Chronic pain in children after cardiac surgery via sternotomy

AbstractIntroductionChronic pain is common after sternotomy in adults with reported prevalence rates of 20–50%. So far, no studies have examined whether children develop chronic pain after sternotomy.Material and methodsPostal questionnaires were sent to 171 children 10–60 months after undergoing cardiac surgery via sternotomy at the age of 0–12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.ResultsA total of 121 children, median (range) age 7.7 (4.2–16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0–12.9) years, and the follow-up period was median (range) 4 (0.8–5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0–10). Quantitative sensory testing of the scar area revealed sensory abnormalities – pinprick hyperalgesia and brush and cold allodynia – in 10 out of 13 children.ConclusionChronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.

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The Relationship Between Plasma BDNF and Pain in Older Adults With Knee Osteoarthritis

Biological Research For Nursing ◽

10.1177/10998004211012479 ◽

2021 ◽

pp. 109980042110124

Author(s):

Setor K. Sorkpor ◽

Kelli Galle ◽

Antonio L. Teixeira ◽

Gabriela D. Colpo ◽

Brian Ahn ◽

...

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Quantitative Sensory Testing ◽

Rating Scale ◽

Secondary Analysis ◽

Numeric Rating Scale ◽

Sensory Testing ◽

Knee Oa ◽

Heat Pain Threshold ◽

The Relationship

Osteoarthritis (OA) is the most prevalent cause of chronic pain and disability in people aged ≥45 years, with the knee being the most affected joint. Neurotrophic factors like brain-derived neurotrophic factor (BDNF), which promotes neurogenesis and neuroplasticity, have been shown to significantly affect chronic pain. This study aimed to investigate the relationship between resting plasma BDNF levels and clinical pain and quantitative sensory testing measures in older adults with knee OA pain. For this secondary analysis, a previously reported dataset was used comprised of older adults with knee OA who underwent quantitative sensory testing. A comprehensive generalized linear model (GLM) was built to understand the relationships between BDNF and important covariates, followed by the elastic net (EN) method for variable selection. GLM was then performed to regress BDNF levels against only the variables selected by EN. The mean age of the sample was 60.4 years ( SD = 9.1). Approximately half of the participants were female (53%). Plasma BDNF levels were positively associated with heat pain threshold and the numeric rating scale of pain. Future mechanistic studies are needed to replicate and extend these findings to advance our knowledge of the underlying mechanisms of BDNF in knee OA and other chronic pain conditions.

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A Survey of Chronic Pain Due to Spinal Dural Arteriovenous Fistulae

Neurosurgery ◽

10.1227/neu.0000000000000745 ◽

2015 ◽

Vol 77 (1) ◽

pp. 113-118 ◽

Cited By ~ 7

Author(s):

Toru Sasamori ◽

Kazutoshi Hida ◽

Toshiya Osanai ◽

Shunsuke Yano ◽

Toshitaka Seki ◽

...

Keyword(s):

Chronic Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Leg Pain ◽

Spontaneous Pain ◽

Resonance Imaging ◽

Spinal Cord Atrophy ◽

The Mean ◽

Numeric Rating

Abstract BACKGROUND: Chronic pain due to spinal dural arteriovenous fistulae (SDAVF) during follow-up is a serious issue because it can affect patients' quality of life. The severity of posttreatment chronic leg pain in patients with SDAVF is unclear. OBJECTIVE: To investigate the prevalence, severity, and characteristics of chronic leg pain in patients with SDAVF and to examine the clinical factors associated with chronic pain. METHODS: We conducted a survey of their chronic posttreatment leg pain in 49 SDAVF patients. It consisted of a numeric rating scale and a neuropathic pain symptom inventory (NPSI). Of the 49 patients, 32 (65.3%) completed the questionnaire. There were 24 males and 8 females whose mean age was 69.1 years. The mean follow-up period was 86.3 months. RESULTS: Chronic leg pain was reported by 26 (81.3%) of 32 patients; 14 experienced pain before treatment and 12 had new-onset posttreatment pain. The pain was reported as moderate to severe by 21 (80.8%) of 26 patients; the mean numeric rating scale and NPSI scores were 6.0 ± 2.3 and 17.4 ± 10.3, respectively. The NPSI subscores were significantly higher for spontaneous pain and paresthesia/dysesthesia than for paroxysmal pain. We found no significant clinical factors related to chronic posttreatment pain; on magnetic resonance imaging scans we identified spinal cord atrophy in 8 patients with chronic pain. CONCLUSION: Most of our SDAVF patients reported moderate to severe chronic leg pain characterized by spontaneous pain and paresthesia/dysesthesia. Spinal cord atrophy on magnetic resonance imaging scans was a characteristic in patients with chronic pain.

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Relationship between acute pain trajectories after an emergency department visit and chronic pain: a Canadian prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040390 ◽

2020 ◽

Vol 10 (12) ◽

pp. e040390

Author(s):

Raoul Daoust ◽

Jean Paquet ◽

Alexis Cournoyer ◽

Éric Piette ◽

Judy Morris ◽

...

Keyword(s):

Chronic Pain ◽

Cohort Study ◽

Pain Intensity ◽

Acute Pain ◽

Severe Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Pain Trajectories ◽

Numeric Rating

ObjectivesInadequate acute pain management can reduce the quality of life, cause unnecessary suffering and can often lead to the development of chronic pain. Using group-based trajectory modelling, we previously identified six distinct pain intensity trajectories for the first 14-day postemergency department (ED) discharge; two linear ones with moderate or severe pain during follow-up (~40% of the patients) and four cubic polynomial order trajectories with mild or no pain at the end of the 14 days (low final pain trajectories). We assessed if previously described acute pain intensity trajectories over 14 days after ED discharge are predictive of chronic pain 3 months later.DesignProspective cohort study.SettingTertiary care trauma centre academic hospital.ParticipantsThis study included 18 years and older ED patients who consulted for acute (≤2 weeks) pain conditions that were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity (0–10 numeric rating scale).OutcomesThree months after ED visit, participants were questioned by phone about their current pain intensity (0–10 numeric rating scale). Chronic pain was defined as patients with current pain intensity ≥4 at 3 months.ResultsA total of 305 participants remained in the study at 3 months, 49% were women and a mean age of 55±15 years. Twelve per cent (11.9; 95% CI 8.2 to 15.4) of patients had chronic pain at the 3-month follow-up. Controlling for age, sex and pain condition, patients with moderate or severe pain trajectories and those with only a severe pain trajectory were respectively 5.1 (95% CI 2.2 to 11.8) and 8.2 (95% CI 3.4 to 20.0) times more likely to develop chronic pain 3 months later compared with patients in the low final pain trajectories.ConclusionSpecific acute pain trajectories following an ED visit are closely related to the development of chronic pain 3 months later.Trial registration numberNCT02799004; Results.

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Quantitative Sensory Testing in Animal Models of Chronic Pain: A Pilot Study

10.1055/s-0038-1660884 ◽

2018 ◽

Author(s):

B. Monteiro ◽

M. Moreau ◽

C. Otis ◽

L. De Lorimier ◽

J. Pelletier ◽

...

Keyword(s):

Chronic Pain ◽

Pilot Study ◽

Animal Models ◽

Quantitative Sensory Testing ◽

Sensory Testing

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Quantitative Sensory Testing of Spinal Cord and Dorsal Root Ganglion Stimulation in Chronic Pain Patients

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13329 ◽

2021 ◽

Author(s):

Vishwanath Sankarasubramanian ◽

Srinivas Chiravuri ◽

Ehsan Mirzakhalili ◽

Carlos J. Anaya ◽

John Ryan Scott ◽

...

Keyword(s):

Spinal Cord ◽

Chronic Pain ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Quantitative Sensory Testing ◽

Sensory Testing ◽

Chronic Pain Patients ◽

Pain Patients

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Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽

10.1136/rmdopen-2020-001372 ◽

2020 ◽

Vol 6 (3) ◽

pp. e001372

Author(s):

Sella Aarrestad Provan ◽

Brigitte Michelsen ◽

Joseph Sexton ◽

Tillmann Uhlig ◽

Hilde Berner Hammer

Keyword(s):

Rheumatoid Arthritis ◽

Rating Scale ◽

Numeric Rating Scale ◽

Tender Joint Count ◽

Tender Joint ◽

Logistic Regression Models ◽

Patient Reported ◽

Biologic Dmard ◽

Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

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Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

Open Heart ◽

10.1136/openhrt-2020-001474 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001474

Author(s):

Ellaha Kakar ◽

Ryan J Billar ◽

Joost van Rosmalen ◽

Markus Klimek ◽

Johanna J M Takkenberg ◽

...

Keyword(s):

Systematic Review ◽

Cardiac Surgery ◽

Rating Scale ◽

Meta Analysis ◽

Numeric Rating Scale ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Music Intervention ◽

Opioid Use ◽

Beneficial Effects

ObjectivesPrevious studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery.MethodsFive electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated.ResultsTwenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01).ConclusionsOffering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.

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Ejaculatory Pain

Anesthesiology ◽

10.1097/01.anes.0000270736.28324.61 ◽

2007 ◽

Vol 107 (2) ◽

pp. 298-304 ◽

Cited By ~ 47

Author(s):

Eske K. Aasvang ◽

Bo Møhl ◽

Henrik Kehlet

Keyword(s):

Chronic Pain ◽

Sexual Dysfunction ◽

Quantitative Sensory Testing ◽

Groin Hernia ◽

Pain Treatment ◽

Detection Threshold ◽

Control Group ◽

Sensory Testing ◽

Detection Thresholds ◽

Pain Detection

Background Sexual dysfunction due to ejaculatory and genital pain after groin hernia surgery may occur in approximately 2.5% of patients. However, the specific psychosexological and neurophysiologic characteristics have not been described, thereby precluding assessment of pathogenic mechanisms and treatment strategies. Methods Ten patients with severe pain-related sexual dysfunction and ejaculatory pain were assessed in detail by quantitative sensory testing and interviewed by a psychologist specialized in evaluating sexual functional disorders and were compared with a control group of 20 patients with chronic pain after groin hernia repair but without sexual dysfunction, to identify sensory changes associated with ejaculatory pain. Results Quantitative sensory testing showed significantly higher thermal and mechanical detection thresholds and lowered mechanical pain detection thresholds in both groups compared with the nonpainful side. Pressure pain detection threshold and tolerance were significantly lower in the ejaculatory pain group compared with the control group. 'The maximum pain was specifically located at the external inguinal annulus in all ejaculatory pain patients, but not in controls. The psychosexual interview revealed no major psychosexual disturbances and concluded that the pain was of somatic origin. All patients with ejaculatory pain had experienced major negative life changes and deterioration in their overall quality of life and sexual function as a result of the hernia operation. Conclusions Postherniotomy ejaculatory pain and pain-related sexual dysfunction is a specific chronic pain state that may be caused by pathology involving the vas deferens and/or nerve damage. Therapeutic strategies should therefore include neuropathic pain treatment and/or surgical exploration.

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A Treatment-Based Classification Algorithm to Treat Achilles Tendinopathy: An Exploratory Case Series

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0033 ◽

2017 ◽

Vol 26 (3) ◽

pp. 260-268

Author(s):

Patti Syvertson ◽

Emily Dietz ◽

Monica Matocha ◽

Janet McMurray ◽

Russell Baker ◽

...

Keyword(s):

Outcome Measures ◽

Repeated Measures ◽

Rating Scale ◽

Case Series ◽

Numeric Rating Scale ◽

Achilles Tendinopathy ◽

Global Rating ◽

Physically Active ◽

Indirect Treatment

Context:Achilles tendinopathy is relatively common in both the general and athletic populations. The current gold standard for the treatment of Achilles tendinopathy is eccentric exercise, which can be painful and time consuming. While there is limited research on indirect treatment approaches, it has been proposed that tendinopathy patients do respond to indirect approaches in fewer treatments without provoking pain.Objective:To determine the effectiveness of using a treatment-based-classification (TBC) algorithm as a strategy for classifying and treating patients diagnosed with Achilles tendinopathy.Participants:11 subjects (mean age 28.0 ±15.37 y) diagnosed with Achilles tendinopathy.Design:Case series.Setting:Participants were evaluated, diagnosed, and treated at multiple clinics.Main Outcome Measures:Numeric Rating Scale (NRS), Disablement in the Physically Active Scale (DPA Scale), Victorian Institute of Sport Assessment–Achilles (VISA-A), Global Rating of Change (GRC), and Nirschl Phase Rating Scale were recorded to establish baseline scores and evaluate participant progress.Results:A repeated-measures ANOVA was conducted to analyze NRS scores from initial exam to discharge and at 1-mo follow-up. Paired t tests were analyzed to determine the effectiveness of using a TBC algorithm from initial exam to discharge on the DPA Scale and VISA-A. Descriptive statistics were evaluated to determine outcomes as reported on the GRC.Conclusion:The results of this case series provide evidence that using a TBC algorithm can improve function while decreasing pain and disability in Achilles tendinopathy participants.

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CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort

Pain Medicine ◽

10.1093/pm/pnaa122 ◽

2020 ◽

Vol 21 (11) ◽

pp. 3199-3204 ◽

Cited By ~ 1

Author(s):

Chrysanthi Batistaki ◽

Eleni Chrona ◽

Andreas Kostroglou ◽

Georgia Kostopanagiotou ◽

Maria Gazouli

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Adverse Effects ◽

Rating Scale ◽

Numeric Rating Scale ◽

Cyp2d6 Genotype ◽

Chronic Pain Patients ◽

Reduction Of Pain ◽

Pain Patients ◽

Numeric Rating

Abstract Objective To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. Design Prospective cohort study. Setting General hospital, pain management unit. Subjects Patients with chronic pain, treated with codeine or tramadol. Methods Patients’ pain was assessed at baseline (numeric rating scale [NRS]; 0–10). Prescription of codeine or tramadol was selected randomly. The assessment of patients’ response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients’ blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). Results Seventy-six consecutive patients were studied (20 males, 56 females), aged 21–85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). Conclusions Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

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