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Masaud K, Galvin AD, De Loughry G, Meachair AO, Galea S, Shorten G. Preoperative psychological factors influence analgesic consumption and self-reported pain intensity following breast cancer surgery. BMC Anesthesiol 2024; 24:239. [PMID: 39014332 PMCID: PMC11250972 DOI: 10.1186/s12871-024-02622-6] [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: 03/08/2023] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Psychological factors such as anxiety and mood appear to influence acute postoperative pain; however, there is conflicting evidence on the relationship between preoperative psychological parameters and the severity of postoperative pain. In the context of the stressful setting of initial surgery for breast cancer, we conducted a prospective observational study of patients who were scheduled to undergo initial breast cancer surgery. METHODS The objectives were to examine the potential associations between predefined preoperative psychological parameters and (i) Self-reported pain scores at discharge from the postoperative acute care unit, (ii) Cumulative perioperative opioid consumption at four hours postoperatively and (iii) Self-reported pain as measured during the first seven days after surgery. Patients completed the following questionnaires during the three hours prior to surgery: the Spielberger State Trait Anxiety Inventory (STAI State and Trait), the Pain Catastrophizing Scale (PCS), the Cohen Stress Questionnaire (CSQ), the Hospital Anxiety and Depression Scale (HADS A and D), and the short-form McGill Pain Questionnaire. Postoperative pain experience was assessed using patient self-reports of pain (SF Magill Pain questionnaire on discharge from the postanaesthesia care unit and a pain diary for seven days postoperatively) and records of analgesic consumption. RESULTS Pre- to postoperative self-reported pain was significantly different with respect to the STAI State, Cohen score and PCS for both low and high values (p < 0.001), but only patients categorized as having low STAI Trait, HADS A, and HADS D values achieved significant differences (p < 0.001). A significant positive correlation was demonstrated between preoperative state anxiety (STAI) and the most severe pain reported during the first seven days postoperatively (r = 0.271, p = 0.013). Patients who were categorized preoperatively as having a "high value" for each of the psychological parameters studied (HADS A and D, STAI State and Trait and PCS) tended to have greater perioperative opioid consumption (up to four hours postoperatively); this trend was statistically significant for HADS D and HADS A only. Using a linear regression model, state anxiety was found to be a significant predictor of postoperative pain based on self-reports during the first seven postoperative days (standardized β = 0.271, t = 2.286, p = 0.025). CONCLUSION Preoperative state anxiety, in particular, is associated with the severity of postoperative pain experienced by women undergoing initial breast cancer surgery. Formal preoperative assessment of anxiety may be warranted in this setting with a view to optimize perioperative analgesia and wellbeing.
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Affiliation(s)
- Khaled Masaud
- Department of Anaesthesia, Cork University Hospital, Cork, Ireland.
- Department of Anaesthesia and Intensive Care Medicine, University College of Cork, Cork, Ireland.
| | - Audrey Dunn Galvin
- Department of Anaesthesia, School of Applied Psychology, University College Cork Ireland, University College Cork, Cork, Ireland
| | | | | | - Sarah Galea
- Department of Anaesthesia, Cork University Hospital, Cork, Ireland
| | - George Shorten
- Department of Anaesthesia, Cork University Hospital, Cork, Ireland
- Department of Anaesthesia and Intensive Care Medicine, University College of Cork, Cork, Ireland
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Vetterlein A, Plieger T, Monzel M, Hogeterp SA, Wagner L, Grünhage T, Felten A, Trautner P, Karneboge J, Reuter M. Neuronal activation patterns during self-referential pain imagination. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2024; 16:100158. [PMID: 39252991 PMCID: PMC11382119 DOI: 10.1016/j.ynpai.2024.100158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/04/2024] [Accepted: 07/22/2024] [Indexed: 09/11/2024]
Abstract
In clinical assessments and pain therapy, patients are asked to imagine themselves in pain. However, the underlying neuronal processes remain poorly understood. Prior research has focused on empathy for pain or reported small sample sizes. Thus, the present study aimed to promote the neurobiological understanding of self-referential pain imagination. We hypothesised to find activation contrasts (pain vs. no pain) across pain-related areas and expected two of the most prominent predictors of chronic pain, pain sensitivity (PS) and locus of control (LoC), to be moderators. In an fMRI study, N = 82 participants completed a pain imagination task, in which they were asked to imagine themselves in painful and non-painful situations presented in the form of pictures and texts. After each trial, they were instructed to give painfulness ratings. As a laboratory measure of PS, electrical pain thresholds were assessed. A questionnaire was completed to measure LoC. Across presentation modes we found activity contrasts in previously pain-related regions, such as the prefrontal, supplementary motor, primary motor, somatosensory and posterior parietal cortices, and the cerebellum. We found positive associations of PS and external LoC with painfulness ratings, and a negative correlation between PS and internal LoC. Despite our hypotheses, neither PS nor internal LoC were significant predictors of the BOLD-signal contrasts. Though future studies are needed to draw further conclusions, our results provide preliminary evidence of a potential neuronal imagination-perception overlap in pain.
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Affiliation(s)
| | - Thomas Plieger
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Merlin Monzel
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Lilli Wagner
- Department of Psychology, University of Bonn, Bonn, Germany
| | | | - Andrea Felten
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Peter Trautner
- Institute for Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany
- Core Facility Human 3T MRI, University of Bonn, Bonn, Germany
| | - Jana Karneboge
- Department of Psychology, University of Bonn, Bonn, Germany
| | - Martin Reuter
- Department of Psychology, University of Bonn, Bonn, Germany
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Angadi SP, Ramachandran K, Shetty AP, Kanna RM, Shanmuganathan R. Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery - a prospective observational study. Spine J 2023; 23:1306-1313. [PMID: 37220813 DOI: 10.1016/j.spinee.2023.05.010] [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: 01/17/2023] [Revised: 04/18/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND CONTENT The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSE The primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries. STUDY DESIGN Prospective, observational study. PATIENT SAMPLE Sixty patients requiring a single-level lumbar fusion surgery. OUTCOME MEASURES Postoperative pain intensity and the amount of postoperative analgesics consumption. METHODS In our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3. RESULTS The average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics. CONCLUSION Preoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.
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Affiliation(s)
- Sachin P Angadi
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Ajoy P Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India.
| | - Rishi M Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
| | - Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, 641043, Tamilnadu, India
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Dias P, Tavares I, Fonseca S, Pozza DH. Outcomes of a QST Protocol in Healthy Subjects and Chronic Pain Patients: A Controlled Clinical Trial. Biomedicines 2023; 11:biomedicines11041023. [PMID: 37189640 DOI: 10.3390/biomedicines11041023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Chronic pain is an important cause of disability with a high burden to society. Quantitative sensory testing (QST) is a noninvasive multimodal method used to discriminate the function of nerve fibers. The aim of this study is to propose a new, reproducible, and less time-consuming thermal QST protocol to help characterize and monitor pain. Additionally, this study also compared QST outcomes between healthy and chronic pain subjects. Forty healthy young/adult medical students and fifty adult/elderly chronic pain patients were evaluated in individual sessions including pain history, followed by QST assessments divided into three proposed tests: pain threshold, suprathreshold, and tonic pain. In the chronic pain group, a significantly higher pain threshold (hypoesthesia) and a higher pain sensibility (hyperalgesia) were demonstrated at threshold temperature when compared to healthy participants. The sensitivity to the suprathreshold and tonic stimulus did not prove to be significantly different between both groups. The main results demonstrated that the heat threshold QST tests can be helpful in evaluating hypoesthesia and that the sensitivity threshold temperature test can demonstrate hyperalgesia in individuals with chronic pain. In conclusion, this study demonstrates the importance of using tools such as QST as a complement to detect changes in several pain dimensions.
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Ji W, Sang C, Zhang X, Zhu K, Bo L. Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12162. [PMID: 36231463 PMCID: PMC9565184 DOI: 10.3390/ijerph191912162] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Research has shown that personality is associated with anxiety levels in the general population. However, little is known about the relationship between personality and preoperative anxiety and the subsequent health outcomes in patients undergoing surgery. Therefore, this review aimed to identify studies that explored the relationship between personality traits and preoperative anxiety, as well as their association with postoperative outcomes. Existing literature shows that anxiety may play an intermediary role in the relationship between personality and postoperative outcomes. Severe anxiety may partially explain the adverse effects of certain personality traits, such as neuroticism, on postoperative outcomes. However, the relationship between personality traits, preoperative anxiety, and postoperative outcomes remains unclear. Interventions such as clinical evaluation, preoperative counseling, and management strategies can be of great value in identifying and resolving patients' anxiety and negative emotions to improve postoperative outcomes.
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Affiliation(s)
- Wentao Ji
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Chao Sang
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Keming Zhu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Ibancos-Losada MDR, Osuna-Pérez MC, Cortés-Pérez I, Montoro-Cárdenas D, Díaz-Fernández Á. Validation and Cross-Cultural Adaptation of the Spanish Version of the Pain Sensitivity Questionnaire (PSQ-S). J Clin Med 2021; 11:jcm11010151. [PMID: 35011891 PMCID: PMC8745301 DOI: 10.3390/jcm11010151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 11/23/2022] Open
Abstract
Experimental pain testing requires specific equipment and may be uncomfortable for patients. The Pain Sensitivity Questionnaire (PSQ) was developed to assess pain sensitivity, based on the pain intensity ratings (range: 0–10) of painful situations that occur in daily life. The main objective of this study was to carry out a cross-cultural adaptation and validation of the Spanish version of the PSQ (PSQ-S). A total of 354 subjects (296 healthy and 58 chronic pain patients) filled in the PSQ-S. A subgroup of 116 subjects performed experimental pain testing, including two modalities (cold and pressure), with different measures: pain intensity rating, pressure pain threshold, and tolerance. The validation results showed two factors: PSQ-S-moderate and PSQ-S-minor and, for the total scale and the two factors, an excellent internal consistency (Cronbach’s alpha coefficient > 0.9) and a substantial reliability (Intraclass Correlation Coefficient > 0.8). We obtained strong correlations with all the experimental pain rating parameters, catastrophizing, and depression variables, as well as moderate correlations with anxiety, central sensibilization, and impact on the quality of life. Chronic pain patients received elevated PSQ-S scores compared to healthy controls, and three cut-off values (PSQ-S-total = 7.00, PSQ-S-moderate = 7.57, and PSQ-S-minor = 6.29) based on ROC curve analyses were shown to be able to discriminate between healthy adults and adults with chronic pain. Therefore, PSQ-S may be a simple alternative to experimental pain procedures for clinical and experimental pain research.
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Affiliation(s)
| | | | - Irene Cortés-Pérez
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain
- Granada Northeast Health District, Andalusian Health Service, Street San Miguel 2, 18500 Guadix, Spain
| | | | - Ángeles Díaz-Fernández
- Department of Health Sciences, University of Jaén, Campus Las Lagunillas s/n, 23071 Jaén, Spain
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Inal FY, Gul K, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain. J Int Med Res 2021; 49:3000605211060158. [PMID: 34855531 PMCID: PMC8646826 DOI: 10.1177/03000605211060158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The Pain Sensitivity Questionnaire (PSQ) is a clinically beneficial instrument that has been proven to be correlated with various experimental pain sensitivity assessments in healthy people and in patients with chronic pain. In this study, we aimed to translate the PSQ into Turkish (PSQ-T) and validate it for the measurement of pain sensitivity among Turkish people. Methods Seventy-three patients with chronic back pain who were planning to undergo an interventional procedure completed the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory (BDI), Beck Anxiety Inventory, Pain Catastrophizing Scale, and PSQ prior to their procedure. Subcutaneous infiltration of lidocaine was used as a standardized experimental pain stimulus. Pain was evaluated using a visual analog scale (VAS 1: infiltration in the hand, and VAS 2: infiltration in the procedure area) Results Scores on the PSQ-T were significantly correlated with those on the BPI-SF. A significant positive relationship was observed between VAS 1 and VAS 2 values and the PSQ-T score, BPI pain score, and BPI interference score. Conclusions The PSQ-T can be used as a valid and reliable tool for the assessment of pain sensitivity in the Turkish population.
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Affiliation(s)
- Ferda Yilmaz Inal
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34000, Turkey
| | - Kursat Gul
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34000, Turkey
| | - Yadigar Yilmaz Camgoz
- Clinic of Anaesthesiology and Reanimation, Sultan Abdülhamid Han Training and Research Hospital, Istanbul 34000, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34000, Turkey
| | - Hasan Kocoglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34000, Turkey
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Yilmaz Inal F, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography. Pain Ther 2021; 10:1283-1293. [PMID: 34292516 PMCID: PMC8586400 DOI: 10.1007/s40122-021-00292-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain. METHODS The present study includes 80 ASA 1-2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg-1 intravenous midazolam, 1 mg kg-1 lidocaine, 1 µ kg-1 fentanyl, and then a bolus dose of 1 mg kg-1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg-1 h-1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg-1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65-75, and the propofol infusion was halted once the BIS value dropped below 65. RESULTS STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T. CONCLUSION The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption. TRIAL REGISTRATION The study was registered with the number NCT03114735 on ClinicalTrials.gov.
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Affiliation(s)
- Ferda Yilmaz Inal
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722, Istanbul, Turkey.
| | - Yadigar Yilmaz Camgoz
- Clinic of Anaesthesiology and Reanimation, Sultan Abdülhamid Han Training and Research Hospital, Selimiye mh, Tıbbiye Cd, Uskudar, 34668 Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Iskender Pasa Mh, Adnan Menderes Blv., Fatih, 34093 Istanbul, Turkey
| | - Hasan Kocoglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722 Istanbul, Turkey
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Yaari L, Dolev A, Kittani M, Yassin M, Gbaren M, Feicht E, Haviv B. Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2021; 29:4198-4204. [PMID: 33704517 DOI: 10.1007/s00167-021-06438-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate correlations between preoperative pain sensitivity and postoperative analgesic consumption together with pain perception shortly after arthroscopic partial meniscectomy in non-arthritic knees. METHODS Ninety-nine patients who underwent primary arthroscopic meniscectomy were prospectively divided into three postoperative treatment groups that were prescribed with betamethasone injection (at the end of surgery), oral celecoxib or rescue analgesia (control). Preoperative pain sensitivity was evaluated by pain sensitivity questionnaires (PSQ). Patients were followed for the first three postoperative weeks to evaluate knee injury and osteoarthritis outcome score (KOOS) pain scores and analgesics consumption. Statistical analysis included correlations among preoperative pain sensitivity, postoperative pain levels and analgesics consumption. A receiver operating characteristic curve was plotted to investigate the cutoff values of the PSQ score to predict insufficient postoperative pain reduction. RESULTS There were no differences at baseline among all study groups in age, sex, BMI, level of activity, comorbidities and surgical findings. At the final follow-up, KOOS pain scores improved in all groups (p < 0.001). Mean final KOOS pain scores were 76.1 ± 15.2 for the betamethasone group, 70.8 ± 12.6 for the celecoxib group and 78.7 ± 11.6 for the control group. No differences in scores were observed among groups (n.s.). In the control group, a negative correlation was observed between PSQ score and KOOS-pain scores at the end of the follow-up in addition to a positive correlation between PSQ score and rescue analgesia consumption at the first postoperative week. The optimal cutoff value for PSQ score to predict insufficient improvement in KOOS-pain subscale was 5.0 points. CONCLUSIONS A cutoff value of pain sensitivity questionnaire score above 5.0 points was determined to identify patients with higher sensitivity to pain who underwent arthroscopic partial meniscectomy. These patients reported relatively increased pain and consumed more rescue analgesics postoperatively unless treated with a single intraoperative corticosteroids injection or oral non-steroidal anti-inflammatories. Therefore, surgeons can use pain sensitivity questionnaire score as a preoperative tool to identify patients with high sensitivity to pain and customize their postoperative analgesics protocol to better fit their pain levels. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Amir Dolev
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mohamed Kittani
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Mahmod Gbaren
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Elia Feicht
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Rabin Medical Center, Hasharon Hospital, 7 Keren Kayemet St, 49372, Petach-Tikva, Israel.
- Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
- Orthopedic Department, Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel.
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Fuchs X, Diers M, Trojan J, Kirsch P, Milde C, Bekrater-Bodmann R, Rance M, Foell J, Andoh J, Becker S, Flor H. Phantom limb pain after unilateral arm amputation is associated with decreased heat pain thresholds in the face. Eur J Pain 2021; 26:114-132. [PMID: 34288253 DOI: 10.1002/ejp.1842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The mechanisms underlying chronic phantom limb pain (PLP) are complex and insufficiently understood. Altered sensory thresholds are often associated with chronic pain but quantitative sensory testing (QST) in PLP has so far been inconclusive due to large methodological variation between studies and small sample sizes. METHODS In this study, we applied QST in 37 unilateral upper-limb amputees (23 with and 14 without PLP) and 19 healthy controls. We assessed heat pain (HPT), pressure pain, warmth detection and two-point discrimination thresholds at the residual limb, a homologous point and the thenar of the intact limb as well as both corners of the mouth. RESULTS We did not find significant differences in any of the thresholds between the groups. However, PLP intensity was negatively associated with HPT at all measured body sites except for the residual limb, indicating lower pain thresholds with higher PLP levels. Correlations between HPT and PLP were strongest in the contralateral face (r = -0.65, p < 0.001). Facial HPT were specifically associated with PLP, independent of residual limb pain (RLP) and various other covariates. HPT at the residual limb, however, were significantly associated with RLP, but not with PLP. CONCLUSION We conclude that the association between PLP and, especially facial, HPT could be related to central mechanisms. SIGNIFICANCE Phantom limb pain (PLP) is still poorly understood. We show that PLP intensity is associated with lower heat pain thresholds, especially in the face. This finding could be related to central nervous changes in PLP.
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Affiliation(s)
- Xaver Fuchs
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Biopsychology and Cognitive Neuroscience, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Martin Diers
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jörg Trojan
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Pinar Kirsch
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christopher Milde
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Robin Bekrater-Bodmann
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mariela Rance
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jens Foell
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jamila Andoh
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany
| | - Susanne Becker
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Integrative Spinal Research, Research Chiropractic, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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11
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Effect of Occipital Nerve Stimulation (ONS) on the Orbicularis Oculi Reflex Triggered by a Standardized Air Flow in Patients with Chronic Migraine-A Prospective, Randomized, Interventional Study. Pain Ther 2021; 10:567-576. [PMID: 33630252 PMCID: PMC8119542 DOI: 10.1007/s40122-021-00242-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Occipital nerve stimulation (ONS) is a specific form of peripheral neuromodulation used in the treatment of chronic pain disorders. A particular field of application is in the therapy of treatment-refractory headaches, especially of chronic migraine. The precise mode of action is unknown. It is presumed that central and peripheral sensitization are reduced in patients with chronic headache. The aim of this study was to examine the effect of ONS on pain-modulatory mechanisms in the trigeminocervical area in patients with chronic migraine. Methods In a balanced repeated measurements design in eight patients with chronic migraine with and without active ONS, we analyzed which effects ONS had on the orbicularis oculi reflex dynamically elicited by corneal air flow. Results The orbicularis oculi reflex in active ONS (7.38 ± 20.14 eyelid closures/minute) compared to inactive ONS (18.73 ± 14.30 eyelid closures/minute) is significantly reduced (p = 0.021). Conclusions The results show that under active ONS compared to inactive ONS in patients with chronic migraine, the orbicularis oculi reflex, dynamically triggered by a standardized air flow, is significantly reduced. This suggests that ONS is able to directly counteract the trigeminally mediated central sensitization in chronic migraine and protectively reduce the effects of aversive peripheral stimulation.
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Abstract
Purpose of Review We review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges. Recent Findings Predicting the occurrence of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic procedures. Summary Current evidence underlines the potential of preoperative QST to predict postoperative pain in patients undergoing elective surgery. Implementing QST in routine preoperative screening can help advancing traditional pain therapy toward personalized perioperative pain medicine.
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13
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Ramaswamy S, Wodehouse T. Conditioned pain modulation-A comprehensive review. Neurophysiol Clin 2020; 51:197-208. [PMID: 33334645 DOI: 10.1016/j.neucli.2020.11.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 01/05/2023] Open
Abstract
Conditioned pain modulation (CPM) is a centrally processed measure of the net effect of the descending pain pathway. This comprises both the facilitatory as well as the inhibitory effect. In the past, CPM or similar effects have been previously described using different terminologies such as diffuse noxious inhibitory control (DNIC), heterotopic noxious conditioning stimulation (HNCS) or endogenous analgesia (EA). A variety of patient-related factors such as age, gender, hormones, race, genetic and psychological factors have been thought to influence the CPM paradigms. CPM paradigms have also been associated with a wide range of methodological variables including the mode of application of the 'test' as well as the 'conditioning' stimuli. Despite all these variabilities, CPM seems to reliably lend itself to the pain modulation profile concept and could in future become one of the phenotypic biomarkers for pain and also a guide for mechanism-based treatment in chronic pain. Future research should focus on establishing consistent methodologies for measuring CPM and thereby enhancing the robustness of this emerging biomarker for pain.
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Affiliation(s)
- Shankar Ramaswamy
- 1St Bartholomew's Hospital, Bart's Health NHS Trust, London, EC1A 4AS, UK.
| | - Theresa Wodehouse
- 1St Bartholomew's Hospital, Bart's Health NHS Trust, London, EC1A 4AS, UK
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14
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Hood CO, Badour CL. The Effects of Posttraumatic Stress and Trauma-Focused Disclosure on Experimental Pain Sensitivity Among Trauma-Exposed Women. J Trauma Stress 2020; 33:1071-1081. [PMID: 32790962 PMCID: PMC7725999 DOI: 10.1002/jts.22571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 01/04/2023]
Abstract
Previous studies evaluating the impact of trauma history and posttraumatic stress disorder (PTSD) on pain sensitivity have yielded inconsistent findings. The presence of trauma-related negative affective states may account for these discrepancies. The current study aimed to evaluate the effect of PTSD and trauma-related negative affect on sensory, affective, physiological, and neuroendocrine responses to an experimental pain task. Trauma-exposed adult women (N = 87) with or without probable PTSD underwent an emotional disclosure paradigm during which they wrote about a traumatic event or a neutral topic. Participants then completed a pain induction procedure. Sensory and affective reports of pain, as well as physiological and neuroendocrine reactivity, were assessed. Compared to women without PTSD, those with PTSD demonstrated decreased sensory pain responses, ηp ² = .11, including increased time to pain detection (i.e., threshold) and ability to withstand the pain stimuli (i.e., tolerance) after accounting for relevant covariates. Women with PTSD also demonstrated increased cortisol reactivity following the pain stimulus, ηp ² = .06. The main and interactive effects of PTSD group and writing condition did not significantly predict alterations in affective reports of pain or heart rate reactivity. The results suggest that PTSD symptoms may contribute to alterations in pain sensitivity in trauma-exposed women, but this association is complex and requires further exploration.
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Affiliation(s)
- Caitlyn O. Hood
- Department of Psychology University of Kentucky Lexington Kentucky USA
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15
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Jung K, Park MH, Kim DK, Kim BJ. Prediction of Postoperative Pain and Opioid Consumption Using Intraoperative Surgical Pleth Index After Surgical Incision: An Observational Study. J Pain Res 2020; 13:2815-2824. [PMID: 33192089 PMCID: PMC7654540 DOI: 10.2147/jpr.s264101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background We evaluated whether the surgical pleth index (SPI) following surgical incision was related to postoperative pain and opioid consumption. Methods This prospective observational study was performed in 50 patients undergoing laparotomy under sevoflurane-based general anesthesia. We recorded the highest SPI during surgical incision. The postoperative pain with a numerical rating scale (NRS) and opioid consumption during postoperative 24 h were compared in patients who showed SPI over 50 (Group H) or 20–50 (Group L). The relationship between postoperative opioid consumption and SPI values (pre-incision, post-incision SPI value, change of SPI value, and post-incision SPI minus pre-incision SPI) was evaluated using receiver-operating characteristic analysis. Results The mean of the highest SPI value during surgical incision was 56 (SD, 12; range, 26–85). Twenty-nine (63%) patients were included in Group H and 17 (37%) patients in Group L. There was a significant difference in NRS during recovery room stay and on postoperative 24 h in two groups (5 [5, 6] vs 7 [6, 8], p=0.007 and 3.5 [3, 5] vs 5 [5,6], p=0.006, Group L vs Group H). Group H used higher fentanyl via patient control analgesia during postoperative 24 h (573 (253) µg vs 817 (305) µg, p=0.008). A change of pre-incision and post-incision SPI value of 23, which showed the highest sensitivity (67%) and specificity (68%), was defined post hoc as the cut-off for fentanyl consumption during postoperative 24 h ≥1000 µg. Conclusion Our finding suggests that the SPI response to nociceptive stimuli during surgery is closely related to the degree of patient postoperative pain and opioid requirements. This information may be used to provide proper intraoperative analgesia and individual postoperative pain management.
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Affiliation(s)
- Kangha Jung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Hye Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Jun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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16
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Wodehouse T, Bahra A, Mehta V. Changes in peripheral and central sensitization in patients undergoing occipital nerve stimulation. Br J Pain 2020; 14:250-255. [PMID: 33194189 DOI: 10.1177/2049463719860548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Central sensitization and impaired conditioned pain modulation (CPM) response have been reported to contribute to migraine progression. Migraine patients can present with allodynia possibly attributed to increased sensitivity of peripheral ends of nociceptors with both peripheral and central sensitization. Occipital nerve stimulation (ONS) works by stimulating the distal branches of C1, C2 and C3 possibly altering the nociceptive traffic to the trigemino-cervical complex, brainstem and supranuclear connections. Aims This observational study explores peripheral and central sensitization in patients undergoing percutaneous ONS. Methods Following local regulatory approval, 13 patients undergoing ONS with dual Octrode 90 cm leads and rechargeable implantable pulse generator (IPG) (St Jude) were recruited to have quantitative sensory testing (QST) pre- and post-procedure 2 weeks, 1, 3, 6 and 12 months. Results Patients with intractable migraine demonstrated impaired CPM (mean baseline pressure pain thresholds (PPTs): 61.98 kPa vs 48.01 kPa cuff inflated) prior to ONS, reverting to an efficient CPM response within 2 weeks following ONS implant (68.9 kPa vs 104.5 kPa cuff inflated) and continuing positively over the next 12 months. In contrast, no statistical difference was observed in PPTs. Conclusion This is the first reported observation highlighting the effects on central sensitization following ONS. A consistent and sustained improvement in CPM was observed in contrast to PPT's where there was no difference. Normalisation of the CPM response following ONS indicates that the treatment may reduce central sensitization in the migraine population.
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Affiliation(s)
- Theresa Wodehouse
- Barts Neuromodulation Unit & Pain and Anaesthesia Research Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anish Bahra
- Barts Neuromodulation Unit & Pain and Anaesthesia Research Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Vivek Mehta
- Barts Neuromodulation Unit & Pain and Anaesthesia Research Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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17
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Abstract
This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.
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18
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Kuperman P, Granovsky Y, Bahouth H, Fadel S, Ben Lulu H, Bosak N, Buxbaum C, Sprecher E, Crystal S, Granot M. Explaining very early acute mild traumatic brain injury after motor vehicle collision pain variability: additive value of pain sensitivity questionnaire. Pain Rep 2020; 5:e821. [PMID: 32903910 PMCID: PMC7447377 DOI: 10.1097/pr9.0000000000000821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic pain is a common postcollision consequence. Wherein, a clearer understanding of acute pain can help stem the acute-to-chronic pain transition. However, the variability of acute pain is only partially explained by psychophysical pain characteristics as measured by quantitative sensory testing. The Pain Sensitivity Questionnaire (PSQ) may reflect inherent psychocognitive representations of patient's sensitivity and thus may reveal less-explored pain dimensions. In the vein of the biopsychosocial approach, this study aimed to explore whether PSQ holds additive value in explaining head and neck pain reports in very early acute-stage mild traumatic brain injury (mTBI) after collision, above the use of psychophysical assessment. METHODS Study cohort (n = 130) consisted of mTBI patients (age range 19-66, 57 F) after accident with area-of-injury pain of at least 20 on the day of testing (mean pain 58.4 ± 21.6, range 20-100 Numerical Pain Scale) who underwent clinical, psychophysical, and pain-related psychological assessment within 72-hour after injury. RESULTS Pain Sensitivity Questionnaire scores were significantly correlated with acute clinical, psychophysical, and pain-related psychological measures. Regression model (R 2 = 0.241, P < 0.001) showed that, together, age, sex, high PSQ, enhanced temporal summation, and less-efficient conditioned pain modulation explained head and neck pain variance. This model demonstrated that the strongest contribution to degree of postinjury pain was independently explained by PSQ (ß = 0.32) and then pressure pain threshold-conditioned pain modulation (ß = -0.25). CONCLUSION Appraisal of cognitive daily-pain representations, by way of memory and imagination, provides an additional important dispositional facet to explain the variability in the acute mTBI postcollision clinical pain experience, above assessing nociceptive responsiveness to experimentally induced pain.
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Affiliation(s)
- Pora Kuperman
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Yelena Granovsky
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Hany Bahouth
- Trauma and Emergency Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Shiri Fadel
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Hen Ben Lulu
- Trauma and Emergency Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Noam Bosak
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Chen Buxbaum
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Shoshana Crystal
- Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Michal Granot
- Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel
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19
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Masgoret P, de Soto I, Caballero Á, Ríos J, Gomar C. Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy: A prospective, observational investigation. Medicine (Baltimore) 2020; 99:e19101. [PMID: 32176037 PMCID: PMC7440329 DOI: 10.1097/md.0000000000019101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.
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Affiliation(s)
- Paula Masgoret
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - Inés de Soto
- Department of Anesthesiology, Consorci Sanitari Parc Taulí de Sabadell
| | - Ángel Caballero
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
| | - José Ríos
- Laboratory of Biostatistics and Epidemiology, Universitat Autonoma de Barcelona, Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Carmen Gomar
- Department of Anesthesiology, Hospital Clinic, University of Barcelona
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20
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Personalized analgesic management for cesarean delivery. Int J Obstet Anesth 2019; 40:91-100. [DOI: 10.1016/j.ijoa.2019.02.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/04/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023]
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21
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Gamez BH, Habib AS. Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review. Anesth Analg 2019; 126:1606-1614. [PMID: 29210789 DOI: 10.1213/ane.0000000000002658] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice.
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Affiliation(s)
- Brock H Gamez
- From the Department of Anesthesiology, Division of Women's Anesthesia, Duke University School of Medicine, Durham, North Carolina
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22
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Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth 2019; 40:78-90. [PMID: 31281032 DOI: 10.1016/j.ijoa.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 05/01/2019] [Accepted: 06/03/2019] [Indexed: 01/22/2023]
Abstract
The incidence of persistent pain after cesarean deliveries (CD) varies but is much lower than after comparable surgeries. However, with over four million deliveries annually and a rising CD rate, even a low prevalence of persistent pain after CD impacts many otherwise healthy young women. Consideration of the pathophysiology of persistent pain after surgery and the risk factors predisposing women to persistent and chronic pain after CD provides insights into the prevention and treatment of persistent pain; and improves the quality of care and recovery after CD. The findings that the peripartum state and oxytocin confer protection against persistent pain may provide new and interesting perspectives for the prevention and treatment of chronic pain caused by trauma or surgery. Predictive tools available to identify and target patients at high risk of acute and chronic pain have mostly weak to modest predictive correlations and many are either not clinically feasible or too time-consuming to apply. Persistent pain has been linked to the severity of acute postoperative pain and opioid exposure. Modified surgical techniques, neuraxial anesthesia and opioid-sparing analgesia may help limit the development of persistent and chronic pain. The goal of this narrative review is to examine the incidence of persistent pain after CD; review briefly the underlying pathophysiology of persistent pain and the transition from acute to chronic pain (with particular emphasis on the uniqueness after CD); and to review modifiable risk factors and prevention strategies that identify at-risk patients and allow tailored treatment.
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Affiliation(s)
- K W Sun
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - P H Pan
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Short- and long-term impact of remifentanil on thermal detection and pain thresholds after cardiac surgery: A randomised controlled trial. Eur J Anaesthesiol 2019; 36:32-39. [PMID: 30211725 PMCID: PMC6286874 DOI: 10.1097/eja.0000000000000887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The clinical relevance of the suggested hyperalgesic effects of remifentanil is still unclear, especially in the long term. OBJECTIVE The current study evaluated the impact of remifentanil on thermal thresholds 3 days and 12 months after surgery, measured with Quantitative Sensory Testing. DESIGN A single-blind, randomised controlled trial. SETTING A tertiary care teaching hospital in The Netherlands, from 2014 to 2016. PATIENTS A total of 126 patients aged between 18 and 85 years, undergoing cardiothoracic surgery via sternotomy (coronary artery bypass grafts and/or valve replacement) were included. Exclusion criteria were BMI above 35 kg m, history of cardiac surgery, chronic pain conditions, neurological conditions, allergy to opioids or paracetamol, language barrier and pregnancy. INTERVENTIONS Patients were allocated randomly to receive intra-operatively either a continuous remifentanil infusion or intermittent intra-operative fentanyl as needed in addition to standardised anaesthesia with propofol and intermittent intravenous fentanyl at predetermined time points. MAIN OUTCOME MEASURES Warm and cold detection and pain thresholds 3 days and 12 months after surgery. In addition the use of remifentanil, presence of postoperative chronic pain, age, opioid consumption and pre-operative quality of life were tested as a predictor for altered pain sensitivity 12 months after surgery. RESULTS Both warm and cold detection, and pain thresholds, were not significantly different between the remifentanil and fentanyl groups 3 days and 12 months after surgery (P > 0.05). No significant predictors for altered pain sensitivity were identified. CONCLUSION Earlier reports of increased pain sensitivity 1 year after the use of remifentanil could not be confirmed in this randomised study using Quantitative Sensory Testing. This indicates that remifentanil plays a minor role in the development of chronic thoracic pain. Still, the relatively high incidence of chronic thoracic pain and its accompanying impact on quality of life remain challenging problems. TRIAL REGISTRATION The study was registered at EudraCT (ref: 2013-000201-23) and ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02031016).
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Latka D, Miekisiak G, Kozlowska K, Olbrycht T, Chowaniec J, Latka K, Niedzwiecki M, Ruscheweyh R, Jarmuzek P. Translation, validation, and cross-cultural adaptation of the Polish version of the pain sensitivity questionnaire. J Pain Res 2019; 12:969-973. [PMID: 30936737 PMCID: PMC6421867 DOI: 10.2147/jpr.s189427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The purpose of this study was to provide a translation, cross-cultural adaptation, and validation of the Polish language version of the pain sensitivity questionnaire (PSQ). The process followed widely accepted guidelines. Methods The translated questionnaire underwent thorough psychometric testing. In total, the data of 144 subjects (mean age 52.53±13 years), who underwent evaluation for lower back pain, were included. Results The exploratory factor analysis revealed a two-factor structure, PSQ-moderate and PSQ-minor. The internal consistency was good (Cronbach’s α was 0.96). There was a fair and significant correlation between the results of the PSQ and the coping strategy questionnaire (CSQ; Spearman’s rho was 0.27). The test-retest reliability was favorable, and the intraclass correlation coefficient (ICC) for the CSQ total was 0.93 with a mean interval of 9.04 days between administrations. Conclusion Our results show that the Polish version of the PSQ is valid and can be recommended for Polish-speaking patients.
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Affiliation(s)
- Dariusz Latka
- Department of Anatomy, Institute of Medicine, University of Opole, Opole, Poland, .,Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Grzegorz Miekisiak
- Department of Anatomy, Institute of Medicine, University of Opole, Opole, Poland, .,Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Klaudia Kozlowska
- Department of Bioengineering, Institute of Biomedical Engineering, Technical University of Wroclaw, Wroclaw, Poland
| | - Tomasz Olbrycht
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Jacek Chowaniec
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Kajetan Latka
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | | | - Ruth Ruscheweyh
- Department of Neurology, University of Munich, Munich, Germany
| | - Paweł Jarmuzek
- Department of Neurosurgery, University Hospital, Zielona Gora, Poland
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Carvalho B, Sutton CD, Kowalczyk JJ, Flood PD. Impact of patient choice for different postcesarean delivery analgesic protocols on opioid consumption: a randomized prospective clinical trial. Reg Anesth Pain Med 2019; 44:578-585. [PMID: 30867278 DOI: 10.1136/rapm-2018-100206] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/23/2019] [Accepted: 02/01/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Choice of postcesarean delivery analgesic protocol may improve pain experience and reduce analgesic requirements. METHODS Cesarean delivery patients were randomly assigned either to choose their postcesarean delivery analgesia protocol or to have no choice and receive routine care. Choices were low (50 μg intrathecal morphine), medium (identical to routine care: 150 μg intrathecal morphine), or high (300 μg intrathecal morphine with 600 mg oral gabapentin). All groups received scheduled acetaminophen and ibuprofen. The primary outcome was oxycodone requirements 0-48 hours postdelivery in those offered versus not offered a choice. RESULTS Of 160 women enrolled, 120 were offered a choice and 40 were not offered a choice. There was no difference in oxycodone requirements or pain associated with choice, but those who had a choice expressed more satisfaction than those who did not have a choice (mean (95% CI) difference 5% (0% to 10 %), p=0.005). In the choice group, the high dose group required more oxycodone (5 (0 to 15) mg 0-24 hours after delivery and 15 (10 to 25) mg at 24-48 hours; p=0.05 and p=0.001) versus the low and medium groups. The low dose group had less pruritus (p=0.001), while the high dose group had more vomiting (p=0.01) requiring antiemetic treatment (p=0.04). CONCLUSION Having a choice compared with no choice routine care did not reduce oxycodone requirements or pain scores. However, women have insight into their analgesic needs; women offered a choice and who chose the higher dose analgesic protocol required more oxycodone, and women who chose the lower dose protocol required less oxycodone. Despite providing additional analgesic (six times more intrathecal morphine plus gabapentin in high dose vs low dose protocols), we still did not equalize postcesarean oxycodone requirement differences between groups. TRIAL REGISTRATION NUMBER NCT02605187.
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Affiliation(s)
- Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - John J Kowalczyk
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Dru Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Carvalho B, Mirza F, Flood P. Patient choice compared with no choice of intrathecal morphine dose for caesarean analgesia: a randomized clinical trial. Br J Anaesth 2018; 118:762-771. [PMID: 28486595 DOI: 10.1093/bja/aex039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The study aimed to determine whether a patient's choice for their intrathecal morphine (ITM) dose reflects their opioid requirements and pain after caesarean delivery and if giving women a choice of ITM dose would reduce opioid use and improve pain scores compared with women who did not have a choice. Methods A total of 120 women undergoing caesarean delivery with spinal anaesthesia were enrolled in this randomized, double-blind study. Patients were randomly assigned to a choice of 100 or 200 μg ITM or no choice. The study involved deception, such that all participants were still randomly assigned 100 or 200 μg ITM regardless of choice. Rescue opioid use over the 48-h study period was the primary outcome measure. Pain at rest and movement and side effect (pruritus, nausea, and vomiting) data were collected 3, 6, 12, 24, 36 and 48 h postoperatively. Data are presented as median [95% confidence interval (CI)]. Results Women who requested the larger ITM dose required more supplemental opioid [median 0.8 (95% CI 0.4-1.3)] mg morphine equivalents at each assessment interval; P < 0.001] and reported more pain with movement [median 1.2 (95% CI 0.5-1.9)] verbal numerical rating score of 0-10 points] than patients who requested the smaller ITM dose ( P = 0.0008), regardless of the ITM dose given. There was no difference in opioid use whether the patient was offered a perceived choice or not. Conclusions Women who were given a choice and chose the larger ITM dose correctly anticipated a greater postoperative opioid requirement and more pain compared with women who chose the smaller dose. Simply being offered a choice did not impact opioid use or pain scores after caesarean delivery. Trial Registration ClinicalTrials.gov (NCT01425762).
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Affiliation(s)
- B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - F Mirza
- Department of Anesthesiology, Santa Rosa Hospital, Santa Rosa, CA, USA
| | - P Flood
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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van Helmond N, Olesen SS, Wilder-Smith OH, Drewes AM, Steegers MA, Vissers KC. Predicting Persistent Pain After Surgery. Anesth Analg 2018; 127:1264-1267. [DOI: 10.1213/ane.0000000000003318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ramaswamy S, Wodehouse T, Langford R, Thomson S, Taylor R, Mehta V. Characterizing the Somatosensory Profile of Patients With Failed Back Surgery Syndrome With Unilateral Lumbar Radiculopathy Undergoing Spinal Cord Stimulation: A Single Center Prospective Pilot Study. Neuromodulation 2018; 22:333-340. [DOI: 10.1111/ner.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/25/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Richard Langford
- Pain and Anaesthesia Research CentreBarts Health NHS TrustLondonUK
| | - Simon Thomson
- Basildon and Thurrock University HospitalsBasildonUK
| | - Rod Taylor
- South CloistersUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Vivek Mehta
- Pain and Anaesthesia Research CentreBarts Health NHS TrustLondonUK
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Miller VE, Poole C, Golightly Y, Barrett D, Chen DG, Ohrbach R, Greenspan JD, Fillingim RB, Slade GD. Characteristics Associated With High-Impact Pain in People With Temporomandibular Disorder: A Cross-Sectional Study. THE JOURNAL OF PAIN 2018; 20:288-300. [PMID: 30292793 DOI: 10.1016/j.jpain.2018.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/16/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
High-impact (disabling) pain diminishes the quality of life and increases health care costs. The purpose of this study was to identify the variables that distinguish between high- and low-impact pain among individuals with painful temporomandibular disorder (TMD). Community-dwelling adults (N = 846) with chronic TMD completed standardized questionnaires that assessed the following: 1) sociodemographic characteristics, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high-impact pain, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate the contribution of variables from each domain. Cross-validated area under the receiver operating characteristic curve (AUC) quantified model discrimination. One-third of the participants had high-impact pain. Sociodemographic variables discriminated weakly between low- and high-impact pain (AUC = .61, 95% confidence interval [CI] = 0.57, 0.65), with the exception of race. An 18-variable model encompassing all 4 domains had good discrimination (AUC = 0.79, 95% CI = 0.75, 0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites) (AUC = 0.79, 95% CI = 0.76, 0.82). Duration of pain, sex, and experimental pain testing results were not associated. The characteristics that discriminated most effectively between people with low- and high-impact TMD pain included clinical pain features and the ability to cope with pain. PERSPECTIVE: This article presents the results of a multivariable model designed to discriminate between people with high- and low-impact pain in a community-based sample of people with painful chronic TMD. The findings emphasize the importance of catastrophizing, jaw limitation, and painful body sites associated with pain-related impact.
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Affiliation(s)
- Vanessa E Miller
- Program on Integrative Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah Barrett
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ding-Geng Chen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York
| | - Joel D Greenspan
- Department of Neural and Pain Sciences, University of Maryland, Baltimore, Maryland
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Gary D Slade
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Dental Ecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Pain Research and Innovation, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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30
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Persson AKM, Åkeson J. Prediction of Acute Postoperative Pain from Assessment of Pain Associated With Venous Cannulation. Pain Pract 2018; 19:158-167. [PMID: 30269418 DOI: 10.1111/papr.12729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/02/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND It has previously been reported that venous cannulation-induced pain (VCP) can be used to predict acute postoperative pain after laparoscopic cholecystectomy. Patients rating VCP at ≥2.0 VAS units had 3.4 times higher risk for moderate or severe pain. The purpose of this study was to evaluate if VCP scores of ≥2.0 VAS units are associated with higher risk for acute postoperative pain after various common surgical procedures. METHODS In a prospective clinical observational study, 600 male and female 18- to 80-year-old patients scheduled for elective surgery were included. The primary outcome measure was the difference in maximum postoperative pain intensity between low responders (VCP < 2.0) and high responders (VCP ≥ 2.0) to VCP. Secondary outcome measures were the difference in proportion of patients with moderate or severe postoperative pain between low and high responders, and potential influence of age, gender, and preoperative habitual pain. RESULTS Patients scoring VCP ≥2.0 VAS units reported higher acute postoperative pain intensity levels than those scoring VCP <2.0 VAS units (median 3.0 [interquartile range 0.0 to 5.0] vs. 0.2 [interquartile range 0.0 to 4.0], P = 0.001), and also had 1.7 times higher risk for moderate or severe postoperative pain (P = 0.005). Moderate or severe postoperative pain was reported by 38% of patients with VCP scores of ≥2.0 VAS units and by 26% with VCP scores of <2.0 VAS units (P = 0.005). CONCLUSION Scoring of VCP intensity before surgery, requiring no specific equipment or training, is useful to predict individual risks for moderate or severe postoperative pain, regardless of patient age or gender, in a setting involving different kinds of surgery.
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Affiliation(s)
- Anna K M Persson
- Department of Clinical Sciences Malmo, Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.,Department of Anesthesiology and Intensive Care Medicine, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences Malmo, Anesthesiology and Intensive Care Medicine, Skåne University Hospital, Lund University, Malmö, Sweden
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Sankarasubramanian V, Harte SE, Chiravuri S, Harris RE, Brummett CM, Patil PG, Clauw DJ, Lempka SF. Objective Measures to Characterize the Physiological Effects of Spinal Cord Stimulation in Neuropathic Pain: A Literature Review. Neuromodulation 2018; 22:127-148. [PMID: 30246905 DOI: 10.1111/ner.12804] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The physiological mechanisms behind the therapeutic effects of spinal cord stimulation (SCS) are only partially understood. Our aim was to perform a literature review of studies that used objective measures to characterize mechanisms of action of SCS in neuropathic pain patients. MATERIALS AND METHODS We searched the PubMed data base to identify clinical studies that used objective measures to assess the effects of SCS in neuropathic pain. We extracted the study factors (e.g., type of measure, diagnoses, painful area[s], and SCS parameters) and outcomes from the included studies. RESULTS We included 67 studies. Of these, 24 studies used neurophysiological measures, 14 studies used functional neuroimaging techniques, three studies used a combination of neurophysiological and functional neuroimaging techniques, 14 studies used quantitative sensory testing, and 12 studies used proteomic, vascular, and/or pedometric measures. Our findings suggest that SCS largely inhibits somatosensory processing and/or spinal nociceptive activity. Our findings also suggest that SCS modulates activity across specific regions of the central nervous system that play a prominent role in the sensory and emotional functions of pain. CONCLUSIONS SCS appears to modulate pain via spinal and/or supraspinal mechanisms of action (e.g., pain gating, descending pain inhibition). However, to better understand the mechanisms of action of SCS, we believe that it is necessary to carry out systematic, controlled, and well-powered studies using objective patient measures. To optimize the clinical effectiveness of SCS for neuropathic pain, we also believe that it is necessary to develop and implement patient-specific approaches.
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Affiliation(s)
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Srinivas Chiravuri
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.,Biointerfaces Institute, University of Michigan, Ann Arbor, MI, USA
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Wodehouse T, Poply K, Ramaswamy S, Snidvongs S, Bourke J, Tahir H, Ullrich K, Mehta V. A pilot study investigating whether quantitative sensory testing alters after treatment in patients with fibromyalgia. Br J Pain 2018; 12:250-256. [PMID: 30349699 DOI: 10.1177/2049463718776336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Fibromyalgia is a chronic musculoskeletal pain condition that is often associated with sleep disturbances and fatigue. The pathophysiology of fibromyalgia is not understood, but indirect evidence suggests a central dysfunction of the nociceptive modulating system. The aim of this study was to evaluate whether quantitative sensory testing detects a change in pain thresholds in fibromyalgia patient receiving pregabalin treatment. Methods A total of 25 patients were recruited for the study and received routine pregabalin, but only 14 patients completed the treatment. Assessment of pressure pain thresholds and changes in conditioned pain modulation using ischaemic pain as a conditioning stimulus were measured at baseline and every 4 weeks for 12 weeks. Fibromyalgia impact questionnaire, PainDETECT and SF-12 were also completed. Results Patients with fibromyalgia demonstrated a less-efficient conditioned pain modulation at baseline. An efficient conditioned pain modulation was observed at 1 month and this was maintained until the final visit. Pressure pain thresholds (PPTs) showed a significant improvement from baseline. Patients also reported a similar magnitude of improvements in PainDETECT, fibromyalgia impact questionnaire (FIQ) and its impact on daily life and change in outcome for SF-12. Conclusion This pilot study reports an increase in PPTs and improved conditioned pain modulation response after commencing pregabalin, which was maintained at 12 weeks, and this was supported by positive pain scores. Pregabalin is a licenced treatment for fibromyalgia in Europe, and its response to central sensitisation, particularly 'dynamic responses', has not been reported. We conclude that pregabalin has the potential to reduce peripheral and central sensitisation in patients with fibromyalgia, as measured using quantitative sensory testing.
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Affiliation(s)
- Theresa Wodehouse
- Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK
| | - Kavita Poply
- Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK
| | - Shankar Ramaswamy
- Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK
| | - Saowarat Snidvongs
- Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK
| | - Julius Bourke
- Centre for Psychiatry, Barts Health NHS Trust, London, UK
| | - Hasan Tahir
- Rheumatology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Kristin Ullrich
- Anaesthetic and Pain Management Department, Barts Health NHS Trust, London, UK
| | - Vivek Mehta
- Pain and Anaesthesia Research Centre, Barts Health NHS Trust, London, UK
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Kim DH, Roh GU, Lee YB, Choi CI, Lee JM, Chae YJ. Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial. Ther Clin Risk Manag 2018; 14:189-194. [PMID: 29416346 PMCID: PMC5790080 DOI: 10.2147/tcrm.s154264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA. Methods A total of 40 patients were enrolled in this study. During anesthesia induction, the withdrawal reaction after loss of consciousness following rocuronium injection was assessed using a 4-point scale. After surgery, EA was assessed using the Watcha scale. Results There was a correlation between withdrawal reaction and EA on admission to the postanesthesia care unit (PACU). Patients with a severe withdrawal reaction (grade 3) showed a significantly higher incidence of severe EA requiring medication on admission to the PACU. Conclusion The findings of this preliminary exploratory observational study suggest that it is possible for withdrawal movement following rocuronium injection during anesthesia induction to reflect pain sensitivity of pediatric patients, which in turn may be useful in identifying those at risk of severe EA on admission to the PACU among preschool children undergoing inguinal herniorrhaphy. Further studies with a larger sample size are required to validate these findings. The exact correlation between pain reaction following rocuronium injection and postoperative pain or pain-related phenomenon should be elucidated.
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Affiliation(s)
- Dae Hee Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
| | - Go Un Roh
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, Seongnam
| | - Young Bok Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chang Ik Choi
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Moon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon
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Arendt‐Nielsen L, Morlion B, Perrot S, Dahan A, Dickenson A, Kress H, Wells C, Bouhassira D, Drewes AM. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018; 22:216-241. [DOI: 10.1002/ejp.1140] [Citation(s) in RCA: 390] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
AbstractDifferent neuroplastic processes can occur along the nociceptive pathways and may be important in the transition from acute to chronic pain and for diagnosis and development of optimal management strategies. The neuroplastic processes may result in gain (sensitisation) or loss (desensitisation) of function in relation to the incoming nociceptive signals. Such processes play important roles in chronic pain, and although the clinical manifestations differ across condition processes, they share some common mechanistic features. The fundamental understanding and quantitative assessment of particularly some of the central sensitisation mechanisms can be translated from preclinical studies into the clinic. The clinical perspectives are implementation of such novel information into diagnostics, mechanistic phenotyping, prevention, personalised treatment, and drug development. The aims of this paper are to introduce and discuss (1) some common fundamental central pain mechanisms, (2) how they may translate into the clinical signs and symptoms across different chronic pain conditions, (3) how to evaluate gain and loss of function using quantitative pain assessment tools, and (4) the implications for optimising prevention and management of pain. The chronic pain conditions selected for the paper are neuropathic pain in general, musculoskeletal pain (chronic low back pain and osteoarthritic pain in particular), and visceral pain (irritable bowel syndrome in particular). The translational mechanisms addressed are local and widespread sensitisation, central summation, and descending pain modulation.SignificanceCentral sensitisation is an important manifestation involved in many different chronic pain conditions. Central sensitisation can be different to assess and evaluate as the manifestations vary from pain condition to pain condition. Understanding central sensitisation may promote better profiling and diagnosis of pain patients and development of new regimes for mechanism based therapy. Some of the mechanisms underlying central sensitisation can be translated from animals to humans providing new options in development of therapies and profiling drugs under development.
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Affiliation(s)
| | - B. Morlion
- The Leuven Centre for Algology University Hospitals Leuven University of Leuven Belgium
| | - S. Perrot
- INSERM U987 Pain Center Cochin Hospital Paris Descartes University Paris France
| | - A. Dahan
- Department of Anesthesiology Leiden University Medical Center Leiden The Netherlands
| | - A. Dickenson
- Neuroscience Physiology & Pharmacology University College London UK
| | - H.G. Kress
- Department of Special Anaesthesia and Pain Therapy Medizinische Universität/AKH Wien Vienna Austria
| | | | - D. Bouhassira
- INSERM U987 Centre d'Evaluation et de Traitement de la Douleur Hôpital Ambroise Paré Boulogne Billancourt France
| | - A. Mohr Drewes
- Mech‐Sense Department of Gastroenterology and Hepatology Clinical Institute Aalborg University Hospital Aalborg Denmark
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Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients. Knee Surg Sports Traumatol Arthrosc 2017; 25:3417-3423. [PMID: 27329175 DOI: 10.1007/s00167-016-4201-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/07/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate the effects of kinesiophobia on the outcomes of total knee arthroplasty (TKA), and to investigate whether kinesiophobia represents an independent factor influencing the surgery success or whether the observed effects are driven by other physical or psychological aspects such as anxiety and depression. METHODS Two hundred patients were evaluated prospectively (mean age 65.7 ± 9.1 years, 134 women and 66 men) at 12 months after TKA. Kinesiophobia was assessed with the Tampa Scale for kinesiophobia (TSK: Activity Avoidance-TSK1 and Harm-TSK2 subscales); anxiety and depression were assessed with STAI and BDI, respectively, and preoperative pain and function, sex, age, BMI, education level, number of painful joints and years of symptoms' duration before surgery were documented as well. Results were evaluated with pain and function on 0-10 numeric rating scales, while the overall clinical outcome was documented with WOMAC and SF-12 (Physical and Mental subscales) scores. RESULTS TSK1 was correlated with WOMAC results at 12 months (p = 0.005, ρ = 0.197). STAI (p = 0.002, ρ = 0.222), BDI (p < 0.0005, ρ = 0.307), and sex (p = 0.004) also influenced the outcome after TKA, while other parameters, such as age, BMI, education level, and number of painful joints and years of symptoms' duration before surgery, did not correlate with the clinical outcome. The multivariate analysis confirmed the role of BDI (p = 0.006, partial η 2 = 0.038), TSK1 (p = 0.011, partial η 2 = 0.033), and sex (p = 0.048, partial η 2 = 0.020), and a synergic interaction of BDI and TSK1, which together presented an even stronger correlation (p < 0.0005, partial η 2 = 0.111) with WOMAC at 12-month follow-up. CONCLUSIONS Kinesiophobia is a factor influencing the outcome after TKA independently from other psychological and physical variables. This risk factor may affect TKA results, especially in women, and shows a further synergic interaction with depression in terms of lower surgical outcome. These findings are of clinical relevance because they show the impact of psychological factors such as kinesiophobia, and suggest the possibility of adopting co-interventions to overcome the fear of physical activity, and in the end improve patient recovery and final outcome after TKA. LEVEL OF EVIDENCE IV.
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Mehta V, Snidvongs S, Ghai B, Langford R, Wodehouse T. Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: a prospective pilot study. Br J Anaesth 2017; 118:924-931. [DOI: 10.1093/bja/aex089] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 12/30/2022] Open
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Valeberg BT, Pedersen LM, Girotto V, Christensen VL, Stubhaug A. Validation of the Norwegian Pain Sensitivity Questionnaire. J Pain Res 2017; 10:1137-1142. [PMID: 28553134 PMCID: PMC5439722 DOI: 10.2147/jpr.s129540] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and purpose There is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. Methods Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. Results The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. Conclusion This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain.
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Affiliation(s)
- Berit Taraldsen Valeberg
- Department of Nursing and Health promotion, Oslo and Akershus University College of Applied Sciences
| | - Linda Margareth Pedersen
- Research and communication unit for musculoskeletal health (FORMI).,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Valentina Girotto
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Vivi Lycke Christensen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Exercise-induced Hypoalgesia in People With Knee Osteoarthritis With Normal and Abnormal Conditioned Pain Modulation. Clin J Pain 2017; 33:395-404. [DOI: 10.1097/ajp.0000000000000418] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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MacLachlan C, Shipton EA, Wells JE. The Cold Pressor Test as a Predictor of Prolonged Postoperative Pain, a Prospective Cohort Study. Pain Ther 2016; 5:203-213. [PMID: 27650441 PMCID: PMC5130906 DOI: 10.1007/s40122-016-0056-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Presently, it is difficult to predict which patients are at increased risk of ongoing pain problems postoperatively. This study followed a group of patients from the week before their operation until 3 months after it, to identify potential risk variables. METHODS Fifty-four patients undergoing moderate-major gynaecological surgery at Christchurch Women's Hospital were recruited and assessed preoperatively over an 11-week period. At this initial assessment, participants were subjected to a cold pressor test (CPT). Telephonic follow-up was conducted at 6 weeks and 3 months postoperatively, to determine pain status. Information regarding the type of operation and surgical approach was collected from hospital records. RESULTS Pain threshold (time taken to report the onset of pain), as measured by the CPT, was significantly predictive of prolonged pain outcomes (area under the curve = 0.80, 95 % CI 0.66, 0.95). Pain tolerance (total time taken to end the CPT voluntarily) was similarly predictive but non-significant (area under the curve = 0.69, 95 % CI 0.47, 0.90). CONCLUSION The preoperative cold pressor test shows some promise for predicting ongoing postoperative pain. However, more research is needed to determine the clinical significance of these findings in larger samples and how they could be incorporated into clinical practice.
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Affiliation(s)
- Cameron MacLachlan
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Edward A Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand.
| | - J Elisabeth Wells
- Department of Biostatistics and Computational Biology, University of Otago, Christchurch, New Zealand
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Valeberg BT, Høvik LH, Gjeilo KH. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program. J Pain Res 2016; 9:625-9. [PMID: 27660489 PMCID: PMC5019430 DOI: 10.2147/jpr.s113258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings.
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Affiliation(s)
- Berit T Valeberg
- Faculty of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Lise H Høvik
- Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital
| | - Kari H Gjeilo
- Department of Cardiothoracic Surgery; Department of Cardiology; National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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O'Leary H, Smart KM, Moloney NA, Doody CM. Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review. Pain Pract 2016; 17:249-266. [DOI: 10.1111/papr.12484] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/23/2016] [Accepted: 06/03/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Helen O'Leary
- School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
| | - Keith M. Smart
- Physiotherapy Department; St. Vincent's University Hospital; Dublin Ireland
| | - Niamh A. Moloney
- Faculty of Medicine and Health Sciences; Macquarie University; Sydney New South Wales Australia
| | - Catherine M. Doody
- School of Public Health, Physiotherapy and Sports Science; University College Dublin; Dublin Ireland
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Li W, Graham AD, Lin MC. Understanding Ocular Discomfort and Dryness Using the Pain Sensitivity Questionnaire. PLoS One 2016; 11:e0154753. [PMID: 27137908 PMCID: PMC4854470 DOI: 10.1371/journal.pone.0154753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To utilize the Pain Sensitivity Questionnaire (PSQ) to assess the influence of pain sensitivity on perceptions of ocular discomfort and dryness. METHODS Subjects completed a battery of questionnaires, including history of ocular and general health, contact lens wear history, the Ocular Surface Disease Index (OSDI) questionnaire, visual analog scale (VAS) 100-point rating scales to assess severity and frequency of average and end of day (EOD) discomfort and dryness, and the PSQ to assess pain sensitivity level. Masked subjects were then instructed to wear one inverted and one normally oriented soft contact lens contralaterally for 30 minutes to induce an inter-eye difference in comfort and dryness sensations. Subjects rated comfort and dryness in each eye on VAS every 5 minutes during contact lens wear. A slit lamp examination was performed to evaluate ocular surface health and to assess contact lens fit. RESULTS One hundred and fifty-three subjects (111 females, 42 males) completed the study. In separate models, a higher PSQ score was significantly associated with higher OSDI score (p = 0.002), lower average and EOD comfort (p = 0.005 and 0.001, respectively), and greater EOD dryness (p = 0.04). The minimum (0.14) and maximum (7.14) PSQ scores observed in our subject cohort (i.e., from the subjects who were the least and most sensitive to pain, respectively) corresponded to an estimated difference of 11 points on the OSDI, 20 points on the VAS scale for average comfort, 31 points for EOD comfort and 17 points for EOD dryness. In a mixed effects model, a higher PSQ score was significantly associated with a greater inter-eye difference in comfort (p = 0.013) and dryness (p = 0.010) during CL wear. CONCLUSIONS Pain sensitivity influences perceptions of ocular discomfort and dryness, and should be taken into account when evaluating subjective assessments of these symptoms.
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Affiliation(s)
- Wing Li
- Vision Science Program, University of California, Berkeley, CA, United States of America
- Clinical Research Center, School of Optometry, University of California, Berkeley, CA, United States of America
| | - Andrew D. Graham
- Clinical Research Center, School of Optometry, University of California, Berkeley, CA, United States of America
| | - Meng C. Lin
- Vision Science Program, University of California, Berkeley, CA, United States of America
- Clinical Research Center, School of Optometry, University of California, Berkeley, CA, United States of America
- * E-mail:
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A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery. Anesthesiol Res Pract 2016; 2016:7948412. [PMID: 27143966 PMCID: PMC4838779 DOI: 10.1155/2016/7948412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings could predict pain intensity and analgesic usage following cesarean delivery (CD). Methods. 50 healthy women undergoing scheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated psychological questionnaires (Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale, and Eysenck Personality Questionnaire) and 3 simple ratings: expected postoperative pain (0–10), anticipated analgesic threshold (0–10), and perceived analgesic needs (0–10). Postoperative outcome measures included post-CD pain (combined rest and movement) and opioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage (r = 0.349), anticipated analgesic threshold and post-CD pain (r = −0.349), and perceived analgesic needs and post-CD pain (r = 0.313). Multiple linear regression analysis found that expected postoperative pain and anticipated analgesic needs contributed to post-CD pain prediction modeling (R2 = 0.443, p < 0.0001); expected postoperative pain, ASI, and FPQ were associated with opioid usage (R2 = 0.421, p < 0.0001). Conclusion. Preoperative psychological tests combined with simple pain prediction ratings accounted for 44% and 42% of pain and analgesic use variance, respectively. Preoperatively determined expected postoperative pain and perceived analgesic needs appear to be useful predictors for post-CD pain and analgesic requirements.
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Campbell CM, Moscou-Jackson G, Carroll CP, Kiley K, Haywood C, Lanzkron S, Hand M, Edwards RR, Haythornthwaite JA. An Evaluation of Central Sensitization in Patients With Sickle Cell Disease. THE JOURNAL OF PAIN 2016; 17:617-27. [PMID: 26892240 DOI: 10.1016/j.jpain.2016.01.475] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Central sensitization (CS), nociceptive hyperexcitability known to amplify and maintain clinical pain, has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. Recent evidence suggests that it may explain differences in the symptom experience of individuals with sickle cell disease (SCD). Quantitative sensory testing (QST) can be used to examine CS and identify individuals who may have a heightened CS profile. The present study categorized patients with SCD on the basis of QST responses into a high or low CS phenotype and compared these groups according to measures of clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity. Eighty-three adult patients with SCD completed QST, questionnaires, and daily sleep and pain diaries over a 3-month period, weekly phone calls for 3 months, and monthly phone calls for 12 months. Patients were divided into CS groups (ie, no/low CS [n = 17] vs high CS [n = 21]), on the basis of thermal and mechanical temporal summation and aftersensations, which were norm-referenced to 47 healthy control subjects. High CS subjects reported more clinical pain, vaso-occlusive crises, catastrophizing, and negative mood, and poorer sleep continuity (Ps < .05) over the 18-month follow-up period. Future analyses should investigate whether psychosocial disturbances and sleep mediate the relationship between CS and pain outcomes. PERSPECTIVE In general, SCD patients with greater CS had more clinical pain, more crises, worse sleep, and more psychosocial disturbances compared with the low CS group.
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Affiliation(s)
- Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kasey Kiley
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carlton Haywood
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Hand
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert R Edwards
- Departments of Anesthesiology, Perioperative, Pain Medicine, and Psychiatry, Harvard Medical School, and Brigham and Women's Hospital, Pain Management Center, Chestnut Hill, Massachusetts
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Persson AKM, Pettersson FD, Dyrehag LE, Åkeson J. Prediction of postoperative pain from assessment of pain induced by venous cannulation and propofol infusion. Acta Anaesthesiol Scand 2016; 60:166-76. [PMID: 26373922 DOI: 10.1111/aas.12634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Postoperative pain may lead to delayed mobilization, persisting pain, and psychosocial distress. There are no simple and reliable techniques for prediction of postoperative pain. This study was designed to evaluate if pain induced by venous cannulation or propofol injection can be used to predict postoperative pain. METHODS This prospective study included 180 patients scheduled for laparoscopic cholecystectomy. Pain intensity associated with peripheral venous cannulation and administration of propofol preoperatively and pain intensity, and use of opioid postoperatively was recorded. RESULTS Patients scoring cannulation-induced pain intensity > 2.0 VAS units were given postoperative opioid more often (65% vs. 36%; P < 0.001), earlier (12 min vs. 90 min; P < 0.001), and in higher doses (4.8 mg vs. 0 mg; P < 0.001), and also reported higher levels of postoperative pain intensity (5.8 vs. 2.9 VAS units; P < 0.001). There were also significant (P < 0.01) correlations with postoperative pain intensity (rs = 0.24), time to opioid administration (rs = -0.26), and total dose of opioid (rs = 0.25). Propofol-induced pain intensity correlated significantly (P < 0.05) with postoperative pain intensity (rs = 0.19). CONCLUSION Pain intensity associated with venous cannulation and propofol infusion can easily be evaluated at bedside before surgery without specific equipment or training. Patients scoring > 2.0 VAS units on venous cannulation were found to have 3.4 times higher risk of postoperative pain after laparoscopic cholecystectomy. Low pain intensity associated with venous cannulation and propofol infusion indicate lower risk of postoperative pain.
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Affiliation(s)
- A K M Persson
- Department of Clinical Sciences Malmö, Anesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
- Department of Anesthesiology and Intensive Care Medicine, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - F D Pettersson
- Karolinska Institute, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Stockholm, Sweden
| | - L-E Dyrehag
- Department of Anesthesiology and Intensive Care Medicine, Hallands Sjukhus Halmstad, Halmstad, Sweden
| | - J Åkeson
- Department of Clinical Sciences Malmö, Anesthesiology and Intensive Care Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR. Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery. Arch Phys Med Rehabil 2015; 96:1763-70. [PMID: 26101845 DOI: 10.1016/j.apmr.2015.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. DESIGN Prospective observational cohort study. SETTING Academic medical center. PARTICIPANTS Patients (N=68; mean age, 57.9±13.1y; 40 women [58.8%]) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥4 and Oswestry Disability Index scores ≥21 at all postoperative time points. RESULTS From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR, 1.1; 95% CI, 1.0-1.2), pain interference (OR, 1.1; 95% CI, 1.0-1.2), and disability (OR, 1.3; 95% CI, 1.1-1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (P>.05). CONCLUSIONS The findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing to identify patients at risk for poor postoperative pain intensity, pain interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors.
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Affiliation(s)
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, FL; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN.
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Campbell CM, Buenaver LF, Raja SN, Kiley KB, Swedberg LJ, Wacnik PW, Cohen SP, Erdek MA, Williams KA, Christo PJ. Dynamic Pain Phenotypes are Associated with Spinal Cord Stimulation-Induced Reduction in Pain: A Repeated Measures Observational Pilot Study. PAIN MEDICINE 2015; 16:1349-60. [PMID: 25800088 DOI: 10.1111/pme.12732] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Spinal cord stimulation (SCS) has become a widely used treatment option for a variety of pain conditions. Substantial variability exists in the degree of benefit obtained from SCS and patient selection is a topic of expanding interest and importance. However, few studies have examined the potential benefits of dynamic quantitative sensory testing (QST) to develop objective measures of SCS outcomes or as a predictive tool to help patient selection. Psychological characteristics have been shown to play an important role in shaping individual differences in the pain experience and may aid in predicting responses to SCS. Static laboratory pain-induction measures have also been examined in their capacity for predicting SCS outcomes. METHODS The current study evaluated clinical, psychological and laboratory pain measures at baseline, during trial SCS lead placement, as well as 1 month and 3 months following permanent SCS implantation in chronic pain patients who received SCS treatment. Several QST measures were conducted, with specific focus on examination of dynamic models (central sensitization and conditioned pain modulation [CPM]) and their association with pain outcomes 3 months post SCS implantation. RESULTS Results suggest few changes in QST over time. However, central sensitization and CPM at baseline were significantly associated with clinical pain at 3 months following SCS implantation, controlling for psycho/behavioral factors and pain at baseline. Specifically, enhanced central sensitization and reduced CPM were associated with less self-reported pain 3 months following SCS implantation. CONCLUSIONS These findings suggest a potentially important role for dynamic pain assessment in individuals undergoing SCS, and hint at potential mechanisms through which SCS may impart its benefit.
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Affiliation(s)
- Claudia M Campbell
- Departments of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Luis F Buenaver
- Departments of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Srinivasa N Raja
- Anesthesiology, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Kasey B Kiley
- Departments of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Lauren J Swedberg
- Departments of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | | | - Steven P Cohen
- Anesthesiology, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Michael A Erdek
- Anesthesiology, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Kayode A Williams
- Anesthesiology, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
| | - Paul J Christo
- Anesthesiology, Johns Hopkins University School of Medicine Baltimore, Maryland, USA
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Predicting Postcesarean Delivery Pain. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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49
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Lewis GN, Rice DA, McNair PJ, Kluger M. Predictors of persistent pain after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2014; 114:551-61. [PMID: 25542191 DOI: 10.1093/bja/aeu441] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Several studies have identified clinical, psychosocial, patient characteristic, and perioperative variables that are associated with persistent postsurgical pain; however, the relative effect of these variables has yet to be quantified. The aim of the study was to provide a systematic review and meta-analysis of predictor variables associated with persistent pain after total knee arthroplasty (TKA). METHODS Included studies were required to measure predictor variables prior to or at the time of surgery, include a pain outcome measure at least 3 months post-TKA, and include a statistical analysis of the effect of the predictor variable(s) on the outcome measure. Counts were undertaken of the number of times each predictor was analysed and the number of times it was found to have a significant relationship with persistent pain. Separate meta-analyses were performed to determine the effect size of each predictor on persistent pain. Outcomes from studies implementing uni- and multivariable statistical models were analysed separately. RESULTS Thirty-two studies involving almost 30 000 patients were included in the review. Preoperative pain was the predictor that most commonly demonstrated a significant relationship with persistent pain across uni- and multivariable analyses. In the meta-analyses of data from univariate models, the largest effect sizes were found for: other pain sites, catastrophizing, and depression. For data from multivariate models, significant effects were evident for: catastrophizing, preoperative pain, mental health, and comorbidities. CONCLUSIONS Catastrophizing, mental health, preoperative knee pain, and pain at other sites are the strongest independent predictors of persistent pain after TKA.
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Affiliation(s)
- G N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - D A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand
| | - P J McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - M Kluger
- Waitemata Pain Services, Waitemata District Health Board, Auckland, New Zealand Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
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Kim HJ, Park JH, Kim JW, Kang KT, Chang BS, Lee CK, Yeom JS. Prediction of Postoperative Pain Intensity after Lumbar Spinal Surgery Using Pain Sensitivity and Preoperative Back Pain Severity. PAIN MEDICINE 2014; 15:2037-45. [DOI: 10.1111/pme.12578] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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