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The Effect of a Single Intravenous Corticosteroid Administration on Pain after Knee Arthroscopy: A Prospective, Double-Blind, Non-Randomized Controlled Clinical Trial. J Clin Med 2022; 12:jcm12010197. [PMID: 36614998 PMCID: PMC9820949 DOI: 10.3390/jcm12010197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Knee arthroscopy is a standard surgical procedure that is nowadays widely performed as day-case surgery. The aim of the study was to observe the effect of a single dose of intravenous corticosteroid on pain after undergoing knee arthroscopy for non-bony procedures. METHODS A prospective, double-blind study design was adopted. Patients undergoing knee arthroscopy for non-bony procedures were prospectively assigned into two equal groups: control (those who were not given steroids) and treatment (those who were given eight milligrams of dexamethasone intravenously 15 min prior to the inflation of the tourniquet). The pain was assessed pre-operatively on admission and on the first post-operative day during the morning round in five different movements using a visual analogue scale (VAS). RESULTS A total of 60 patients were included in the study. There was no significant difference in the pre-and post-operatively scores between both groups. The treatment group experienced a significant reduction in post-operative morphine requirements, with 80% of patients who did not receive dexamethasone requiring post-operative morphine compared to only 53.3% of patients who did (p = 0.027). CONCLUSIONS Pre-operative intravenous administration of a single dose of dexamethasone may decrease opioid requirements for adequate pain control after knee arthroscopy.
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Götz JS, Benditz A, Reinhard J, Schindler M, Zeman F, Grifka J, Greimel F, Leiss F. Influence of Anxiety/Depression, Age, Gender and ASA on 1-Year Follow-Up Outcomes Following Total Hip and Knee Arthroplasty in 5447 Patients. J Clin Med 2021; 10:jcm10143095. [PMID: 34300261 PMCID: PMC8305027 DOI: 10.3390/jcm10143095] [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] [Received: 06/27/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: There are many factors influencing the outcome after total joint arthroplasty (TJA). In particular, patient-related factors such as age, gender, ASA (American Society of Anesthesiologists), or preoperative anxiety/depression have become increasingly important. The aim of this study was to examine the association of these parameters with 1-year postoperative outcomes after total knee and total hip arthroplasty (TKA, THA). Methods: A retrospective cohort of 5447 TJA patients was evaluated by pre- and postoperative analysis of EQ-5D, EQ-VAS and WOMAC Score. Furthermore, major focus was put on the association between age, gender, ASA, preoperative anxiety/depression and outcome parameters. Results: 53.3% (2903/5447) of all patients were identified with anxiety/depression at time of surgery. In the analysis, patients without anxiety/depression showed statistically significantly (p < 0.05) better EQ-5D, EQ-VAS and WOMAC scores. In addition, patients with ASA 2 or 3 and age over 70 years showed statistically significantly (p < 0.01) worse EQ-5D and WOMAC scores. Gender did not influence the postoperative EQ-5D and WOMAC results, but men had significantly better EQ-VAS scores than women in this study. Conclusion: Preoperative anxiety/depression symptoms show worse clinical outcomes 1 year postoperatively after TJA. Other outcome-influencing factors are higher age and ASA 2 or 3. In the future, such patients should be identified, and as far as applicable, a treatment of anxiety/depression or comorbidities should be implemented preoperatively of the surgical procedure to improve clinical outcomes.
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Affiliation(s)
- Julia Sabrina Götz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
- Correspondence:
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
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Cui H, Zhao Y, Ju C, Hao J. The effectiveness of traditional Chinese medicine fumigation and washing nursing care after arthroscopic debridement of Knee Osteoarthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24752. [PMID: 33725941 PMCID: PMC7982246 DOI: 10.1097/md.0000000000024752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy. METHODS Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software. RESULTS The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy. CONCLUSION This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy. ETHICS AND DISSEMINATION Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/THZP4.
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Affiliation(s)
- Honghong Cui
- Department of supply room, Weifang Yidu Central Hospital
| | - Yanxia Zhao
- Department of supply room, Weifang Yidu Central Hospital
| | - Chunmei Ju
- Department of supply room, Weifang Yidu Central Hospital
| | - Jixiu Hao
- People's Hospital of Weifang, Weifang, Shandong province, China
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Skowron M, Kociuga J, Domzalski M. Electrostimulation has a positive effect on the knee function after knee arthroscopic surgery: A randomized trial. J Back Musculoskelet Rehabil 2021; 33:777-783. [PMID: 31868656 DOI: 10.3233/bmr-170917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is a wide range of rehabilitation protocols after knee arthroscopic procedures, mainly based on specialist exercises. They comprise of specific stages and key moments but should also be individualized and adjusted to the patient's needs. OBJECTIVE The aim of the study was to evaluate the BodyFlow device impact on physical and psychological functioning of the subjects after knee arthroscopy. METHODS Ninety three patients were randomly divided into the study and control group. Each study group subject performed mild electrostimulation using the BodyFlow device for three weeks, five times a day for 20 minutes along with the standard rehabilitation protocol. Control group subjects were treated according to the standard rehabilitation protocol after knee arthroscopy. Healthy and operated lower limb size, a range of the knee joint motion, and the flexor and extensor strength were measured 3, 6, and 9 weeks after arthroscopy. At each measurement, the SF-36 and KOOS surveys were collected. RESULTS On study day 21, a positive, statistically significant, difference in the knee joint size, range of flection and extension, flexor and extensor strength as well as all KOOS survey subscales and physical functioning categories included in the SF-36 survey was observed. On study day 63, positive effects persisted and significant differences in other categories included in the SF-36 survey were observed. CONCLUSION Application of mild electrostimulation using the BodyFlow device has a positive impact on the swelling in the knee joint region, range of motion, extensor and flexor strength as well as physical, psychological, and social functioning.
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Affiliation(s)
- Marta Skowron
- Department of Orthopedic and Traumatology, Veterans Memorial Hospital, Medical University of Lodz, Poland
| | - Jerzy Kociuga
- Department of Orthopedics, Poddebice Medical Centre, Poddebice, Poland
| | - Marcin Domzalski
- Department of Orthopedic and Traumatology, Veterans Memorial Hospital, Medical University of Lodz, Poland
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Xin J, Zhang Y, Li Q, Cheng X, Lin Y, Liu B, Zhou L. Adductor canal block is similar to femoral nerve block for the quality of rehabilitation after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2020; 28:2334-2342. [PMID: 31781802 DOI: 10.1007/s00167-019-05796-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 11/07/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Adductor canal block (ACB) provides postoperative pain relief as effectively as femoral nerve block (FNB) does, and it preserves the strength of the quadriceps femoris. However, its effect on rehabilitation after arthroscopic partial meniscectomy has not been reported. The purpose of this study was to determine the effect of pre-operative ACB and FNB on the quality of rehabilitation after arthroscopic partial meniscectomy. METHODS A total of 150 patients undergoing arthroscopic partial meniscectomy were randomly allocated to the FNB group (receiving 0.3% ropivacaine 30 ml at the thighroot-femoral nerve), the ACB group (receiving 0.3% ropivacaine 30 ml at mid-thigh adductor canal), or the control group. The primary outcome was the Hospital for Special Surgery (HSS) knee score on the 30th postoperative day. RESULTS The HSS knee score of the ACB group on the 30th day after the operation was significantly higher than those of the FNB and control groups (88.6 ± 5.3 vs. 85.3 ± 6.9 and 81.2 ± 5.9, respectively; P < 0.05). Both the ACB and FNB groups showed excellent rehabilitation, indicating similar rehabilitation quality for both treatments. CONCLUSION ACB is similar to FNB concerning the quality of rehabilitation and pain relief after arthroscopic partial meniscectomy, while ACB has little effect on the strength of the quadriceps femoris. LEVEL OF EVIDENCE I TRIAL REGISTRATAION: This trial was registered in the Chinese Clinical Trial Registry (ChiCTR-INC-16008346).
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Affiliation(s)
- Juan Xin
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yabing Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qian Li
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xu Cheng
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - YanJun Lin
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, No.37 Wai Nan Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Murayama I, Asai T, Misu S, Yamauchi M, Miura A, Ikemura T, Takehisa T, Takehisa Y. Is increased "stay away from bed" time associated with improved clinical rehabilitation outcomes in Japanese rehabilitation hospitals? A prospective observational study and clinical practice. Aging Clin Exp Res 2019; 32:913-920. [PMID: 31327123 PMCID: PMC7190592 DOI: 10.1007/s40520-019-01269-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/04/2019] [Indexed: 11/15/2022]
Abstract
Background A comprehensive team approach for increasing stay away from bed time (SaB-time) called CASaB was conducted at multiple rehabilitation hospitals. Aims The aim of the present study was to investigate the association between SaB-time and clinical rehabilitation outcomes (CROs) before introducing CASaB (observational phase), and comparing CROs before and after CASaB (CASaB phase). Methods This prospective observational study included patients who were admitted to nine rehabilitation hospitals, with complete data. The final analysis included 197/229 patients in the observation phase, and 229/256 patients in the CASaB phase. We first tested whether SaB-time was positively associated with CROs in an observational study, then compared CROs before and after CASaB. Results In the observation phase, longer SaB-time was significantly associated with greater rehabilitation efficiency (REy) after adjusting for confounders (standardized β = 0.20, p = 0.007). In a comparison of CROs before and after CASaB, the length of hospital stay during the CASaB phase was significantly shorter than during the observational phase (61.5, 57.6–65.4 days vs 75.6, 71.4–79.9 days, p < 0.001), and the REy after CASaB was significantly greater than that before the CASaB (0.38, 0.33–0.42/day vs 0.28, 0.25–0.33/day, p = 0.006). Discussion The current results suggest that increasing SaB-time may help the recovery of functional abilities, particularly for patients in rehabilitation hospitals. Conclusions The CASaB provides a method for improving the recovery efficiency of patients in rehabilitation hospitals.
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Weinbroum AA. Postoperative hyperalgesia—A clinically applicable narrative review. Pharmacol Res 2017; 120:188-205. [DOI: 10.1016/j.phrs.2017.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 02/08/2023]
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Nicot R, Vieira AR, Raoul G, Delmotte C, Duhamel A, Ferri J, Sciote JJ. ENPP1 and ESR1 genotypes influence temporomandibular disorders development and surgical treatment response in dentofacial deformities. J Craniomaxillofac Surg 2016; 44:1226-37. [PMID: 27519661 DOI: 10.1016/j.jcms.2016.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/04/2016] [Accepted: 07/13/2016] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Dentofacial deformities are dys-morpho-functional disorders involving the temporomandibular joints (TMJ). Many authors have reported a TMJ improvement in dysfunctional subjects with malocclusion after orthodontic or combined orthodontic and surgical treatment particularly for the relief of pain. In particular, few studies have highlighted the demographic and clinical predictors of response to surgical treatment. To date, no genetic factor has yet been identified as a predictor of response to surgical treatment. The aim of this cohort study is therefore to identify single-nucleotide polymorphisms associated with postoperative temporomandibular disorders (TMD) or with TMJ symptoms after orthognathic surgery. Here, we found the AA genotype of SNP rs1643821 (ESR1 gene) as a risk factor for dysfunctional worsening after orthognathic surgery. In addition, we have identified TT genotype of SNP rs858339 (ENPP1 gene) as a protective factor against TMD in a population of patients with dentofacial deformities. Conversely, the heterozygous genotype AT was identified as a risk factor of TMD with respect to the rest of our population. All these elements are particularly important to bring new screening strategies and tailor future treatment. PERSPECTIVE This study allows us to identify sub-populations at high risk of developing postoperative temporomandibular disorders after orthognathic surgery procedures. Many other genes of interest could be potential factors influencing the dysfunctional response to orthognathic surgery, particularly genes of the Opera cohort.
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Affiliation(s)
- Romain Nicot
- Univ. Lille, Oral and Maxillofacial Department, Roger Salengro Hospital, CHU Lille, F-59000, Lille, France.
| | - Alexandre R Vieira
- Department of Oral Biology, University of Pittsburgh School of Dental Medicine, 3501 Terrace St, Pittsburgh, PA 15261, USA.
| | - Gwénaël Raoul
- Univ. Lille, Oral and Maxillofacial Department, Roger Salengro Hospital, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000, Lille, France.
| | - Constance Delmotte
- Univ. Lille, Oral and Maxillofacial Department, Roger Salengro Hospital, CHU Lille, F-59000, Lille, France.
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France.
| | - Joël Ferri
- Univ. Lille, Oral and Maxillofacial Department, Roger Salengro Hospital, CHU Lille, INSERM U 1008, Controlled Drug Delivery Systems and Biomaterials, F-59000, Lille, France.
| | - James J Sciote
- Department of Orthodontics, Kornberg School of Dentistry, Temple University, Philadelphia, PA 19140, USA.
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Hoofwijk DMN, Fiddelers AAA, Emans PJ, Joosten EA, Gramke HF, Marcus MAE, Buhre WFFA. Prevalence and Predictive Factors of Chronic Postsurgical Pain and Global Surgical Recovery 1 Year After Outpatient Knee Arthroscopy: A Prospective Cohort Study. Medicine (Baltimore) 2015; 94:e2017. [PMID: 26559300 PMCID: PMC4912294 DOI: 10.1097/md.0000000000002017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Outpatient knee arthroscopy is one of the most commonly performed surgical procedures. Previous research has demonstrated that chronic postsurgical pain (CPSP) after outpatient surgery is prevalent. Our objective was to determine the prevalence and predictive factors of CPSP and Global Surgical Recovery (GSR) 1 year after knee arthroscopy.A prospective longitudinal cohort study was performed. Patients were included during an 18-month period. Data were collected by using 3 questionnaires: at 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale (NRS) was defined as moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor GSR. Stepwise logistic regression analysis was performed to determine which variables were predictors for CPSP and poor GSR.The prevalence of moderate to severe preoperative pain in patients undergoing knee arthroscopy (n = 104) was 71.2%, of acute postsurgical pain 37.5%, and of CPSP 32.7%. Risk factors for CPSP were the presence of preoperative pain and preoperative analgesic use, with odds ratios of 6.31 (1.25-31.74) and 4.36 (1.58-12.07), respectively. The prevalence of poor GSR 1 year after outpatient knee arthrosocpy was 50.0%. Poor GSR 4 days after the surgery was a risk factor with an odds ratio of 8.38 (0.92-76.58) and quality of life 4 days after surgery was a protective factor with and odds ratio of 0.10 (0.02-0.64).Both CPSP and poor GSR are common 1 year after knee arthroscopy. Patients at risk for CPSP can be identified during the preoperative phase. Prediction of poor GSR 1 year after surgery is mainly related to early postoperative recovery.
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Affiliation(s)
- Daisy M N Hoofwijk
- From the Department of Anesthesiology and Pain Treatment (DMNH, AAAF, EAJ, H-FG, MAEM, WFFAB); Department of Orthopedic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands (PJE); and Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Qatar (MAEM)
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Kumar A, Liu NJ, Madia PA, Gintzler AR. Contribution of Endogenous Spinal Endomorphin 2 to Intrathecal Opioid Antinociception in Rats Is Agonist Dependent and Sexually Dimorphic. THE JOURNAL OF PAIN 2015; 16:1200-10. [PMID: 26342648 DOI: 10.1016/j.jpain.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/05/2015] [Accepted: 08/10/2015] [Indexed: 12/16/2022]
Abstract
UNLABELLED Interactions between exogenous and endogenous opioids are not commonly investigated as a basis for sexually dimorphic opioid analgesia. We investigated the influence of spinal endomorphin 2 (EM2), an endogenous mu-opioid receptor (MOR) ligand, on the spinal antinociception produced by intrathecally administered opioids. Activation of spinal MORs facilitated spinal EM2 release. This effect was sexually dimorphic, occurring in males but not in females. Although activational effects of testosterone were required for opioid facilitation of spinal EM2 release in males, the absence of this facilitation in females did not result from either insufficient levels of testosterone or mitigating effects of estrogens. Strikingly, in males, the contribution of spinal EM2 to the analgesia produced by intrathecally applied MOR agonists depended on their analgesic efficacy relative to that of EM2. Spinal EM2 released by the higher efficacy MOR agonist sufentanil diminished sufentanil's analgesic effect, whereas EM2 released by the lower efficacy morphine had the opposite effect on spinal morphine antinociception. Understanding antithetical contributions of endogenous EM2 to intrathecal opioid antinociception not only enlightens the selection of opioid medications for pain management but also helps to explain variable sex dependence of the antinociception produced by different opioids, facilitating the acceptance of sexually dimorphic antinociception as a basic tenet. PERSPECTIVE The male-specific MOR-coupled enhancement of spinal EM2 release implies a parallel ability to harness endogenous EM2 antinociception. The inferred diminished ability of females to utilize the spinal EM2 antinociceptive system could contribute to their greater frequency and severity of chronic pain syndromes.
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Affiliation(s)
- Arjun Kumar
- Department of Obstetrics and Gynecology, State University of New York, Brooklyn, New York
| | - Nai-Jiang Liu
- Department of Obstetrics and Gynecology, State University of New York, Brooklyn, New York
| | - Priyanka A Madia
- Department of Obstetrics and Gynecology, State University of New York, Brooklyn, New York
| | - Alan R Gintzler
- Department of Obstetrics and Gynecology, State University of New York, Brooklyn, New York.
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Loyd DR, Murphy AZ. The neuroanatomy of sexual dimorphism in opioid analgesia. Exp Neurol 2014; 259:57-63. [PMID: 24731947 DOI: 10.1016/j.expneurol.2014.04.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/11/2014] [Accepted: 04/04/2014] [Indexed: 12/18/2022]
Abstract
The influence of sex has been neglected in clinical studies on pain and analgesia, with the vast majority of research conducted exclusively in males. However, both preclinical and clinical studies indicate that males and females differ in both the anatomical and physiological composition of central nervous system circuits that are involved in pain processing and analgesia. These differences influence not only the response to noxious stimuli, but also the ability of pharmacological agents to modify this response. Morphine is the most widely prescribed opiate for the alleviation of persistent pain in the clinic; however, it is becoming increasingly clear that morphine is less potent in women compared to men. This review highlights recent research identifying neuroanatomical and physiological dimorphisms underlying sex differences in pain and opioid analgesia, focusing on the endogenous descending pain modulatory circuit.
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Affiliation(s)
- Dayna R Loyd
- Pain Management Research Area, United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, United States
| | - Anne Z Murphy
- Neuroscience Institute, Georgia State University, Atlanta, GA 30303, United States.
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Pinto PR, McIntyre T, Ferrero R, Araújo-Soares V, Almeida A. Persistent pain after total knee or hip arthroplasty: differential study of prevalence, nature, and impact. J Pain Res 2013; 6:691-703. [PMID: 24072977 PMCID: PMC3783511 DOI: 10.2147/jpr.s45827] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study compares the incidence, nature, and impact of persistent post-surgical pain after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and investigates differences between these procedures, with the focus on potential presurgical and post-surgical issues that could be related to the distinct persistent post-surgical pain outcomes between these two groups. A consecutive sample of 92 patients was assessed prospectively 24 hours before, 48 hours, and 4-6 months after surgery. The data show that TKA patients had a higher likelihood of developing persistent post-surgical pain, of reporting higher pain levels, and of using more neuropathic descriptors when classifying their pain. In addition, TKA patients more often reported interference from pain on functional domains, including general activity, walking ability, and normal work. Demographic factors, like gender and age, along with presurgical clinical factors like disease onset, existence of medical comorbidities, and other pain problems, may have contributed to these differences, whereas baseline psychologic factors and functionality levels did not seem to exert an influence. Heightened acute post-surgical pain experience among TKA patients could also be related to distinct outcomes for persistent post-surgical pain. Future prospective studies should therefore collect TKA and THA samples wherein patients are homogeneous for demographic and presurgical clinical issues. Overall, these findings contribute to a small but growing body of literature documenting persistent post-surgical pain after major arthroplasty, conducted in different countries and across different health care settings.
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Affiliation(s)
- Patrícia R Pinto
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal ; Life and Health Sciences Research Institute/3Bs, PT Government Associate, Braga/Guimarães, Portugal ; Health Psychology Group, Newcastle University, Newcastle, UK
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Deumens R, Steyaert A, Forget P, Schubert M, Lavand’homme P, Hermans E, De Kock M. Prevention of chronic postoperative pain: Cellular, molecular, and clinical insights for mechanism-based treatment approaches. Prog Neurobiol 2013; 104:1-37. [DOI: 10.1016/j.pneurobio.2013.01.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 01/15/2013] [Accepted: 01/31/2013] [Indexed: 01/13/2023]
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Belze O, Remerand F, Laulan J, Augustin B, Rion M, Laffon M, Fusciardi J. Chronic pain after carpal tunnel surgery: Epidemiology and associated factors. ACTA ACUST UNITED AC 2012; 31:e269-74. [DOI: 10.1016/j.annfar.2012.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/04/2012] [Indexed: 11/16/2022]
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Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromsø study. Pain 2012; 153:1390-1396. [PMID: 22445291 DOI: 10.1016/j.pain.2012.02.018] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 02/13/2012] [Accepted: 02/14/2012] [Indexed: 11/16/2022]
Abstract
Population-based data on the prevalence of persistent postsurgical pain are scarce. This study aimed to assess the prevalence of persistent postsurgical pain in a general population and to describe associated physical, social, and psychological factors, including symptoms of nerve injury and sensitization. A cross-sectional survey was performed in northern Norway with questionnaire items covering surgery, pain, and sensory abnormalities in the area of surgery. Of the 12,982 participants, 24.0% (3111) had undergone one or more surgical procedures during the 3 years preceding the survey. Of these, 2043 had the surgery performed more than 3 months before the investigation. Persistent pain in the area of surgery was reported by 40.4% of the patients (826 of 2043), moderate or severe pain by 18.3% (373 of 2043). Hypoesthesia, hyperesthesia, or both was reported by 24.5% (501 of 2043). There were strong associations between sensory abnormalities and persistent pain, increasingly with higher pain intensities; odds ratios were 2.68 for hypoesthesia and 6.27 for hyperesthesia. Of the 826 individuals reporting persistent pain in the anatomical area of surgery, 51.0% reported chronic pain when questioned without specific reference to the surgery. The present study supports evidence from clinical studies of persistent postsurgical pain, indicating a high prevalence, but reveals large discrepancies in report of pain, depending on the questions asked and the context in which the questions are presented. Strong associations between sensory abnormalities and pain indicate neuropathic mechanisms in a major proportion of cases.
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Affiliation(s)
- Aslak Johansen
- Division of Surgical Medicine and Intensive Care, University Hospital of North Norway, Tromsø, Norway Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway Department of Mental Health, Norwegian Institute of Public Health, Oslo, Norway Department of Clinical Medicine, University of Tromsø, Tromsø, Norway Department of Pain Management and Research, Oslo University Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
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Abstract
BACKGROUND Total joint arthroplasty (TJA) is remarkably successful for treating osteoarthritis: most patients see substantial gains in function. However, there are considerable geographic, racial, and gender variations in the utilization of these procedures. The reasons for these differences are complex. QUESTIONS/PURPOSES We examined sex and gender disparities in TJA. METHODS Through Medline/PubMed searches, we identified 632 articles and from these selected 61 for our review. WHERE ARE WE NOW?: A number of factors might explain sex and gender disparities in TJA: underrepresentation in clinical trials, differences in willingness to undergo surgery, pain responses to underlying disease and treatment, patient-physician relationships, treatment preferences, provider-level factors such as physician-patient communication style, and system-level factors such as access to specialist care. Since women have a higher prevalence of arthritis and degenerative joint diseases and overall demand for these procedures will continue to grow, the need to understand why there is a gap in utilization based on gender is imperative. WHERE DO WE NEED TO GO?: Understanding what exactly is meant by "disparity" is essential because it is possible anatomic factors may have different impacts on utilization from cultural factors. Ideally, information about these factors should be integrated into the decision-making process so that patients and providers can make the most informed choice about whether or not to undergo the procedure. HOW DO WE GET THERE?: To better understand all of the potential reasons for how anatomic and cultural factors related to sex and gender might impact decision-making and overall utilization of TJA, more research focusing on these factors must be designed and carried out.
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Affiliation(s)
- Wendy M Novicoff
- Departments of Orthopaedic Surgery and Public Health Sciences, University of Virginia School of Medicine, Box 80015, HSC, Charlottesville, VA 22908, USA.
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Suter LG, Fraenkel L, Losina E, Katz JN, Gomoll AH, Paltiel AD. Medical decision making in patients with knee pain, meniscal tear, and osteoarthritis. ACTA ACUST UNITED AC 2010; 61:1531-8. [PMID: 19877094 DOI: 10.1002/art.24893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Meniscal tears and osteoarthritis (OA) frequently coexist, but to our knowledge, no data exist to identify who will benefit from arthroscopic partial meniscectomy (APM) versus nonoperative management. Our objective was to evaluate the capability of preoperative information to predict APM outcomes in OA. METHODS Using a mathematical model and published data, we combined 2 clinical (mechanical symptoms and pain pattern) and 2 magnetic resonance imaging (tear type and bone marrow lesions) indicators into 36 possible combinations and ranked each combination according to the likelihood of having primarily tear- versus OA-related pain in individuals ages 45-65 years with knee pain, OA, and meniscal tears. By considering alternative thresholds for performing APM, we identified the cutoff rank that maximized the overall population International Knee Documentation Committee (IKDC) score (0-100 scale). RESULTS Rank 1 (e.g., displaced tear, locking, increased pain, no bone marrow lesions) represented the highest likelihood of APM benefit; rank 36 (e.g., oblique tear, no mechanical symptoms, static pain, severe bone marrow lesions) represented the lowest likelihood of APM benefit. Indeterminate middle ranks included individuals with mixed findings (i.e., 2 findings consistent with high and 2 with low likelihood of APM benefit). APM thresholds between ranks 17 and 23 resulted in >82% of the population receiving treatment producing the greatest possible IKDC improvement, with mean incremental gains in IKDC score of >24 points. Findings were robust across a broad range of indicator assumptions, but were sensitive to outcome assumptions. CONCLUSION Among individuals with degenerative meniscal tears and OA, easily obtainable clinical information can differentiate those who are more likely to benefit from APM.
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Affiliation(s)
- Lisa G Suter
- Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, Room TAC S541, PO Box 208031, New Haven, CT 06520-8031, USA.
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, gender, and pain: a review of recent clinical and experimental findings. THE JOURNAL OF PAIN 2009; 10:447-85. [PMID: 19411059 DOI: 10.1016/j.jpain.2008.12.001] [Citation(s) in RCA: 1728] [Impact Index Per Article: 115.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/04/2008] [Indexed: 02/07/2023]
Abstract
UNLABELLED Sex-related influences on pain and analgesia have become a topic of tremendous scientific and clinical interest, especially in the last 10 to 15 years. Members of our research group published reviews of this literature more than a decade ago, and the intervening time period has witnessed robust growth in research regarding sex, gender, and pain. Therefore, it seems timely to revisit this literature. Abundant evidence from recent epidemiologic studies clearly demonstrates that women are at substantially greater risk for many clinical pain conditions, and there is some suggestion that postoperative and procedural pain may be more severe among women than men. Consistent with our previous reviews, current human findings regarding sex differences in experimental pain indicate greater pain sensitivity among females compared with males for most pain modalities, including more recently implemented clinically relevant pain models such as temporal summation of pain and intramuscular injection of algesic substances. The evidence regarding sex differences in laboratory measures of endogenous pain modulation is mixed, as are findings from studies using functional brain imaging to ascertain sex differences in pain-related cerebral activation. Also inconsistent are findings regarding sex differences in responses to pharmacologic and non-pharmacologic pain treatments. The article concludes with a discussion of potential biopsychosocial mechanisms that may underlie sex differences in pain, and considerations for future research are discussed. PERSPECTIVE This article reviews the recent literature regarding sex, gender, and pain. The growing body of evidence that has accumulated in the past 10 to 15 years continues to indicate substantial sex differences in clinical and experimental pain responses, and some evidence suggests that pain treatment responses may differ for women versus men.
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Affiliation(s)
- Roger B Fillingim
- University of Florida, College of Dentistry, Gainesville, Florida 32610-3628, USA.
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. THE JOURNAL OF PAIN 2009. [DOI: 10.1016/j.jpain.2008.12.001 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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