High Prevalence of Chronic Pain With Neuropathic Characteristics After Open Reduction and Internal Fixation of Ankle Fractures

Background: Unstable ankle fractures require treatment with open reduction and internal fixation (ORIF). Long-term functional outcome is satisfying in most patients; however, a number of patients have persistent complaints. Superficial nerve complications following ankle surgery may be the cause of chronic pain and disability. Methods: In this observational retrospective survey, a cohort of 527 women and men, who underwent ORIF in the period from January 2007 to January 2014, were invited to an online questionnaire. Pain symptoms were assessed using the McGill Pain Questionnaire (MPQ) and the Douleur Neuropathic en 4 Questions (DN4) Questionnaire. Descriptive statistics were used to present patient characteristics; a logistic regression model was used to analyze prognostic factors of neuropathic pain. A total of 271 patients completed the questionnaire. Mean follow-up period was 5.8 years (±1.9). Results: Persistent neuropathic pain symptoms were present in 61 of all patients, and 51 of these patients reported an impaired quality of life caused by their symptoms. In univariate analysis, the following parameters were associated with neuropathic pain: age, hypertension, a thyroid disorder, lower back pain, fracture dislocations, and late complications such as nonunion, posttraumatic arthritis, or osteochondral injury. In multivariate analysis, an age between 40 and 60 years was found to be a significant predictor of neuropathic pain. Hypertension, dislocation, and late complications were significant predictors of persistent pain without neuropathic characteristics. Conclusion: The present study demonstrated a prevalence of persistent neuropathic pain symptoms after ORIF for ankle fractures in 23% of the respondents, which caused an impaired health-related quality of life. We identified 4 significant predictors of chronic and neuropathic pain after ORIF. This knowledge may aid the treating surgeon to identify patients who are at increased risk of persistent postoperative neuropathic pain and may affect the treatment of pain in these patients. Level of Evidence: Level IV, retrospective case series.

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Buprenorphine: Far Beyond the “Ceiling”

Biomolecules ◽

10.3390/biom11060816 ◽

2021 ◽

Vol 11 (6) ◽

pp. 816

Author(s):

Rosmara Infantino ◽

Consalvo Mattia ◽

Pamela Locarini ◽

Antonio Luigi Pastore ◽

Sabatino Maione ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Drug Abuse ◽

Side Effects ◽

National Health System ◽

Analgesic Drugs ◽

Third Line ◽

Dynamic Profile

Chronic pain, including neuropathic pain, represents an untreated disease with important repercussions on the quality of life and huge costs on the national health system. It is well known that opioids are the most powerful analgesic drugs, but they represent the second or third line in neuropathic pain, that remain difficult to manage. Moreover, these drugs show several side effects that limit their use. In addition, opioids possess addictive properties that are associated with misuse and drug abuse. Among available opioids compounds, buprenorphine has been suggested advantageous for a series of clinical reasons, including the effectiveness in neuropathic pain. Some properties are partly explained by its unique pharmacological characteristics. However, questions on the dynamic profile remain to be answered. Pharmacokinetics optimization strategies, and additional potentialities, are still to be explored. In this paper, we attempt to conceptualize the potential undiscovered dynamic profile of buprenorphine.

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Neuropathic pain symptoms in inflammatory hand osteoarthritis (OA) lower quality of life and may require another approach than anti-inflammatory treatment

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2021.02.319 ◽

2021 ◽

Vol 29 ◽

pp. S237-S238

Author(s):

C. van der Meulen ◽

L.A. van de Stadt ◽

F.P. Kroon ◽

M.C. Kortekaas ◽

A. Boonen ◽

...

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Hand Osteoarthritis ◽

Anti Inflammatory ◽

Pain Symptoms

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Chronic Pain After Lung Resection: Risk Factors, Neuropathic Pain, and Quality of Life

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.03.012 ◽

2020 ◽

Vol 60 (2) ◽

pp. 326-335 ◽

Cited By ~ 1

Author(s):

Silvia Fiorelli ◽

Luigi Cioffi ◽

Cecilia Menna ◽

Mohsen Ibrahim ◽

Roberto A. De Blasi ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Chronic Pain ◽

Neuropathic Pain ◽

Lung Resection

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Evaluation of open reduction and internal fixation of proximal humerus fractures using a locking plate with smooth pegs – A retrospective study

Shoulder & Elbow ◽

10.1177/1758573218791166 ◽

2018 ◽

Vol 11 (6) ◽

pp. 411-418

Author(s):

Frida Hansson ◽

Magdalena Riddar ◽

Anders Ekelund

Keyword(s):

Quality Of Life ◽

Retrospective Study ◽

Internal Fixation ◽

Avascular Necrosis ◽

Open Reduction ◽

Locking Plate ◽

Constant Score ◽

Humeral Fracture ◽

The Mean

Background Optimal treatment of displaced proximal humeral fractures is controversial. This retrospective study aims to identify complications and clinical outcomes using a locking plate with smooth pegs instead of screws (S3 plate). Method Eighty-two patients with displaced proximal humeral fracture classified with 2–4 fragments (Neer’s classification) treated with open reduction and internal fixation (ORIF) with S3 plate were studied retrospectively. Clinical outcome according to constant score; Single Shoulder Value; Disabilities of Arm, Shoulder and Hand; and European Quality of life-5 dimensions and complication rate defined radiologically including peg penetration, avascular necrosis, and loss of reduction was assessed minimum 2.5 years after surgery. Results A total of 11 peg penetrations were identified (13.6%). Avascular necrosis was seen in 8.5% (n = 7). Mean constant score at follow-up was 64.4 with a relative constant score of 87% (standard deviation 18%) compared to the contralateral uninjured side. The mean Disabilities of Arm, Shoulder and Hand score was 12.7 and mean European Quality of life-5 dimensions score 0.83. The mean Single Shoulder Value was 78.3. No cases of deep infection were seen. Conclusions Fixation with S3 plate shows a proper osteosynthesis and the functional outcome is good. Symptomatic peg penetrations are rare and the incidence is lower compared to what has been reported with locked screws.

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Dorsal Root Ganglion (DRG) and Chronic Pain

Anesthesiology and Pain Medicine ◽

10.5812/aapm.113020 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Amnon A. Berger ◽

Yao Liu ◽

HarLee Possoit ◽

Anna C. Rogers ◽

Warner Moore ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Dorsal Root ◽

Randomized Trials ◽

Pain Treatment ◽

Common Condition ◽

Significant Morbidity ◽

Chronic Neuropathic Pain

Context: Chronic neuropathic pain is a common condition, and up to 11.9% of the population have been reported to suffer from uncontrolled neuropathic pain. Chronic pain leads to significant morbidity, lowered quality of life, and loss of workdays, and thus carries a significant price tag in healthcare costs and lost productivity. dorsal root ganglia (DRG) stimulation has been recently increasingly reported and shows promising results in the alleviation of chronic pain. This paper reviews the background of DRG stimulation, anatomical, and clinical consideration and reviews the clinical evidence to support its use. Evidence Acquisition: The DRG span the length of the spinal cord and house the neurons responsible for sensation from the periphery. They may become irritated by direct compression or local inflammation. Glial cells in the DRG respond to nerve injury, producing inflammatory markers and contribute to the development of chronic pain, even after the resolution of the original insult. While the underlying mechanism is still being explored, recent studies explored the efficacy of DRG stimulation and neuromodulation for chronic pain treatment. Results: Several reported cases and a small number of randomized trials were published in recent years, describing different methods of DRG stimulation and neuromodulation with promising results. Though evidence quality is mostly low, these results provide evidence to support the utilization of this technique. Conclusions: Chronic neuropathic pain is a common condition and carries significant morbidity and impact on the quality of life. Recent evidence supports the use of DRG neuromodulation as an effective technique to control chronic pain. Though studies are still emerging, the evidence appears to support this technique. Further studies, including large randomized trials evaluating DRG modulation versus other interventional and non-interventional techniques, are needed to further elucidate the efficacy of this method. These studies are also likely to inform the patient selection and the course of treatment.

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Delayed-Onset Neuropathic Pain after Septoplasty

Case Reports in Otolaryngology ◽

10.1155/2021/9966318 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Foteini-Stefania Koumpa ◽

Mark Ferguson ◽

Hesham Saleh

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Neuropathic Pain ◽

Postoperative Pain ◽

Facial Pain ◽

Substantial Effect ◽

Maxillary Nerve ◽

Delayed Onset ◽

Neuralgic Pain

Postoperative pain following a septoplasty is expected to be mild and limited to a few days after the operation. Chronic pain following the procedure is rare. No cases of delayed-onset neuropathic pain or allodynia have been described in the literature. This paper presents a case of delayed-onset neuropathic pain after septoplasty in a previously pain-free asthmatic patient that was successfully managed by administration of intranasal local anaesthesia. Physical examination and imaging excluded any other cause of neuralgia. A literature review revealed reports of chronic pain in patients following septoplasty if there were nasal contact or compression points or nasal tumours. Separately, acute postseptoplasty allodynia is documented in iatrogenic maxillary nerve damage. However, delayed-onset neuralgic pain, exacerbated by certain environmental triggers, has not been previously described. Facial pain can be debilitating; successfully managing this neuralgic pain with administration of intranasal local anaesthetic had a substantial effect on the patient’s quality of life.

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Effectiveness and cost-effectiveness of primary arthrodesis versus open reduction and internal fixation in patients with Lisfranc fracture instability (The BFF Study) study protocol for a multicenter randomized controlled trial

BMC Surgery ◽

10.1186/s12893-021-01320-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

N. A. C. van den Boom ◽

G. A. N. L. Stollenwerck ◽

S. M. A. A. Evers ◽

M. Poeze

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Internal Fixation ◽

Study Protocol ◽

Functional Outcomes ◽

Open Reduction ◽

Controlled Trial ◽

Optimal Treatment ◽

Fracture Dislocation

Abstract Background The Lisfranc injury is a complex injury of the midfoot. It can result in persistent pain and functional impairment if treated inappropriately. In Lisfranc fracture dislocation, treatment options are primary arthrodesis of the midfoot joints or open reduction and internal fixation. The purpose of the proposed study is to define the optimal treatment for the Lisfranc fracture dislocation, either primary arthrodesis or open reduction and internal fixation, in regard to quality of life, complications, functional outcomes, and cost effectiveness. Methods Study design: A prospective multicenter RCT. Study population: All patients of 18 years and older with an acute (< 6 weeks) traumatic fracture dislocation in the Lisfranc midfoot joints, displaced on static radiographic evaluation or unstable with dynamic evaluation, weight bearing radiographs or fluoroscopic stress testing under anesthesia, and eligible for either one of the surgical procedures. In total, this study will include n = 112 patients with Lisfranc fracture dislocation. Interventions: Patients with Lisfranc fracture dislocation will be randomly allocated to treatment in “The Better to Fix or Fuse Study” (The BFF Study) with either PA or ORIF. Main study parameters/endpoints: Primary outcome parameter: the quality of life. Secondary outcomes: complications, functional outcomes, secondary surgical interventions and cost effectiveness. Nature and extent of the burden: PA is expected to have a better outcome, however both treatments are accepted for this injury with a similar low risk of complications. Follow up is standardized and therefore this study will not add extra burden to the patient. Discussion This study protocol provides a comprehensive overview of the aims and methods of the attached clinical study. Limitations of this study are the absence of patient blinding since it is impossible in surgical intervention, and the outcome measure (AOFAS) that has limited validity not for these injuries. This study will be the first with enough power to define optimal treatment for Lisfranc fracture dislocations. This is necessary since current literature is unclear on this topic. Trial registration Current controlled Trial: NCT04519242 with registration date: 08/13/2020. Retrospectively registered; Protocol date and version: Version 4 05/06/2020

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