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Lee S, Xue Y, Petricca J, Kremic L, Xiao MZX, Pivetta B, Ladha KS, Wijeysundera DN, Diep C. The impact of pre-operative depression on pain outcomes after major surgery: a systematic review and meta-analysis. Anaesthesia 2024; 79:423-434. [PMID: 38050423 DOI: 10.1111/anae.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Abstract
Symptoms of depression are common among patients before surgery. Depression may be associated with worse postoperative pain and other pain-related outcomes. This review aimed to characterise the impact of pre-operative depression on postoperative pain outcomes. We conducted a systematic review of observational studies that reported an association between pre-operative depression and pain outcomes after major surgery. Multilevel random effects meta-analyses were conducted to pool standardised mean differences and 95%CI for postoperative pain scores in patients with depression compared with those without depression, at different time intervals. A meta-analysis was performed for studies reporting change in pain scores from the pre-operative period to any time-point after surgery. Sixty studies (n = 501,962) were included in the overall review, of which 18 were eligible for meta-analysis. Pre-operative depression was associated with greater pain scores at < 72 h (standardised mean difference 0.97 (95%CI 0.37-1.56), p = 0.009, I2 = 41%; moderate certainty) and > 6 months (standardised mean difference 0.45 (95%CI 0.23-0.68), p < 0.001, I2 = 78%; low certainty) after surgery, but not at 3-6 months after surgery (standardised mean difference 0.54 (95%CI -0.06-1.15), p = 0.07, I2 = 83%; very low certainty). The change in pain scores from pre-operative baseline to 1-2 years after surgery was similar between patients with and without pre-operative depression (standardised mean difference 0.13 (95%CI -0.06-0.32), p = 0.15, I2 = 54%; very low certainty). Overall, pre-existing depression before surgery was associated with worse pain severity postoperatively. Our findings highlight the importance of incorporating psychological care into current postoperative pain management approaches in patients with depression.
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Affiliation(s)
- S Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J Petricca
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Kremic
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - B Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - K S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - D N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - C Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
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Sampath Kumar S, Bano S, P J. Placebo hypoalgesic and nocebo hyperalgesic effects in post-extraction patients-A cross sectional study. Br J Pain 2023; 17:366-374. [PMID: 37538946 PMCID: PMC10395389 DOI: 10.1177/20494637231161915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background and objectives Pain is an unpleasant sensory and emotional experience that affects people's physical, mental, and social health. Patients at times present with postoperative pain with no clinical signs after the surgical dental procedures and adequate pharmacological management. This can be due to the amplified emotional component of the individual in their postoperative period. Hence, this study aimed to estimate the association between placebo, nocebo effects, and postoperative pain associated with tooth extraction procedures. Methods A cross-sectional study was conducted among 301 patients attending the Department of Oral and Maxillofacial Surgery for tooth extraction. Preoperatively, the expected postoperative pain score was recorded using the "Numerical Rating Scale" (NRS), Anxiety and Depression were assessed using the "Hospital Anxiety and Depression Scale" (HADS), and Patients' expectancy regarding the treatment outcome was assessed using the "Credibility Expectancy Questionnaire" (CEQ). Observed postoperative pain scores at the 6th hour, 24th hour, and peak pain score of the day were recorded using the NRS. Results There were statistically significant associations (p < 0.05) found between expected and observed postoperative pain, preoperative anxiety and observed postoperative pain, preoperative depression and observed postoperative pain, placebo, nocebo effects, and observed postoperative pain. Interpretation and conclusion Our study showed a strong association between these variables suggesting that post-extraction pain is a multifaceted condition wherein pain expectation, preoperative anxiety, depression, and expectancy regarding the treatment outcome should be scrutinized before the extraction procedure.
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Affiliation(s)
| | - Sidra Bano
- Department of Oral Medicine and Radiology, Sri Ramakrishna Dental College and Hospital, Coimbatore, India
| | - Jagan P
- Department of Public Health Dentistry, Sri Ramakrishna Dental College and Hospital, Coimbatore, India
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Chiancone F, Fabiano M, Fedelini M, Carrino M, Meccariello C, Fedelini P. Preliminary evidence of the impact of social distancing on psychological status and functional outcomes of patients who underwent robot-assisted radical prostatectomy. Cent European J Urol 2020; 73:265-268. [PMID: 33133651 PMCID: PMC7587480 DOI: 10.5173/ceju.2020.0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 07/27/2020] [Accepted: 08/10/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Social distancing is considered the best strategy to prevent the spread of COVID-19 (COronaVIrus Disease 19). We aimed to analyse the effect of 'social distancing' on the emotional state, post-operative pain and functional outcomes of patients undergoing robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS We retrospectively reviewed data of male patients who underwent RARP within the study period (from March to April 2019 [Group A = 27 patients] and from March to April 2020 [Group B = 29 patients]). Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) results were collected on the first day of hospitalization. Post-operative pain was assessed using the numerical rating scale (NRS) and visual analogic scale (VAS) after surgery in the post-anesthesia care unit (PACU) and at 24 hours. Functional outcomes were evaluated at the one-month follow-up. Demographic, pathological and peri-operative data were collected for all patients. RESULTS There were no significant differences in demographics and pathological characteristics amongst the groups. We observed that patients in Group A had a statistically lower value on the PHQ-9 and GAD-7 questionnaires than patients of Group B. Moreover, Group A showed statistically significant better post-operative pain control in PACU and at 24 hours. At one-month follow-up, patients in Group B required more diapers for incontinence than Group A, showing poor early continence. Patients in Group A showed interest in sexual rehabilitation after 1.11 ±.320 months while patients in Group B after 2.59 ±.712 months (p <.001). Moreover, 17 out of 29 patients (58.62%) in Group B were referred to an andrologist, compared to 100% of patients from Group A (p = 0.0006). CONCLUSIONS Social distancing during the COVID-19 pandemic is associated with a poor pre-operative emotional state, as well as influencing post-operative pain, early urinary continence and desire for sexual rehabilitation.
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Affiliation(s)
| | - Marco Fabiano
- AORN A. Cardarelli, Department of Urology, Naples, Italy
| | | | | | | | - Paolo Fedelini
- AORN A. Cardarelli, Department of Urology, Naples, Italy
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Khalil H, Shajrawi A, Dweik G, Zaghmouri A, Henker R. The impact of preoperative pain-related psychological factors on pain intensity post-surgery in Jordan. J Health Psychol 2020; 26:2876-2885. [PMID: 32597221 DOI: 10.1177/1359105320937067] [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: 01/04/2023] Open
Abstract
This study aimed to investigate the impact of preoperative psychological factors on postoperative pain. We included 300 postoperative patients who underwent open reduction and internal fixation surgery. Pain Scale, Pain Catastrophizing Scale, and Depression, Anxiety, and Stress Scale were completed by patients preoperatively and at 24 hours after surgery. Clinical characteristics were obtained from medical records. Data were analyzed using multiple linear regression. Postoperative pain was predicted by pain catastrophizing and anxiety symptoms. High preoperative catastrophizing and anxiety levels were associated with increased pain postoperatively. However, the relationships between preoperative depressive and stress symptoms and postoperative pain were not significant.
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Bajpai RR, Razdan S, Barack J, Sanchez MA, Razdan S. Ambulatory Robot-Assisted Laparoscopic Prostatectomy: Is It Ready for Prime Time? A Quality of Life Analysis. J Endourol 2019; 33:814-822. [PMID: 31286788 DOI: 10.1089/end.2019.0261] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the difference, if any, in the quality of life (QoL) at specified intervals in patients undergoing same day discharge (SDD, ambulatory) vs next day discharge (NDD) after robot-assisted laparoscopic prostatectomy (RALP). Materials and Methods: Two hundred consecutive patients underwent RALP with either SDD or NDD. They completed validated pain and health-related QoL questionnaires at predefined intervals postoperatively and results were compared between the two groups. Results: Pearson's coefficient revealed significant correlations between the time of discharge and physical well-being (r = -0.139; p = 0.005), emotional well-being (EWB) (r = -0.71; p < 0.001), functional assessment of cancer therapy-general (FACT-G) (r = -0.367; p < 0.001), functional assessment of cancer therapy-prostate (FACT-P) (r = -0.273; p < 0.001), pain severity score (PSS) (r = 0.237; p < 0.001), and pain interference score (PIS) (r = 0.214; p < 0.001). Student's t-test revealed significant (p < 0.001) difference in the means of PSS, PIS, EWB, FACT-G, and FACT-P between both groups. Time of discharge was found to be an independent significant predictor (p < 0.01) of PSS and PIS. Pearson's coefficients revealed that PSS had significant correlations with age (r = -0.60; p < 0.001), body mass index (r = 0.87; p < 0.001), and console time (CT) (r = 0.63; p < 0.001). CT also correlated with the estimated blood loss (r = 0.65; p < 0.001). Conclusions: Patients who were discharged the same day as their RALP had lesser pain and interference in general activity scores 2 days after discharge and had better perceived overall health than patients who were discharged on postoperative day 1.
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Affiliation(s)
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin Barack
- Department of Anesthesia, MiVIP Miami Medical Group, Miami, Florida
| | - Marcos A Sanchez
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, Florida
| | - Sanjay Razdan
- Department of Urology, International Robotic Prostatectomy Institute, Doral, Florida
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Rutström E, Söndergaard S, Lundborg C, Ene K. Postoperative pain experience, pain treatment and recovery after lumbar fusion and fixation surgery. Int J Orthop Trauma Nurs 2019; 34:3-8. [PMID: 30846358 DOI: 10.1016/j.ijotn.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/16/2019] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Eva Rutström
- The Sahlgrenska Academy at Gothenburg University, Institute of Health and Care Sciences, SE 413 46, Gothenburg, Sweden.
| | - Sören Söndergaard
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lundborg
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Ene
- The Sahlgrenska Academy at Gothenburg University, Institute of Health and Care Sciences, SE 413 46, Gothenburg, Sweden
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Yan J, Qiu T, Lu J, Wu Y, Yang Y. Microwave ablation induces a lower systemic stress response in patients than open surgery for treatment of benign thyroid nodules. Int J Hyperthermia 2018; 34:606-610. [PMID: 29366346 DOI: 10.1080/02656736.2018.1427286] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this study, we compared the systemic stress response induced by microwave ablation with that induced by conventional open surgery for treatment of benign thyroid nodules. METHODS A total of 108 patients with benign thyroid nodules were randomly assigned to receive ultrasound-guided thyroid microwave ablation (microwave group, n = 57) and conventional open thyroid surgery (open group, n = 51). Body temperature, white blood cell (WBC) counts, visual analogue scale (VAS) scores for pain, and serum levels of high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and cortisol were measured at 24 h before operation and at 8 h, 24 h and 48 h after operation. RESULTS No significant between-group differences were observed with respect to preoperative body temperature, VAS scores, WBC counts, serum hs-CRP, IL-6 and cortisol levels. Patients in the open group exhibited higher body temperature at 24 h after operation and higher WBC counts at both 24 h and 48 h after operation, as compared to those in the microwave group. As compared with microwave ablation, open surgery was associated with significantly higher VAS scores, and significantly higher serum levels of hs-CRP, IL-6 and cortisol at all postoperative time-points (8 h, 24 h and 48 h). CONCLUSION Microwave ablation induces a lower systemic stress response than open surgery for treatment of benign thyroid nodules.
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Affiliation(s)
- Jing Yan
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Tihong Qiu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Jing Lu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Yanjun Wu
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
| | - Yinghong Yang
- a Department of General Surgery , Panzhihua Central Hospital , Panzhihua , China
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Affiliation(s)
- Seetharaman Hariharan
- Department of Clinical Surgical Sciences, The University of the West Indies, St Augustine, Trinidad & Tobago
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Sobol-Kwapinska M, Bąbel P, Plotek W, Stelcer B. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain 2016; 20:1573-1586. [DOI: 10.1002/ejp.886] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 12/11/2022]
Affiliation(s)
- M. Sobol-Kwapinska
- Department of Personality Psychology; The Catholic University of Lublin; Lublin Poland
| | - P. Bąbel
- Department of Psychology; The Jagiellonian University; Krakow Poland
| | - W. Plotek
- Department of Anesthesiology; The Poznan University of Medical Sciences; Poznan Poland
| | - B. Stelcer
- Department of Anesthesiology; The Poznan University of Medical Sciences; Poznan Poland
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Bradshaw P, Hariharan S, Chen D. Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean. Br J Pain 2016; 10:108-15. [PMID: 27551421 DOI: 10.1177/2049463716635680] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. DESIGN AND METHODS A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. RESULTS A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. CONCLUSION The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.
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Affiliation(s)
- Prisca Bradshaw
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
| | - Seetharaman Hariharan
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
| | - Deryk Chen
- Anaesthesia and Intensive Care Unit, Department of Clinical Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies at St. Augustine, St. Augustine, Trinidad and Tobago
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Children's and parents' perceptions of care during the peri-radiographic process when the child is seen for a suspected fracture. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Bedeutung präoperativer Angst für den postoperativen Verlauf bei urologischen Patienten. Schmerz 2015; 30:166-73. [DOI: 10.1007/s00482-015-0023-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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The Impact of Assessment and Reassessment Documentation on the Trajectory of Postoperative Pain Severity: A Pilot Study. Pain Manag Nurs 2014; 15:652-63. [DOI: 10.1016/j.pmn.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/11/2013] [Accepted: 07/12/2013] [Indexed: 12/13/2022]
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Ntritsou V, Mavrommatis C, Kostoglou C, Dimitriadis G, Tziris N, Zagka P, Vasilakos D. Effect of perioperative electroacupuncture as an adjunctive therapy on postoperative analgesia with tramadol and ketamine in prostatectomy: a randomised sham-controlled single-blind trial. Acupunct Med 2014; 32:215-22. [PMID: 24480836 DOI: 10.1136/acupmed-2013-010498] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study the analgesic effect of electroacupuncture (EA) as perioperative adjunctive therapy added to a systemic analgesic strategy (including tramadol and ketamine) for postoperative pain, opioid-related side effects and patient satisfaction. METHODS In a sham-controlled participant- and observer-blinded trial, 75 patients undergoing radical prostatectomy were randomly assigned to two groups: (1) EA (n=37; tramadol+ketamine+EA) and (2) control (n=38; tramadol+ketamine). EA (100 Hz frequency) was applied at LI4 bilaterally during the closure of the abdominal walls and EA (4 Hz) was applied at ST36 and LI4 bilaterally immediately after extubation. The control group had sham acupuncture without penetration or stimulation. The following outcomes were evaluated: postoperative pain using the Numerical Rating Scale (NRS) and McGill Scale (SF_MPQ), mechanical pain thresholds using algometer application close to the wound, cortisol measurements, rescue analgesia, Spielberger State Trait Anxiety Inventory (STAI Y-6 item), patient satisfaction and opioid side effects. RESULTS Pain scores on the NRS and SF_MPQ were significantly lower and electronic pressure algometer measurements were significantly higher in the EA group than in the control group (p<0.001) at all assessments. In the EA group a significant decrease in rescue analgesia was observed at 45 min (p<0.001) and a significant decrease in cortisol levels was also observed (p<0.05). Patients expressed satisfaction with the analgesia, especially in the EA group (p<0.01). Significant delays in the start of bowel movements were observed in the control group at 45 min (p<0.001) and 2 h (p<0.05). CONCLUSIONS Adding EA perioperatively should be considered an option as part of a multimodal analgesic strategy.
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Affiliation(s)
- Vagia Ntritsou
- Department of Anaesthesiology, General Hospital of Thessaloniki "G. Gennimatas", Thessaloniki, Greece
| | - Christos Mavrommatis
- Department of Rheumatology, General Hospital of Athens "Evaggelismos", Athens, Greece
| | - Christos Kostoglou
- Department of Anaesthesiology, General Hospital of Thessaloniki "G. Gennimatas", Thessaloniki, Greece
| | - Georgios Dimitriadis
- Department of Urology, General Hospital of Thessaloniki "G. Gennimatas", Thessaloniki, Greece
| | - Nikolaos Tziris
- Department of Surgery, University Hospital of Thessaloniki "Ahepa", Thessaloniki, Greece
| | - Poulcheria Zagka
- Department of Biopathology, General Hospital of Thessaloniki "G. Gennimatas", Thessaloniki, Greece
| | - Dimitrios Vasilakos
- Department of Anaesthesiology and Intensive Care, University Hospital of Thessaloniki "Ahepa", Thessaloniki, Greece
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Reich DL, Porter C, Levin MA, Lin HM, Patel K, Fallar R, Serban S, Chai E, Nash IS, Vezina M, Silverstein JH. Data-Driven Interdisciplinary Interventions to Improve Inpatient Pain Management. Am J Med Qual 2012; 28:187-95. [DOI: 10.1177/1062860612457425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Hung-Mo Lin
- Mount Sinai School of Medicine, New York, NY
| | - Kash Patel
- Mount Sinai School of Medicine, New York, NY
| | | | | | - Emily Chai
- Mount Sinai School of Medicine, New York, NY
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Postoperative pain trajectories in cardiac surgery patients. PAIN RESEARCH AND TREATMENT 2012; 2012:608359. [PMID: 22448322 PMCID: PMC3289864 DOI: 10.1155/2012/608359] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/20/2011] [Accepted: 10/04/2011] [Indexed: 11/17/2022]
Abstract
Poorly controlled postoperative pain is a longstanding and costly problem in medicine. The purposes of this study were to characterize the acute pain trajectories over the first four postoperative days in 83 cardiac surgery patients with a mixed effects model of linear growth to determine whether statistically significant individual differences exist in these pain trajectories, and to compare the quality of measurement by trajectory with conventional pain measurement practices. The data conformed to a linear model that provided slope (rate of change) as a basis for comparing patients. Slopes varied significantly across patients, indicating that the direction and rate of change in pain during the first four days of recovery from surgery differed systematically across individuals. Of the 83 patients, 24 had decreasing pain after surgery, 24 had increasing pain, and the remaining 35 had approximately constant levels of pain over the four postoperative days.
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Riant T, Rigaud J, Delavierre D, Sibert L, Labat JJ. [Predictive factors and prevention of chronic postoperative pelvic and perineal pain]. Prog Urol 2010; 20:1145-57. [PMID: 21056397 DOI: 10.1016/j.purol.2010.08.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 08/16/2010] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chronic postoperative pain has been defined as pain arising after a surgical operation, present for at least 2 months, with no organic (active cancer or chronic infection) or preexisting cause. The purpose of this article is to review the risk factors and prevention of chronic postoperative pelvic and perineal pain. MATERIAL AND METHODS A review of the literature was performed by searching PubMed for articles on risk factors and prevention of chronic postoperative pelvic and perineal pain. RESULTS Chronic postoperative pain is frequent, disabling and represent a high cost to the community. This pain is generated by variable and complex interactions between the surgical procedure (the operated zone, perioperative management, the disease requiring the operative procedure) and the patient (age, gender, genetics, concomitant diseases, personal history). The multifactorial nature of chronic postoperative pain suggests the need for multidisciplinary management with prevention and reduction of the main risk factors. Similarly, appropriate management of acute postoperative pain has a major impact on the risk of chronic pain. CONCLUSION A good knowledge of the risk factors and appropriate prevention can decrease the incidence and consequences of chronic postoperative pain.
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Affiliation(s)
- T Riant
- Unité d'évaluation et de traitement de la douleur, centre Catherine-de-Sienne, 44000 Nantes, France
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