Effects of Patient and Surgery Characteristics on Persistent Postoperative Pain

AbstractBackgroundPersistent pain after hernia repair is widely recognised as a considerable problem, although the natural course of postoperative pain is not fully understood. The aim of the present study was to explore the natural course of persistent pain after hernia repair in a population-based cohort and identify risk factors for prolonged pain duration.MethodsThe study cohort was assembled from the Swedish Hernia Register (SHR), which has compiled detailed information on more than 140 000 groin hernia repairs since 1992. All patients operated on for groin hernia in the County of Uppsala, Sweden, 1998–2004 were identified in the SHR. Those who were still alive in 2005 received the Inguinal Pain Questionnaire, a validated questionnaire with 18 items developed with the aim of assessing postherniorrhaphy pain, by mail. Reminders were sent to non-responders 5 months after the first mail. The halving time was estimated from a linear regression of the logarithmic transformation of the prevalence of pain each year after surgery. A multivariate analysis with pain persisting more than 1 month with a retrospective question regarding time to pain cessation as dependent variable was performed.ResultsAltogether 2834 repairs in 2583 patients were recorded, 162 of who had died until 2005. Of the remaining patients, 1763 (68%) responded to the questionnaire. In 6.7 years the prevalence of persistent pain had decreased by half for the item “pain right now” and in 6.8 years for the item “worst pain last week”. The corresponding figures if laparoscopic repair was excluded were 6.4 years for “pain right now” and 6.4 years for “worst pain past week”. In a multivariate analysis, low age, postoperative complication and open method of repair were found to predict an increased risk for pain persistence exceeding 1 month.ConclusionPersistent postoperative pain is a common problem following hernia surgery, although it often recedes with time. It is more protracted in young patients, following open repair and after repairs with postoperative complications. Whereas efforts to treat persistent postoperative pain, in particular neuropathic pain, are often fruitless, this group can at least rely on the hope that the pain, for some of the patients, gradually decreases with time. On the other hand, 14% still reported a pain problem 7 years after hernia surgery. We do not know the course after that.Although no mathematical model can provide a full understanding of such a complex process as the natural course of postoperative pain, assuming an exponential course may help to analyse the course the first years after surgery, enable comparisons with other studies and give a base for exploring factors that influence the duration of the postoperative pain. Halving times close to those found in our study could also be extrapolated from other studies, assuming an exponential course.

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Identification of biological risk factors for persistent postoperative pain after total knee arthroplasty

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-102953 ◽

2021 ◽

pp. rapm-2021-102953

Author(s):

Alexandra Sideris ◽

Michael-Alexander Malahias ◽

George Birch ◽

Haoyan Zhong ◽

Valeria Rotundo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Synovial Fluid ◽

Knee Arthroplasty ◽

Persistent Pain ◽

Patient Specific ◽

Multiple Time ◽

Cytokine Levels ◽

Total Knee ◽

Persistent Postoperative Pain

BackgroundThere is growing evidence that cytokines and adipokines are associated with osteoarthritis (OA) severity, progression, and severity of associated pain. However, the cytokine response to total knee arthroplasty (TKA) and its association with persistent postoperative pain is not well understood. This study aims to describe the perioperative systemic (plasma) and local (synovial fluid) cytokine profiles of patients who do and do not develop persistent pain after TKA.MethodsPatients undergoing primary unilateral TKA for end-stage OA were prospectively enrolled. Demographic and clinical data were gathered preoperatively and postoperatively. Synovial fluid was collected pre arthrotomy and plasma was collected at multiple time points before and after surgery. Persistent postoperative pain (PPP) was defined as Numerical Rating Score≥4 at 6 months. Cytokine levels were measured using the V-Plex Human Cytokine 30-Plex Panel (Mesoscale—Rockville, Maryland, USA). Cytokine levels were compared between PPP and minimal pain groups. Given that the study outcomes are exploratory, no adjustment was performed for multiple testing.ResultsIncidence of persistent pain at 6 months post TKA was 15/162 (9.3%). Postoperative plasma levels of four cytokines were significantly different in patients who developed persistent postoperative pain: interleukin (IL)-10, IL-1β, vascular endothelial growth factor, and IL12/IL23p40. Significantly lower IL-10 levels in the prearthrotomy synovial fluid were associated with development of postoperative persistent pain.ConclusionsThis prospective cohort study described a distinct acute perioperative inflammatory response profile in patients who developed persistent post-TKA pain, characterized by significant differences in four cytokines over the first 2 postoperative days. These results support the growing evidence that the patient-specific biologic response to surgery may influence longer-term clinical outcomes after TKA.Trial registration numberClinicaltrials.gov NCT02626533.

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Persistent postoperative pain after total knee arthroplasty: a prospective cohort study of potential risk factors

British Journal of Anaesthesia ◽

10.1016/j.bja.2018.05.070 ◽

2018 ◽

Vol 121 (4) ◽

pp. 804-812 ◽

Cited By ~ 23

Author(s):

D.A. Rice ◽

M.T. Kluger ◽

P.J. McNair ◽

G.N. Lewis ◽

A.A. Somogyi ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Cohort Study ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Potential Risk ◽

Prospective Cohort ◽

Potential Risk Factors ◽

Total Knee ◽

Persistent Postoperative Pain

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Persistent postoperative pain after ambulatory paediatric surgery

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001011 ◽

2019 ◽

Vol 36 (10) ◽

pp. 797-798

Author(s):

Corinne Lejus-Bourdeau ◽

Remi Bernardon ◽

Camille Vissac ◽

Olivier Jacqmarcq

Keyword(s):

Postoperative Pain ◽

Paediatric Surgery ◽

Persistent Postoperative Pain

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Incidence of persistent postoperative pain after hepatectomies with 2 regimes of perioperative analgesia containing ketamine

Medicine ◽

10.1097/md.0000000000006624 ◽

2017 ◽

Vol 96 (15) ◽

pp. e6624 ◽

Cited By ~ 2

Author(s):

Paula Masgoret ◽

Carmen Gomar ◽

Beatriz Tena ◽

Pilar Taurá ◽

José Ríos ◽

...

Keyword(s):

Postoperative Pain ◽

Perioperative Analgesia ◽

Persistent Postoperative Pain

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Thermography in persistent postoperative pain after knee surgery

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00330 ◽

2020 ◽

Vol 8 (5_suppl4) ◽

pp. 2325967120S0033

Author(s):

David Friedrich ◽

Manuel Köhne

Keyword(s):

Postoperative Pain ◽

Control Region ◽

Local Anaesthesia ◽

Level Of Evidence ◽

Total N ◽

Diagnosis And Therapy ◽

Significant Difference ◽

Thermographic Image ◽

Persistent Postoperative Pain ◽

The Difference

Aims and Objectives: Background: Postoperative persistent pain occurs in approximately 10% of surgically treated patients. It incapacitates and reduces quality of life in those affected. The aetiology is poorly understood, predictive factors are currently unknown, diagnosis and therapy are difficult. Objectives: To evaluate the benefit of dermal thermography in the diagnosis and therapy of persistent postoperative pain. Study design: retrospective, Level of evidence IV Materials and Methods: A single surgeon performed highly standardized ACL reconstructions, arthroscopies and total endoprotheses of the knee. Patients were seen six weeks postoperative for clinical and thermographic evaluation. Regions of interest were defined for the affected knee, a control region defined for the contralateral knee. The thermographic image was used to pinpoint a site for subcutaneous local anaesthesia. The clinical evaluation was then repeated. Results: Patients in total (n=133), arthroscopy (n=21), total endoprothesis (n=42), ACL (n=50). If the temperature difference (TD) between the site of pathology and the average ipsilateral knee temperature was negative, pathology was classified as hypothermic (n=19), otherwise hyperthermic (n=94). Arthroscopically treated patients showed a TD of 0,88 ± 0,39 °C in hyperthermic (n=12) and -0,811 ± 0,623 °C in hypothermic (n=9) knees. Prosthetically treated patients showed a TD of 1,29 ± 0,51 °C in hyperthermic (n=37) and -0,88 ± 0,33 °C in hypothermic (n=5) knees. ACL treated patients showed a TD of 1,20 ± 0,48 °C in hyperthermic (n=45) and -0,62 ± 0,41 °C in hypothermic (n=5) knees. The difference in temperature between the site of pathology and the average temperature of the ipsilateral knee was significant for all subgroups: arthroscopy-hypothermic p < 0,001, arthroscopy-hypothermic p < 0,005; endoprothesis-hyperthermic p < 0,001, endoprothesis-hypothermic p < 0,004; ACL-hyperthermic p < 0,001, ACL-hypothermic p < 0,027. In contrast to the hyperthermic groups (for all p < 0,001), there was no significant difference between the site of pathology and the contralateral control region in the hypothermic groups. All patients reported a reduction of pain and better mobility after subcutaneous infiltration with Scandicain 2% at the thermographically defined site of pathology. Conclusion: Thermography is useful to pinpoint sites of pathology in persistent postoperative pain. Two types of thermal abnormality could be identified at the site of pathology: hypo- and hyperthermic. Local anaesthesia at the site of pathology resulted in pain reduction and improved mobility. Further studies are necessary to understand the postoperative thermal changes in order to devise a suitable therapy.

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Persistent postoperative pain and healthcare costs associated with instrumented and non-instrumented spinal surgery: a case-control study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01633-6 ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Sharada Weir ◽

Mihail Samnaliev ◽

Tzu-Chun Kuo ◽

Travis S. Tierney ◽

Andrea Manca ◽

...

Keyword(s):

Postoperative Pain ◽

Spinal Surgery ◽

Healthcare Costs ◽

Case Control Study ◽

Case Control ◽

Persistent Postoperative Pain ◽

Control Study

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Ketamine for pain

F1000Research ◽

10.12688/f1000research.11372.1 ◽

2017 ◽

Vol 6 ◽

pp. 1711 ◽

Cited By ~ 24

Author(s):

Kelly Jonkman ◽

Albert Dahan ◽

Tine van de Donk ◽

Leon Aarts ◽

Marieke Niesters ◽

...

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Side Effects ◽

Postoperative Pain ◽

Cancer Pain ◽

Literature Search ◽

Analgesic Agent ◽

Aspartate Receptor ◽

Persistent Postoperative Pain ◽

Meta Analyses

The efficacy of theN-methyl-D-aspartate receptor antagonist ketamine as an analgesic agent is still under debate, especially for indications such as chronic pain. To understand the efficacy of ketamine for relief of pain, we performed a literature search for relevant narrative and systematic reviews and meta-analyses. We retrieved 189 unique articles, of which 29 were deemed appropriate for use in this review. Ketamine treatment is most effective for relief of postoperative pain, causing reduced opioid consumption. In contrast, for most other indications (that is, acute pain in the emergency department, prevention of persistent postoperative pain, cancer pain, and chronic non-cancer pain), the efficacy of ketamine is limited. Ketamine’s lack of analgesic effect was associated with an increase in side effects, including schizotypical effects.

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