How to Study Chronic Postsurgical Pain: The Example of Neuropathic Pain

2014 ◽  
pp. 3-12
Author(s):  
C. Dubray
Keyword(s):  
Neuropathic Pain ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals Post-episiotomy chronic neuropatic pain: Postpartal chronic neuropathic pain

2020 ◽  
Vol 42 (5-6) ◽  
pp. 109-114
Author(s):  
Jelena Jovičić ◽  
Bojan Čegar ◽  
Nataša Petrović ◽  
Nikola Lađević ◽  
Branka Gvozdić ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Psychosocial Functioning ◽  
Current Treatment ◽  
Social Model ◽  
Health Providers ◽  
Postsurgical Pain ◽  
Pain Specialist ◽  
Epidemiological Surveys ◽  
Chronic Postsurgical Pain

Introduction: Chronic postsurgical pain has an estimated mean incidence of 30% and varies according to the type of surgery and patient characteristics. The pain can be severe and result in clinically relevant functional impairment reported by 5-10% of patients. Epidemiological surveys have shown that many patients with neuropathic pain do not receive appropriate treatment. Bio-psycho-social model of chronic pain is highly expressive in neuropathic pain management and requires the adjustment of the therapeutic approach. Case Report: A 37-year-old female complained of numbness, burning, and discomfort of the perineum. In 2016, after the vaginal baby delivery followed by episiotomy, she experienced discomfort and variety of painful sensations in the episiotomy incision region. A year later, after a hemorrhoid surgery followed by episiotomy scar reconstruction symptoms intensified with a strong influence on the patient's psychosocial condition. Consultation of obstetrician, psychiatrist and neurologist took part. Nevertheless, after two years had passed without significant clinical improvement, the patient was referred to a pain specialist. The pain specialist noticed inconsistency in the current treatment and the pain assessment was done only by one specialist. Testing revealed severe symptoms of hyperalgesia and allodynia, impaired psychosocial functioning related to chronic postsurgical pain. Pregabalin and duloxetine were introduced into the therapy and significantly improved pain relief and psychosocial functioning. Conclusion: Chronic postsurgical neuropathic pain is a complex syndrome which is not necessarily related to extensive surgical stimulus. The multidisciplinary therapy approach is crucial. Health providers who understand bio-psycho-social origin of chronic pain should be members of a multidisciplinary team.

Chronic postsurgical pain and complex regional pain syndrome

2021 ◽  
pp. 289-291
Author(s):  
Lesley A. Colvin ◽  
Sebastian Bourn
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
International Association ◽  
Emotional Experience ◽  
Adult Population ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Acute pain is predictable following surgical intervention; chronic pain is less so. Chronic pain, persisting for longer than 3 months, or beyond expected wound healing, is a worldwide problem affecting around 20% of the adult population. Chronic postsurgical pain is multifactorial, although it often involves some form of nerve damage, with clinical signs consistent with this. Neuropathic pain may have a greater impact on quality of life than other chronic pain syndromes. It is important, therefore, to identify neuropathic pain as early as possible, in order to initiate appropriate management and reduce longer-term impact. This chapter focuses on two types of neuropathic pain: chronic postsurgical pain and complex regional pain syndrome.

The different mechanisms of peripheral and central TLR4 on chronic postsurgical pain in rats

2021 ◽  
Author(s):  
Xuemin Han ◽  
Jinping Shao ◽  
Xiuhua Ren ◽  
Yaru Li ◽  
Wenli Yu ◽  
...  
Keyword(s):  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nina Graf ◽  
Katharina Geißler ◽  
Winfried Meißner ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Postsurgical Pain ◽  
Average Pain Intensity ◽  
Chronic Postsurgical Pain ◽  
Average Pain ◽  
Patients At Risk ◽  
Perioperative Assessment ◽  
Numeric Rating

AbstractData on chronic postsurgical pain (CPSP) after otorhinolaryngological surgery are sparse. Adult in-patients treated in 2017 were included into the prospective PAIN OUT registry. Patients’ pain on the first postoperative day (D1), after six months (M6) and 12 months (M12) were evaluated. Determining factor for CPSP was an average pain intensity ≥ 3 (numeric rating scale 0–10) at M6. Risk factors associated with CPSP were evaluated by univariate and multivariate analyses. 10% of 191 included patients (60% male, median age: 52 years; maximal pain at D1: 3.5 ± 2.7), had CPSP. Average pain at M6 was 0.1 ± 0.5 for patients without CPSP and 4.2 ± 1.2 with CPSP. Average pain with CPSP still was 3.7 ± 1.1 at M12. Higher ASA status (Odds ratio [OR] = 4.052; 95% confidence interval [CI] = 1.453–11.189; p = 0.007), and higher minimal pain at D1 (OR = 1.721; CI = 1.189–2.492; p = 0.004) were independent predictors of CPSP at M6. Minimal pain at D1 (OR = 1.443; CI = 1.008–2.064; p = 0.045) and maximal pain at M6 (OR = 1.665; CI = 1.340–2.069; p < 0.001) were independent predictors for CPSP at M12. CPSP is an important issue after otorhinolaryngological surgery. Better instrument for perioperative assessment should be defined to identify patients at risk for CPSP.

scholarly journals Thoracic Paravertebral Blockade Reduces Chronic Postsurgical Pain in Breast Cancer Patients: A Randomized Controlled Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3539-3547
Author(s):  
Zeng-Mao Lin ◽  
Mu-Han Li ◽  
Feng Zhang ◽  
Xue Li ◽  
Chun-Li Shao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trial ◽  
Neuropathic Pain ◽  
Controlled Trial ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Single Shot ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Objective To evaluate the effect of multilevel single-shot thoracic paravertebral blockade (PVB) on the occurrence of chronic postsurgical pain (CPSP) in patients undergoing breast cancer surgery. Design A randomized controlled trial with two parallel groups. Setting A tertiary hospital. Methods Patients scheduled for breast cancer surgery were randomized to receive either ultrasound-guided multilevel single-shot PVB from T2 to T5 (the PVB group) or nothing (the control group). Surgery was then performed under general anesthesia. Patients were followed up for 12 months after surgery. The primary end point was incidence of CPSP at six months after surgery. Results A total of 218 patients were enrolled and randomized; of these, 208 and 204 completed six- and 12-month follow-up, respectively. The incidence of CPSP at six months was significantly lower in the PVB group (12.5% [13/104]) than in the control group (24.0% [25/104], relative risk = 0.52, 95% CI = 0.28–0.96, P = 0.031). Pain scores within 48 hours both at rest and with movement were lower in the PVB group than the control group (P = 0.006 and P &lt; 0.001, respectively). The percentages of patients with neuropathic pain were also lower in the PVB group than the control group at both six and 12 months after surgery (P = 0.016 and 0.028, respectively). Adverse events did not differ between groups. Conclusions For patients undergoing breast cancer surgery, multilevel single-shot PVB reduces the incidence of CPSP at six months; it also improves early postoperative analgesia and reduces neuropathic pain at six and 12 months after surgery.

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