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Vanneman MW, Kiwakyou LM, Harrison TK, Mariano ER. Heartfelt Healing: Charting New Trajectories in Postsurgical Pain. Anesth Analg 2024; 138:1187-1191. [PMID: 38771601 DOI: 10.1213/ane.0000000000006871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Matthew W Vanneman
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Larissa M Kiwakyou
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - T Kyle Harrison
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Department of Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Edward R Mariano
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Department of Anesthesiology, Perioperative and Pain Medicine Service, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
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Pagé MG, Ganty P, Wong D, Rao V, Khan J, Ladha K, Hanlon J, Miles S, Katznelson R, Wijeysundera D, Katz J, Clarke H. A Prospective Cohort Study of Acute Pain and In-Hospital Opioid Consumption After Cardiac Surgery: Associations With Psychological and Medical Factors and Chronic Postsurgical Pain. Anesth Analg 2024; 138:1192-1204. [PMID: 38295119 DOI: 10.1213/ane.0000000000006848] [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: 02/02/2024]
Abstract
BACKGROUND Understanding the association of acute pain intensity and opioid consumption after cardiac surgery with chronic postsurgical pain (CPSP) can facilitate implementation of personalized prevention measures to improve outcomes. The objectives were to (1) examine acute pain intensity and daily mg morphine equivalent dose (MME/day) trajectories after cardiac surgery, (2) identify factors associated with pain intensity and opioid consumption trajectories, and (3) assess whether pain intensity and opioid consumption trajectories are risk factors for CPSP. METHODS Prospective observational cohort study design conducted between August 2012 and June 2020 with 1-year follow-up. A total of 1115 adults undergoing cardiac surgery were recruited from the preoperative clinic. Of the 959 participants included in the analyses, 573 completed the 1-year follow-up. Main outcomes were pain intensity scores and MME/day consumption over the first 6 postoperative days (PODs) analyzed using latent growth mixture modeling (GMM). Secondary outcome was 12-month CPSP status. RESULTS Participants were mostly male (76%), with a mean age of 61 ± 13 years. Three distinct linear acute postoperative pain intensity trajectories were identified: "initially moderate pain intensity remaining moderate" (n = 62), "initially mild pain intensity remaining mild" (n = 221), and "initially moderate pain intensity decreasing to mild" (n = 251). Age, sex, emotional distress in response to bodily sensations, and sensitivity to pain traumatization were significantly associated with pain intensity trajectories. Three distinct opioid consumption trajectories were identified on the log MME/day: "initially high level of MME/day gradually decreasing" (n = 89), "initially low level of MME/day remaining low" (n = 108), and "initially moderate level of MME/day decreasing to low" (n = 329). Age and emotional distress in response to bodily sensations were associated with trajectory membership. Individuals in the "initially mild pain intensity remaining mild" trajectory were less likely than those in the "initially moderate pain intensity remaining moderate" trajectory to report CPSP (odds ratio [95% confidence interval, CI], 0.23 [0.06-0.88]). No significant associations were observed between opioid consumption trajectory membership and CPSP status (odds ratio [95% CI], 0.84 [0.28-2.54] and 0.95 [0.22-4.13]). CONCLUSIONS Those with moderate pain intensity right after surgery are more likely to develop CPSP suggesting that those patients should be flagged early on in their postoperative recovery to attempt to alter their trajectory and prevent CPSP. Emotional distress in response to bodily sensations is the only consistent modifiable factor associated with both pain and opioid trajectories.
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Affiliation(s)
- M Gabrielle Pagé
- From the Department of Anesthesiology and Pain Medicine, Faculty of Medicine
- Department of Psychology, Faculty of Arts and Sciences, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Praveen Ganty
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Dorothy Wong
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vivek Rao
- Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - James Khan
- Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Karim Ladha
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John Hanlon
- Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sarah Miles
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Lee S, Xue Y, Petricca J, Kremic L, Xiao MZX, Pivetta B, Ladha KS, Wijeysundera DN, Diep C. The impact of pre-operative depression on pain outcomes after major surgery: a systematic review and meta-analysis. Anaesthesia 2024; 79:423-434. [PMID: 38050423 DOI: 10.1111/anae.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Abstract
Symptoms of depression are common among patients before surgery. Depression may be associated with worse postoperative pain and other pain-related outcomes. This review aimed to characterise the impact of pre-operative depression on postoperative pain outcomes. We conducted a systematic review of observational studies that reported an association between pre-operative depression and pain outcomes after major surgery. Multilevel random effects meta-analyses were conducted to pool standardised mean differences and 95%CI for postoperative pain scores in patients with depression compared with those without depression, at different time intervals. A meta-analysis was performed for studies reporting change in pain scores from the pre-operative period to any time-point after surgery. Sixty studies (n = 501,962) were included in the overall review, of which 18 were eligible for meta-analysis. Pre-operative depression was associated with greater pain scores at < 72 h (standardised mean difference 0.97 (95%CI 0.37-1.56), p = 0.009, I2 = 41%; moderate certainty) and > 6 months (standardised mean difference 0.45 (95%CI 0.23-0.68), p < 0.001, I2 = 78%; low certainty) after surgery, but not at 3-6 months after surgery (standardised mean difference 0.54 (95%CI -0.06-1.15), p = 0.07, I2 = 83%; very low certainty). The change in pain scores from pre-operative baseline to 1-2 years after surgery was similar between patients with and without pre-operative depression (standardised mean difference 0.13 (95%CI -0.06-0.32), p = 0.15, I2 = 54%; very low certainty). Overall, pre-existing depression before surgery was associated with worse pain severity postoperatively. Our findings highlight the importance of incorporating psychological care into current postoperative pain management approaches in patients with depression.
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Affiliation(s)
- S Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J Petricca
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Kremic
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - B Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - K S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - D N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - C Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
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