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Wu F, Liu J, Zheng L, Chen C, Basnet D, Zhang J, Shen C, Feng X, Sun Y, Du X, Zheng JC, Liu J. Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis. Br J Anaesth 2024; 133:591-604. [PMID: 38879440 DOI: 10.1016/j.bja.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential to identifying patients at high risk for severe postoperative pain and for developing analgesic strategy. This systematic review and meta-analysis summarises PPS and assessed its correlation with postoperative pain. METHODS PubMed, Scopus, Cochrane Library, and PsycINFO were searched up to October 1, 2023, for studies reporting the association between PPS and postsurgical pain. Two authors abstracted estimates of the effect of each method independently. A random-effects model was used to combine data. Subgroup analyses were performed to investigate the effect of pain types and surgical procedures on outcomes. RESULTS A total of 70 prospective observational studies were included. A meta-analysis of 50 studies was performed. Postoperative pain was negatively associated with pressure pain threshold (PPT; r=-0.15, 95% confidence interval [CI] -0.23 to -0.07]) and electrical pain threshold (EPT; r=-0.28, 95% CI -0.42 to -0.14), but positively correlated with temporal summation of pain (TSP; r=0.21, 95% CI 0.12-0.30) and Pain Sensitivity Questionnaire (PSQ; r=0.25, 95% CI 0.13-0.37). Subgroup analysis showed that only TSP was associated with acute and chronic postoperative pain, whereas PPT, EPT, and PSQ were only associated with acute pain. A multilevel (three-level) meta-analysis showed that PSQ was not associated with postoperative pain. CONCLUSIONS Lower PPT and EPT, and higher TSP are associated with acute postoperative pain while only TSP is associated with chronic postoperative pain. Patients with abnormal preoperative pain sensitivity should be identified by clinicians to adopt early interventions for effective analgesia. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42023465727).
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Affiliation(s)
- Fan Wu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jiehui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Zheng
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqi Chen
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Diksha Basnet
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jingya Zhang
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Chaonan Shen
- Research Center for Translation Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuanran Feng
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Yiyan Sun
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Xue Du
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Jialin C Zheng
- Center for Translational Neurodegeneration and Regenerative Therapy, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China; Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Jianhui Liu
- Department of Anaesthesiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China.
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A novel metric of reliability in pressure pain threshold measurement. Sci Rep 2021; 11:6944. [PMID: 33767329 PMCID: PMC7994550 DOI: 10.1038/s41598-021-86344-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
The inter-session Intraclass Correlation Coefficient (ICC) is a commonly investigated and clinically important metric of reliability for pressure pain threshold (PPT) measurement. However, current investigations do not account for inter-repetition variability when calculating inter-session ICC, even though a PPT measurement taken at different sessions must also imply different repetitions. The primary aim was to evaluate and report a novel metric of reliability in PPT measurement: the inter-session-repetition ICC. One rater recorded ten repetitions of PPT measurement over the lumbar region bilaterally at two sessions in twenty healthy adults using a pressure algometer. Variance components were computed using linear mixed-models and used to construct ICCs; most notably inter-session ICC and inter-session-repetition ICC. At 70.1% of the total variance, the source of greatest variability was between subjects (\documentclass[12pt]{minimal}
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\begin{document}$${\sigma }_{subj}^{2}$$\end{document}σsubj2 = 222.28 N2), whereas the source of least variability (1.5% total variance) was between sessions (\documentclass[12pt]{minimal}
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\begin{document}$${\sigma }_{sess}^{2}$$\end{document}σsess2 = 4.83 N2). Derived inter-session and inter-session-repetition ICCs were 0.88 (95%CI: 0.77 to 0.94) and 0.73 (95%CI: 0.53 to 0.84) respectively. Inter-session-repetition ICC provides a more conservative estimate of reliability than inter-session ICC, with the magnitude of difference being clinically meaningful. Quantifying individual sources of variability enables ICC construction to be reflective of individual testing protocols.
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Sterkele I, Pfister PB, Knols R, de Bruin ED. Eine Alternative zur klassischen Testtheorie? – Eine exemplarische Anwendung der Generalisierbarkeitstheorie auf der Basis von Sekundärdaten. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1201-6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Hintergrund Messungen bilden die Grundlage des wissenschaftsbasierten therapeutischen Vorgehens. Messfehler sind jedoch ein verbreitetes Problem. Um Fehlerquellen zu ermitteln, sind erweiterte statistische Modelle notwendig. Im Gegensatz zur klassischen Testtheorie ermöglicht die Generalisierbarkeitstheorie, mehrere Fehlerquellen gleichzeitig zu untersuchen.
Ziel Vergleich der klassischen Testtheorie und der Generalisierbarkeitstheorie anhand eines physiotherapeutischen Beispiels zur Reliabilitätsermittlung und deren Ergebnisse.
Methode Die Messeigenschaft „Reliabilität“ wurde anhand von Daten einer vorangegangenen Reliabilitätsstudie, in der die klassische Testtheorie zum Einsatz kam, untersucht. Dazu wurde exemplarisch eine Generalisierbarkeitsstudie durchgeführt.
Ergebnisse Die Variabilität ging hauptsächlich von den Probanden und der Probanden-Untersucher-Interaktion aus. Unabhängig von fixen oder zufälligen Facetten waren die Generalisierbarkeitskoeffizienten für alle Bedingungen (overall, inter-rater, intra-Messzeitpunkte) exzellent.
Schlussfolgerung Die Ergebnisse deuten darauf hin, dass die Generalisierbarkeitstheorie gegenüber der klassischen Testtheorie Vorteile hat. Diese ermöglicht es, einen wirkungsvollen und effizienten Einsatz von Messinstrumenten im klinischen Alltag zu ermitteln.
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Affiliation(s)
- Iris Sterkele
- Physiotherapie Ergotherapie USZ, Universitätsspital Zürich, Zürich, Schweiz
| | - Pierrette Baschung Pfister
- Physiotherapie Ergotherapie USZ, Universitätsspital Zürich, Zürich, Schweiz
- Forschungszentrum Physiotherapie Ergotherapie USZ, Universitätsspital Zürich, Zürich, Schweiz
| | - Ruud Knols
- Physiotherapie Ergotherapie USZ, Universitätsspital Zürich, Zürich, Schweiz
- Forschungszentrum Physiotherapie Ergotherapie USZ, Universitätsspital Zürich, Zürich, Schweiz
- Departement Gesundheitswissenschaften und Technologie, Institut für Bewegungswissenschaften und Sport, ETH Zürich, Zürich, Schweiz
| | - Eling D de Bruin
- Departement Gesundheitswissenschaften und Technologie, Institut für Bewegungswissenschaften und Sport, ETH Zürich, Zürich, Schweiz
- Division of Physiotherapy, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden
- Research Line Functioning and Rehabilitation, Department of Epidemiology, School CAPHRI Care and Public Health Research Institute, Maastrich University, The Netherland
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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: 403] [Impact Index Per Article: 67.2] [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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Moana-Filho EJ, Alonso AA, Kapos FP, Leon-Salazar V, Durand SH, Hodges JS, Nixdorf DR. Multifactorial assessment of measurement errors affecting intraoral quantitative sensory testing reliability. Scand J Pain 2017; 16:93-98. [PMID: 28850419 DOI: 10.1016/j.sjpain.2017.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/11/2017] [Accepted: 03/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE (AIMS) Measurement error of intraoral quantitative sensory testing (QST) has been assessed using traditional methods for reliability, such as intraclass correlation coefficients (ICCs). Most studies reporting QST reliability focused on assessing one source of measurement error at a time, e.g., inter- or intra-examiner (test-retest) reliabilities and employed two examiners to test inter-examiner reliability. The present study used a complex design with multiple examiners with the aim of assessing the reliability of intraoral QST taking account of multiple sources of error simultaneously. METHODS Four examiners of varied experience assessed 12 healthy participants in two visits separated by 48h. Seven QST procedures to determine sensory thresholds were used: cold detection (CDT), warmth detection (WDT), cold pain (CPT), heat pain (HPT), mechanical detection (MDT), mechanical pain (MPT) and pressure pain (PPT). Mixed linear models were used to estimate variance components for reliability assessment; dependability coefficients were used to simulate alternative test scenarios. RESULTS Most intraoral QST variability arose from differences between participants (8.8-30.5%), differences between visits within participant (4.6-52.8%), and error (13.3-28.3%). For QST procedures other than CDT and MDT, increasing the number of visits with a single examiner performing the procedures would lead to improved dependability (dependability coefficient ranges: single visit, four examiners=0.12-0.54; four visits, single examiner=0.27-0.68). A wide range of reliabilities for QST procedures, as measured by ICCs, was noted for inter- (0.39-0.80) and intra-examiner (0.10-0.62) variation. CONCLUSION Reliability of sensory testing can be better assessed by measuring multiple sources of error simultaneously instead of focusing on one source at a time. In experimental settings, large numbers of participants are needed to obtain accurate estimates of treatment effects based on QST measurements. This is different from clinical use, where variation between persons (the person main effect) is not a concern because clinical measurements are done on a single person. IMPLICATIONS Future studies assessing sensory testing reliability in both clinical and experimental settings would benefit from routinely measuring multiple sources of error. The methods and results of this study can be used by clinical researchers to improve assessment of measurement error related to intraoral sensory testing. This should lead to improved resource allocation when designing studies that use intraoral quantitative sensory testing in clinical and experimental settings.
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Affiliation(s)
- Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, 6-320d Moos Tower, 515 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Aurelio A Alonso
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, United States.
| | - Flavia P Kapos
- Department of Epidemiology, School of Public Health, University of Washington, United States; Department of Oral Health Sciences, School of Dentistry, University of Washington, United States.
| | - Vladimir Leon-Salazar
- Division of Pediatric Dentistry, School of Dentistry, University of Minnesota, United States.
| | - Scott H Durand
- Private Dental Practice, 115 East Main Street, Wabasha, MN, 55981, United States.
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, United States.
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, 6-320d Moos Tower, 515 Delaware St. SE, Minneapolis, MN 55455, United States; Department of Neurology, Medical School, University of Minnesota, United States; HealthPartners Institute for Education and Research, United States.
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O'Neill S, O'Neill L. Improving QST Reliability—More Raters, Tests, or Occasions? A Multivariate Generalizability Study. THE JOURNAL OF PAIN 2015; 16:454-62. [DOI: 10.1016/j.jpain.2015.01.476] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 12/21/2022]
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Andresen T, Nilsson M, Nielsen AK, Lassen D, Arendt-Nielsen L, Drewes AM. Intradermal Injection with Nerve Growth Factor: A Reproducible Model to Induce Experimental Allodynia and Hyperalgesia. Pain Pract 2014; 16:12-23. [PMID: 25470218 DOI: 10.1111/papr.12267] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 10/10/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nerve growth factor (NGF) plays a pivotal role in survival, growth, and differentiation of the nervous system. Increased levels of NGF have been reported in human pain disorders. Experimental injection of NGF in humans is known to evoke long-lasting mechanical sensitization and subsequent allodynia and hyperalgesia. METHODS Reproducibility of intradermal injection of NGF was investigated. Twenty healthy male volunteers were included (mean age 24 years, range 19 to 31). The experiment consisted of 3 identical treatment periods with period 1 stimulating the right arm, period 2 the left arm, and period 3 stimulating the right arm again (period one and three were separated by at least 21 days). Pain intensity was assessed in response to several phasic stimuli in 3 adjacent sites of the volar forearm: pressure; pinprick; brush; and heat before and after NGF injection. Additionally, areas of allodynia and secondary hyperalgesia were assessed. Rekindling with pressure was performed 1 hour and 24 hours after injection. Reproducibility was assessed with intraclass correlation coefficient (ICC 3,1). RESULTS ICC values > 0.6 for all phasic stimuli and for the area of hyperalgesia. After NGF injection, pressure pain (P < 0.001) and heat pain (P < 0.01) sensitivity increased significantly. After rekindling, the area of hyperalgesia (von Frey 26 g) was significantly increased (P = 0.03) and sensitivity to pinprick was increased (P < 0.02). CONCLUSION Intradermal NGF injection is capable of inducing reproducible allodynia and hyperalgesia, and the model is recommended for future experimental and pharmacological pain studies.
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Affiliation(s)
- Trine Andresen
- Department of Gastroenterology & Hepatology, Center of Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Matias Nilsson
- Department of Gastroenterology & Hepatology, Center of Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Klitgaard Nielsen
- Department of Gastroenterology & Hepatology, Center of Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte Lassen
- Department of Gastroenterology & Hepatology, Center of Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Sensory-Motor Interactions (SMI), Aalborg University, Aalborg, Denmark
| | - Asbjørn Mohr Drewes
- Department of Gastroenterology & Hepatology, Center of Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.,Department of Health Science and Technology, Center for Sensory-Motor Interactions (SMI), Aalborg University, Aalborg, Denmark
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Arendt-Nielsen L, Hoeck HC. Optimizing the early phase development of new analgesics by human pain biomarkers. Expert Rev Neurother 2011; 11:1631-1651. [DOI: 10.1586/ern.11.147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Matsson EM, Palm JE, Eriksson UG, Bottner P, Lundahl A, Knutson L, Lennernäs H. Effects of Ketoconazole on the In Vivo Biotransformation and Hepatobiliary Transport of the Thrombin Inhibitor AZD0837 in Pigs. Drug Metab Dispos 2010; 39:239-46. [DOI: 10.1124/dmd.110.035022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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