Chronic pain with neuropathic characteristics after surgery for major trauma to the lower limb: prevalence, predictors, and association with pain severity, disability, and quality of life in the UK WHiST trial

2021 ◽  
pp. 1-8
Author(s):  
David J. Keene ◽  
Ruth Knight ◽  
Julie Bruce ◽  
Susan J. Dutton ◽  
Elizabeth Tutton ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Lower Limb ◽  
Physical Disability ◽  
Major Trauma ◽  
Pain Severity ◽  
Post Injury ◽  
Fracture Surgery

Aims To identify the prevalence of neuropathic pain after lower limb fracture surgery, assess associations with pain severity, quality of life and disability, and determine baseline predictors of chronic neuropathic pain at three and at six months post-injury. Methods Secondary analysis of a UK multicentre randomized controlled trial (Wound Healing in Surgery for Trauma; WHiST) dataset including adults aged 16 years or over following surgery for lower limb major trauma. The trial recruited 1,547 participants from 24 trauma centres. Neuropathic pain was measured at three and six months using the Doleur Neuropathique Questionnaire (DN4); 701 participants provided a DN4 score at three months and 781 at six months. Overall, 933 participants provided DN4 for at least one time point. Physical disability (Disability Rating Index (DRI) 0 to 100) and health-related quality-of-life (EuroQol five-dimension five-level; EQ-5D-5L) were measured. Candidate predictors of neuropathic pain included sex, age, BMI, injury mechanism, concurrent injury, diabetes, smoking, alcohol, analgaesia use pre-injury, index surgery location, fixation type, Injury Severity Score, open injury, and wound care. Results The median age of the participants was 51 years (interquartile range 35 to 64). At three and six months post-injury respectively, 32% (222/702) and 30% (234/787) had neuropathic pain, 56% (396/702) and 53% (413/787) had chronic pain without neuropathic characteristics, and the remainder were pain-free. Pain severity was higher among those with neuropathic pain. Linear regression analyses found that those with neuropathic pain at six months post-injury had more physical disability (DRI adjusted mean difference 11.49 (95% confidence interval (CI) 7.84 to 15.14, p < 0.001) and poorer quality of life (EQ-5D utility -0.15 (95% CI -0.19 to -0.11), p < 0.001) compared to those without neuropathic characteristics. Logistic regression identified that prognostic factors of younger age, current smoker, below knee fracture, concurrent injuries, and regular analgaesia pre-injury were associated with higher odds of post-injury neuropathic pain. Conclusion Pain with neuropathic characteristics is common after lower limb fracture surgery and persists to six months post-injury. Persistent neuropathic pain is associated with substantially poorer recovery. Further attention to identify neuropathic pain post-lower limb injury, predicting patients at risk, and targeting interventions, is indicated.

scholarly journals The Impact of Enrollment in a Specialized Interdisciplinary Neuropathic Pain Clinic

2011 ◽  
Vol 16 (3) ◽  
pp. 159-168 ◽  
Author(s):  
Alex Garven ◽  
Shauna Brady ◽  
Susan Wood ◽  
Melinda Hatfield ◽  
Jennifer Bestard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Diagnostic Evaluation ◽  
Pain Severity ◽  
Pain Clinic ◽  
Pain Clinics ◽  
The Impact

BACKGROUND: Chronic pain clinics have been created because of the increasing recognition of chronic pain as a very common, debilitating condition that requires specialized care. Neuropathic pain (NeP) is a multifaceted, specialized form of chronic pain that often requires input from multiple disciplines for assessment and management.OBJECTIVE: To determine the impact of an interdisciplinary clinic for evaluation and treatment of patients with NeP.METHODS: Patients with heterogeneous etiologies for NeP were prospectively evaluated using an interdisciplinary approach every six months. Diagnostic evaluation, comorbidity evaluation, education, and pharmacological and/or nonpharmacological management were completed. Severity (visual analogue scale) and features of pain (Modified Brief Pain Inventory), sleep difficulties (Medical Outcomes Study – Sleep Scale), mood/anxiety disruption (Hospital Anxiety and Depression Scale), quality of life (European Quality-of-Life Five-Domain index), health care resources use, patient satisfaction (Pain Treatment Satisfaction Scale and Neuropathic Pain Symptom Inventory) and self-perceived change in well-being (Patient Global Impression of Change scale) were examined at each visit.RESULTS: Pain severity only decreased after one year of follow-up, while anxiety and quality-of-life indexes improved after six months. Moderate improvements of sleep disturbance, less frequent medication use and reduced health care resource use were observed during enrollment at the NeP clinic.DISCUSSION: Despite the limitations of performing a real-world, uncontrolled study, patients with NeP benefit from enrollment in a small interdisciplinary clinic. Education and a complete diagnostic evaluation are hypothesized to lead to improvements in anxiety and, subsequently, pain severity. Questions remain regarding the long-term maintenance of these improvements and the optimal structure of specialized pain clinics.

scholarly journals Buprenorphine: Far Beyond the “Ceiling”

Biomolecules ◽  
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.

scholarly journals Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT

2020 ◽  
Vol 24 (38) ◽  
pp. 1-86
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Ruth Knight ◽  
May Ee Png ◽  
Julie Bruce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Site Infection ◽  
Wound Therapy ◽  
Deep Surgical Site Infection

Background Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. Objectives To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. Design A pragmatic, multicentre, randomised controlled trial. Setting Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. Participants A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. Interventions Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. Main outcome measures Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. Results A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. Conclusions The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. Future work Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.

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

2020 ◽  
Vol 60 (2) ◽  
pp. 326-335 ◽  
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

scholarly journals Dorsal Root Ganglion (DRG) and Chronic Pain

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.

scholarly journals Delayed-Onset Neuropathic Pain after Septoplasty

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.

scholarly journals Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder

2021 ◽  
Vol 8 (3) ◽  
pp. e985
Author(s):  
Ilya Ayzenberg ◽  
Daniel Richter ◽  
Eugenia Henke ◽  
Susanna Asseyer ◽  
Friedemann Paul ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Neuropathic Pain ◽  
Neuromyelitis Optica ◽  
Clinical Characteristics ◽  
Short Form ◽  
Spectrum Disorder ◽  
Pain Severity ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Upper Thoracic

ObjectivesTo evaluate prevalence, clinical characteristics, and predictors of pain, depression, and their impact on the quality of life (QoL) in a large neuromyelitis optica spectrum disorder (NMOSD) cohort.MethodsWe included 166 patients with aquaporin-4–seropositive NMOSD from 13 tertiary referral centers. Patients received questionnaires on demographic and clinical characteristics, PainDetect, short form of Brief Pain Inventory, Beck Depression Inventory–II, and Short Form 36 Health Survey.ResultsOne hundred twenty-five (75.3%) patients suffered from chronic NMOSD-associated pain. Of these, 65.9% had neuropathic pain, 68.8% reported spasticity-associated pain and 26.4% painful tonic spasms. Number of previous myelitis attacks (OR = 1.27, p = 0.018) and involved upper thoracic segments (OR = 1.31, p = 0.018) were the only predictive factors for chronic pain. The latter was specifically associated with spasticity-associated pain (OR = 1.36, p = 0.002). More than a third (39.8%) suffered from depression, which was moderate to severe in 51.5%. Pain severity (OR = 1.81, p < 0.001) and especially neuropathic character (OR = 3.44, p < 0.001) were associated with depression. Pain severity and walking impairment explained 53.9% of the physical QoL variability, while depression and walking impairment 39.7% of the mental QoL variability. No specific medication was given to 70.6% of patients with moderate or severe depression and 42.5% of those with neuropathic pain. Two-thirds (64.2%) of patients with symptomatic treatment still reported moderate to severe pain.ConclusionsMyelitis episodes involving upper thoracic segments are main drivers of pain in NMOSD. Although pain intensity was lower than in previous studies, pain and depression remain undertreated and strongly affect QoL. Interventional studies on targeted treatment strategies for pain are urgently needed in NMOSD.

Synergistic Effects of Vitamin D and Mindfulness Training in Pain Severity, Pain-Related Disability and Neuropathy-Specific Quality of Life Dimensions in Painful Diabetic Neuropathy: A Randomized Clinical Trial with Placebo-controlled

2020 ◽  
Author(s):  
Roya taghadosi nia ◽  
mohammadreza davoudi ◽  
Seyyed Mojtaba Ahmadi ◽  
Amir Abbas Taheri
Keyword(s):  
Quality Of Life ◽  
Vitamin D ◽  
Neuropathic Pain ◽  
Diabetic Neuropathy ◽  
Mindfulness Training ◽  
Pain Severity ◽  
Oral Dosage ◽  
Life Questionnaire ◽  
Painful Diabetic Neuropathy

Abstract Background: This study aimed to examining Synergistic effect of Vitamin D (VD) Supplement and mindfulness on neuropathic pain severity, Pain-Related Disability and Neuropathy-Specific Quality of Life dimensions in painful diabetic neuropathy.Methods: In this randomized controlled trial, totally 225 patients with painful diabetic neuropathy were randomly allocated to five groups: (1) mindfulness and placebo, (2) placebo, (3) mindfulness, (4) VD, and (5) mindfulness and VD. Mindfulness training includes twelves sessions and VD patients received a daily four thousand IU oral dosage (four capsules) with 28,000 IU vitamin D weekly for 12 weeks. Laboratory analyses, Sun exposure time, Vitamin D intake, BMI and Physical activity measured in pre-test and posttest. Pain-Related Disability measured with The Pain Disability Index (PDI). For other outcome variables Neuropathy Specific Quality of Life questionnaire and Neuropathic pain severity scale was utilized.Results: In baseline, measures were not different among the groups. At the end-of-treatment, for outcome variables results showed improvement in all groups except the “placebo” group. About other groups, there was not any difference between VD and mindfulness groups (in and not combined with placebo). However, “VD + mindfulness” has a greater improvement rather than VD and mindfulness groups (P<0.05). Moreover, both protocols have no significant effects on, FBS, BMI and energy intakes (P>0.05).Conclusion: Combining VD and mindfulness can reduce pain severity and pain-related disability, so with these changes patients improve their quality of life.

Severity of chronic pain and its relationship to quality of life in multiple sclerosis

2005 ◽  
Vol 11 (3) ◽  
pp. 322-327 ◽  
Author(s):  
Lorraine V Kalia ◽  
Paul W OConnor
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Chronic Pain ◽  
Short Form ◽  
Depression Scale ◽  
Pain Severity ◽  
Anxiety And Depression ◽  
Mcgill Pain Questionnaire ◽  
Neurogenic Pain

Introduction: This study used reliable and validated instruments to compare pain severity in multiple sclerosis (MS) to that in other chronic painful conditions, and to examine relationships between chronic pain in MS and health-related quality of life (HRQOL). Methods: Ninety-nine MS patients completed a self-administered survey comprised of the Medical Outcomes 36-Item Short-Form Health Survey, the Short-Form McGill Pain Questionnaire, and the Hospital Anxiety and Depression Scale. Results: Pain severity was not different between MS patients with pain and rheumatoid arthritis (P=0.77) or osteoarthritis (P=0.98) patients. Chronic pain in MS was less often neurogenic than non-neurogenic, although severity of neurogenic pain was greater than that of non-neurogenic pain (P=0.048). Chronic pain in MS was found to have no significant relationship to age, disease duration or disease course. Instead, we found that pain was correlated with aspects of HRQOL, particularly mental health (r=0.44, P<0.0001) versus physical functioning (r=0.19, P>0.05). Chronic pain was significantly related to anxiety and depression for females but not for males with MS. Conclusions: Chronic pain in MS is as severe as pain in arthritic conditions and is associated with reduced HRQOL. Thus, pain can be a significant symptom for MS patients and the need for treatment may be underestimated.

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