setting, of intensive elastic resistance training on physical function, pain, psychosocial variables, and inflammatory markers in patients undergoing total knee arthroplasty. DESIGN In a randomized controlled trial, 40 patients with total knee arthroplasty (≥55 yrs) were assigned to either (1) the intervention group (elastic resistance strengthening) or (2) a control group (conventional protocol). Patients performed three sessions in the hospital at 24, 48, and 72 hrs after total knee arthroplasty. Outcome measures included: self-administered physical function, pain intensity, kinesiophobia, catastrophizing, self-efficacy, range of motion, perceived change, test timed up and go, knee joint effusion, isometric strength, pressure pain thresholds, and inflammatory markers (levels of procalcitonin and C-reactive protein). RESULTS The mixed analysis of variance model showed a significant group*time interaction in favor of the intervention group with a large effect size for kinesiophobia (ηp 2 = 0.308, P < 0.001), catastrophizing (ηp 2 = 0.242, P < 0.001), and passive range of motion flexion (ηp 2 = 0.167, P < 0.001) and a moderate effect size for physical function (ηp 2 = 0.103, P = 0.004), pain intensity (ηp 2 = 0.139, P < 0.001), timed up and go (ηp 2 = 0.132, P = 0.001), self-efficacy (ηp 2 = 0.074, P = 0.016), active range of motion flexion (ηp 2 = 0.121, P = 0.002), levels of procalcitonin (ηp 2 = 0.099, P = 0.005), and C-reactive protein (ηp 2 = 0.106, P = 0.004). CONCLUSIONS Three sessions of intensive elastic resistance training improve physical function, perceived pain, psychosocial variables, and inflammatory markers during the hospitalization period after total knee arthroplasty.
Collapse
Affiliation(s)
- Rodrigo Núñez-Cortés
- From the Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain (RN-C, CC-M); Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile (RN-C, CC-M); Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain (LL-B, RL-B, FC-M, LS-M, JCas, JCal); Physiotherapy Service, University Clinical Hospital of Valencia, Valencia, Spain (LL-B); Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain (RL-B); National Research Centre for the Working Environment, Copenhagen, Denmark (RL-B, LLA, JCal); Department of Orthopaedic Surgery, Clinic Hospital of Valencia, Valencia, Spain (AS); Department of Orthopaedic Surgery, School of Medicine, University of Valencia, Valencia, Spain (AS); and Section of Research, Innovation and Development in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile (CC-M)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Tsai AWW, Kobayashi R, Liu IAW, Fim M, Liggieri AC, Machado ES. Update on Musculoskeletal Pain Management. Rev Bras Ortop 2024; 59:e160-e171. [PMID: 38606122 PMCID: PMC11006528 DOI: 10.1055/s-0043-1776135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/25/2023] [Indexed: 04/13/2024] Open
Abstract
Pain is the most common complaint reported to orthopedists in the outpatient clinic, emergency room, or booth. Numerous publications report the inadequate management of both acute and chronic pain by health professionals. This updated article aims to provide information about musculoskeletal pain, its classification, evaluation, diagnosis, and the multimodal therapeutic approach for each case. For acute pain, adequate control allows for earlier rehabilitation to work and reduces the rates of pain chronification. For chronic pain, the goal is to reduce its intensity and improve the quality of life. Currently, some procedures are increasingly used and aided by imaging tests for diagnostic and therapeutic purposes.
Collapse
Affiliation(s)
| | - Ricardo Kobayashi
- Centro de Dor, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Márcio Fim
- Cirurgia de Ombro e Cotovelo, Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, MG, Brasil
| | - André Cicone Liggieri
- Centro de Dor, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Edilson Silva Machado
- Serviço de Dor e Cuidados Paliativos, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| |
Collapse
|
43
|
Defaye M, Bradaia A, Abdullah NS, Agosti F, Iftinca M, Delanne-Cuménal M, Soubeyre V, Svendsen K, Gill G, Ozmaeian A, Gheziel N, Martin J, Poulen G, Lonjon N, Vachiery-Lahaye F, Bauchet L, Basso L, Bourinet E, Chiu IM, Altier C. Induction of antiviral interferon-stimulated genes by neuronal STING promotes the resolution of pain in mice. J Clin Invest 2024; 134:e176474. [PMID: 38690737 PMCID: PMC11060736 DOI: 10.1172/jci176474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/12/2024] [Indexed: 05/03/2024] Open
Abstract
Inflammation and pain are intertwined responses to injury, infection, or chronic diseases. While acute inflammation is essential in determining pain resolution and opioid analgesia, maladaptive processes occurring during resolution can lead to the transition to chronic pain. Here we found that inflammation activates the cytosolic DNA-sensing protein stimulator of IFN genes (STING) in dorsal root ganglion nociceptors. Neuronal activation of STING promotes signaling through TANK-binding kinase 1 (TBK1) and triggers an IFN-β response that mediates pain resolution. Notably, we found that mice expressing a nociceptor-specific gain-of-function mutation in STING exhibited an IFN gene signature that reduced nociceptor excitability and inflammatory hyperalgesia through a KChIP1-Kv4.3 regulation. Our findings reveal a role of IFN-regulated genes and KChIP1 downstream of STING in the resolution of inflammatory pain.
Collapse
Affiliation(s)
- Manon Defaye
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amyaouch Bradaia
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nasser S. Abdullah
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Francina Agosti
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mircea Iftinca
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mélissa Delanne-Cuménal
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa Soubeyre
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Kristofer Svendsen
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gurveer Gill
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
| | - Aye Ozmaeian
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nadine Gheziel
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Jérémy Martin
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Gaetan Poulen
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Nicolas Lonjon
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Florence Vachiery-Lahaye
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
| | - Luc Bauchet
- Department of Neurosurgery, Gui de Chauliac Hospital, Donation and Transplantation Coordination Unit, Montpellier University Medical Center, Montpellier, France
- Institute of Functional Genomics, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Lilian Basso
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM UMR1291, University of Toulouse III, Toulouse, France
| | - Emmanuel Bourinet
- Institute of Functional Genomics, Montpellier University, CNRS, INSERM, Montpellier, France
| | - Isaac M. Chiu
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Christophe Altier
- Department of Physiology and Pharmacology, Cumming School of Medicine
- Inflammation Research Network–Snyder Institute for Chronic Diseases, Cumming School of Medicine, and
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
44
|
Kościuczuk U, Tarnowska K, Rynkiewicz-Szczepanska E. Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study. J Pain Res 2024; 17:941-951. [PMID: 38476874 PMCID: PMC10929647 DOI: 10.2147/jpr.s449563] [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: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA (low opioid anaesthesia) and OFA (opioid-free anaesthesia). The aim was to describe the effects of LOA on nausea, vomiting, and pain control during general anaesthesia and postoperative period after laparoscopic cholecystectomy. Patients and Methods The protocol included the study group-40 patients received low-opioid anaesthesia (LOA), and the control group-40 patients received general anaesthesia with opioid analgesia (OA). The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole. The OA was based on standard opioid (fentanyl) administration in induction and maintenance phase due to clinical observation. Postoperative analgesia included 1g of paracetamol and 1g of metamizol intravenously, with a 6-hour interval between doses. Results Significant differences in the pain score in the periods of 2-6, 6-12, and 12-24 hours after anaesthesia between the groups were noticed (p < 0.001). Moreover, a significant difference in the frequency of nausea (p = 0.005) and vomiting (p = 0.04) between groups were presented. Nausea occurred in 54.05% of OA group, while in the LOA group, it occurred in a 23.08%. Vomiting occurred in 32.43% of control group, while in the study group, it occurred in 12.82% of patients. Conclusion The LOA protocol was more beneficial in reducing nausea and vomiting than the opioid-based method of anaesthesia. The LOA protocol of general anaesthesia during laparoscopic cholecystectomy and non-opioid postoperative analgesia have better outcomes in pain control, as well as nausea and vomiting, and improve postoperative patient comfort. The LOA protocol during anaesthesia and non-opioid postoperative analgesia should be considered in routine practice.
Collapse
Affiliation(s)
- Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
| | - Katarzyna Tarnowska
- Department of Anaesthesiology and Intensive Therapy, Medical University in Bialystok, Bialystok, Poland
| | | |
Collapse
|
45
|
Cavaliere F, Allegri M, Apan A, Brazzi L, Carassiti M, Cohen E, DI Marco P, Langeron O, Rossi M, Spieth P, Turnbull D, Weber F. A year in review in Minerva Anestesiologica 2023: anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2024; 90:222-234. [PMID: 38535972 DOI: 10.23736/s0375-9393.24.18067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Franco Cavaliere
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Lemanic Center of Analgesia and Neuromodulation EHC, Morges, Switzerland
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Türkiye
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pierangelo DI Marco
- Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic, and Geriatric Sciences, Faculty of Medicine, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris (APHP), University Paris-Est Créteil (UPEC), Paris, France
| | - Marco Rossi
- IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
| | - Frank Weber
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
46
|
Khan JS, Dana E, Xiao MZX, Rao V, Djaiani G, Seltzer Z, Ladha K, Huang A, McRae K, Cypel M, Katz J, Wong D, Clarke H. Prevalence and Risk Factors for Chronic Postsurgical Pain After Thoracic Surgery: A Prospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:490-498. [PMID: 39093584 DOI: 10.1053/j.jvca.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Thoracic surgery is associated with one of the highest rates of chronic postsurgical pain (CPSP) among all surgical subtypes. Chronic postsurgical pain carries significant medical, psychological, and economic consequences, and further interventions are needed to prevent its development. This study aimed to determine the prevalence, characteristics, and risk factors associated with CPSP after thoracic surgery. DESIGN A prospective cohort study. SETTING Single-center tertiary care hospital. PARTICIPANTS This study included 285 adult patients who underwent thoracic surgery at Toronto General Hospital in Toronto, Canada, between 2012 and 2020. MEASUREMENTS AND MAIN RESULTS Demographic, psychological, and clinical data were collected perioperatively, and follow-up evaluations were administered at 3, 6, and 12 months after surgery to assess CPSP. Chronic postsurgical pain was reported in 32.4%, 25.4%, and 18.2% of patients at 3, 6, and 12 months postoperatively, respectively. Average CPSP pain intensity was rated to be 3.37 (SD 1.82) at 3 months. Features of neuropathic pain were present in 48.7% of patients with CPSP at 3 months and 71% at 1 year. Multivariate logistic regression models indicated that independent predictors for CPSP at 3 months were scores on the Hospital Anxiety and Depression Scale (adjusted odds ratio [aOR] of 1.07, 95% CI of 1.02 to 1.14, p = 0.012) and acute postoperative pain (aOR of 2.75, 95% CI of 1.19 to 6.36, p = 0.018). INTERVENTIONS None. CONCLUSIONS Approximately 1 in 3 patients will continue to have pain at 3 months after surgery, with a large proportion reporting neuropathic features. Risk factors for pain at 3 months may include preoperative anxiety and depression and acute postoperative pain.
Collapse
Affiliation(s)
- James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Elad Dana
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maggie Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ze'ev Seltzer
- Centre for the Study of Pain, University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada
| | - Karim Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Huang
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen McRae
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for the Study of Pain, University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada
| | - Dorothy Wong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
47
|
Zorina-Lichtenwalter K, Ase AR, Verma V, Parra AIM, Komarova S, Khadra A, Séguéla P, Diatchenko L. Characterization of Common Genetic Variants in P2RX7 and Their Contribution to Chronic Pain Conditions. THE JOURNAL OF PAIN 2024; 25:545-556. [PMID: 37742908 DOI: 10.1016/j.jpain.2023.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
Abstract
The adenosine triphosphate (ATP)-gated channel P2X7 is encoded by a gene enriched for common nonsynonymous variants. Many of these variants have functional cellular effects, and some have been implicated in chronic pain. In this study, we first systematically characterized all 17 common nonsynonymous variants using whole-cell patch clamp electrophysiology. Then, we analyzed these variants for statistical association with chronic pain phenotypes using both individual P2RX7 variants as predictors and cumulative allele counts of same-direction cellular effect in univariate models. Association and validation analyses were conducted in the Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) cohort (N = 3260) and in the Complex Persistent Pain Conditions (CPPC) cohort (N = 900), respectively. Our results showed an association between allele A of rs7958311 and an increased risk of chronic pelvic pain, with convergent evidence for contribution to fibromyalgia and irritable bowel syndrome, confirmed in a meta-analysis. This allelic variant produced a unique cellular phenotype: a gain-of-function in channel opening, and a loss-of-function in pore opening. A computational study using a 12-state Markov model of ATP binding to the P2X7 receptor suggested that this cellular phenotype arises from an increased ATP binding affinity and an increased open channel conductance combined with a loss of sensitization. Cumulative allele count analysis did not provide additional insights. In conclusion, our results go beyond reproducing association for rs7958311 with chronic pain and suggest that its unique combination of gain-of-function in channel and loss-of-function in pore activity may explain why it is likely the only common P2RX7 variant with contribution to chronic pain. PERSPECTIVE: This study characterizes all common P2RX7 variants using cellular assays and statistical association analyses with chronic pain, with Markov state modeling of the most robustly associated variant.
Collapse
Affiliation(s)
- Katerina Zorina-Lichtenwalter
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ariel R Ase
- Department of Neurology & Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Montreal Neurological Institute/Hospital, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Vivek Verma
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Arturo I M Parra
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Svetlana Komarova
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| | - Anmar Khadra
- Department of Physiology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Philippe Séguéla
- Department of Neurology & Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Montreal Neurological Institute/Hospital, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Luda Diatchenko
- Faculty of Dental Medicine and Oral Health Sciences, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Alan Edwards Centre for Research on Pain, Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
| |
Collapse
|
48
|
Dubayev A, Jensen EK, Andersen KG, Bjurström MF, Werner MU. Quantitative somatosensory assessments in patients with persistent pain following groin hernia repair: A systematic review with a meta-analytical approach. PLoS One 2024; 19:e0292800. [PMID: 38295051 PMCID: PMC10830060 DOI: 10.1371/journal.pone.0292800] [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: 05/22/2023] [Accepted: 09/28/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVES Quantitative sensory testing (QST) provides an assessment of cutaneous and deep tissue sensitivity and pain perception under normal and pathological settings. Approximately 2-4% of individuals undergoing groin hernia repair (GHR) develop severe persistent postsurgical pain (PPSP). The aims of this systematic review of PPSP-patients were (1) to retrieve and methodologically characterize the available QST literature and (2) to explore the role of QST in understanding mechanisms underlying PPSP following GHR. METHODS A systematic literature search was conducted from JAN-1992 to SEP-2022 in PubMed, EMBASE, and Google Scholar. For inclusion, studies had to report at least one QST-modality in patients with PPSP. Risk of bias assessment of the studies was conducted utilizing the Newcastle Ottawa Scale and Cochrane's Risk of Bias assessment tool 2.0. The review provided both a qualitative and quantitative analysis of the results. A random effects model was used for meta-analysis. RESULTS Twenty-five studies were included (5 randomized controlled trials, 20 non-randomized controlled trials). Overall, risk of bias was low. Compared with the contralateral side or controls, there were significant alterations in somatosensory function of the surgical site in PPSP-patients. Following thresholds were significantly increased: mechanical detection thresholds for punctate stimuli (mean difference (95% CI) 3.3 (1.6, 6.9) mN (P = 0.002)), warmth detection thresholds (3.2 (1.6, 4.7) °C (P = 0.0001)), cool detection thresholds (-3.2 (-4.9, -1.6) °C (P = 0.0001)), and heat pain thresholds (1.9 (1.1, 2.7) °C (P = 0.00001)). However, the pressure pain thresholds were significantly decreased (-76 (-123, -30) kPa (P = 0.001)). CONCLUSION Our review demonstrates a plethora of methods used regarding outcome assessments, data processing, and data interpretation. From a pathophysiological perspective, the most consistent findings were postsurgical cutaneous deafferentation and development of a pain generator in deeper connective tissues. TRIAL REGISTRATION CRD42022331750.
Collapse
Affiliation(s)
- Akhmedkhan Dubayev
- Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospitals - Rigshospitalet, København, Denmark
| | - Elisabeth Kjær Jensen
- Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospitals - Rigshospitalet, København, Denmark
| | - Kenneth Geving Andersen
- Department of Anesthesia and Intensive Care, Copenhagen University Hospitals - Hvidovre Hospital, Hvidovre, Denmark
| | | | - Mads U. Werner
- Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospitals - Rigshospitalet, København, Denmark
| |
Collapse
|
49
|
Jabbari S, Zakaria ZA, Ahmadimoghaddam D, Mohammadi S. The oral administration of Lotus corniculatus L. attenuates acute and chronic pain models in male rats. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117181. [PMID: 37734474 DOI: 10.1016/j.jep.2023.117181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Lotus corniculatus L. (Fabaceae) traditionally used in Persian folk medicine to heal peritoneal inflammation and back pain. AIM OF THE STUDY To explore the antinociceptive (acute pain) and anti-neuropathic (chronic pain) activities of Lotus corniculatus leaves essential oil (LCEO) in addition to uncovering the possible mechanisms of antinociception. MATERIALS AND METHODS LCEO as well as the pure oleanolic acid (OA) compound, were assayed for their effects on acute (formalin induced paw licking test or FIPT) and chronic (cervical contusion injury models on the fifth cervical vertebra or CCS; 14-day intervals) pain. The possible involvements of NO-cGMP-K+ channel, TRPV, dopamine, cannabinoid, PPAR, adrenergic, and opioid mechanisms in the antinociceptive activity of LCEO have studied by formalin test. The levels of p53 and inflammatory markers were measured using a streptavidin biotin immune peroxidase complex and ELISA methods, respectively. RESULTS The LCEO and OA exerted antinociceptive activity in the first-phase of FIPT. Pretreatment with antagonists of TRPV1, dopamine D2, cannabinoid type1 and 2, and NO-cGMP-K+ channel blockers (glibenclamide, L-NAME and methylene blue) attenuated the antinociceptive effect of LCEO in FIPT. In addition, LCEO and OA meaningfully reduced hyperalgesia (days 6-14) and mechanical allodynia (days 2-14) in the CCS model. LCEO suppressed the apoptotic marker (p53) in CCS model and also ameliorated IL-2, TNF-α, and IL-1 in the spinal cord. CONCLUSION Finally, LCEO inhibited acute (possibly via the modulation of opioid, TRPV, dopamine, cannabinoid mechanisms as well as NO-cGMP-K+ channel) and chronic pain (via suppressing apoptotic and inflammatory markers) in male rats. The results also suggest that OA has analgesic activity against acute and chronic pain conditions.
Collapse
Affiliation(s)
- Sajjad Jabbari
- Department of Biology, Faculty of Sciences, Islamic Azad University, Tehran North Branch, Tehran, Iran.
| | - Zainul Amiruddin Zakaria
- Borneo Research on Algesia, Inflammation and Neurodegeneration (BRAIN) Group, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia.
| | - Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Saeed Mohammadi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran.
| |
Collapse
|
50
|
Moore A, Tumin D. Overlap of pain-related and general measures of disability among adults with chronic pain. Pain Pract 2024; 24:62-71. [PMID: 37534395 DOI: 10.1111/papr.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/10/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE Chronic pain is known to be correlated with disability. We aimed to determine the overlap between a general self-reported measure of disability and a measure of disability due to pain problems among adults with chronic pain. MATERIALS AND METHODS We used data from the National Health Interview Survey (NHIS) and analyzed respondents with chronic pain in the past 3 months. General disability was defined as being limited in the kind or amount of work one can do due to any physical, mental, or emotional problem. Pain-related disability was defined as pain limiting one's activity on "most days" or "every day." RESULTS Based on a sample of 6874 respondents with chronic pain, 58% had either kind of disability, including 9% who reported only pain-related, but not general disability; and 27% who reported both types of disability. Respondents reporting only pain-related, but not general disability tended to be younger and had lower rates of obesity, smoking, diabetes, and hypertension than respondents reporting both pain-related and general disability. DISCUSSION Among people with chronic pain, most people with disability are experiencing limitations related to pain problems. Assessment of disability without addressing pain interference has likely underestimated the disability burden in this population.
Collapse
Affiliation(s)
- Ashley Moore
- Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA
| |
Collapse
|