scholarly journals Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

2021 ◽  
pp. 1-6
Author(s):  
Anastasios Charalampidis ◽  
Lina Rundberg ◽  
Hans Möller ◽  
Paul Gerdhem
Keyword(s):  
Mental Health ◽  
Back Pain ◽  
Postoperative Pain ◽  
Idiopathic Scoliosis ◽  
Pain Group ◽  
Level Of Evidence ◽  
Pain Scores ◽  
Patient Reported ◽  
Persistent Postoperative Pain ◽  
Eq Vas

Purpose: To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis. Methods: In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data. Results: The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73). Conclusion: High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis. Level of Evidence: III

scholarly journals Predictors of Persistent Postoperative Pain at Minimum Two-years After Arthroscopic Treatment of Femoroacetabular Impingement

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0020
Author(s):  
Austin V. Stone ◽  
Philip Malloy ◽  
William H. Neal ◽  
Edward Beck ◽  
Brian Robert Waterman ◽  
...  
Keyword(s):  
Mental Health ◽  
Postoperative Pain ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Persistent Pain ◽  
Anxiety And Depression ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Persistent Postoperative Pain

Objectives: To evaluate predictors for persistent postoperative pain following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesized that patients with chronic preoperative pain, smokers, and those with co-morbid mental health disease would have greater persistent postoperative pain. Methods: Patients undergoing hip arthroscopy for FAIS were identified in a prospectively collected database with a minimum of two-year follow-up with patient reported outcomes (PROs). Previous open hip surgery and diagnoses other than FAIS were excluded. Patients were grouped by VAS-Pain scores as limited (≤30) and persistent (>30). Patient factors and outcomes were analyzed with univariate and correlation analyses to build a logistic regression to identify predictors of postoperative pain. Results: The limited pain (n=514) and persistent pain (n=174) groups totaled 688 patients (449 females). The persistent pain group was significantly older with a greater proportion of revision arthroscopy, worker’s compensation cases, smokers, hypertension, a history of a psychiatric diagnosis and preoperative narcotic use. Both collegiate sport participation [odds ratio (OR) -6.09 (95% CI: -1.23--30.3, p=0.027) and frequent running (OR -1.75, 95% CI: -1.09--2.81; p=0.021) decreased risk for pain. Smokers were 2.22 times more likely to have persistent pain (p=0.032; 95% CI: 1.07-4.46). A history of anxiety and depression is associated with 2.87 greater risk for persistent pain (p=0.030; 95% CI: 1.11-7.45). Conclusion: Independent predictors for persistent postoperative pain include current smoking and mental health history positive for anxiety and depression. Running as a primary form of exercise and high-level athletic participation are protective against persistent pain. Additional risk factors for increased pain include increased age, workers’ compensation claim, previous comorbid disease treated with surgery, and decreased preoperative PROs. Our analysis demonstrated significant improvements in both pain and functional PROs in both the limited pain and persistent pain groups; however, those with persistent pain demonstrated significantly inferior PROs.

scholarly journals Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery

2020 ◽  
Vol 14 (4) ◽  
pp. 259-265
Author(s):  
Heather M. Richard ◽  
Shelby P. Cerza ◽  
Adriana De La Rocha ◽  
David A. Podeszwa
Keyword(s):  
Mental Health ◽  
Postoperative Pain ◽  
Slipped Capital Femoral Epiphysis ◽  
Integrated Treatment ◽  
Postoperative Outcomes ◽  
Harris Hip Score ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Pain Scores ◽  
Patient Reported

Purpose This study was designed to evaluate predictive factors that influence pain, mental health symptoms and postoperative outcomes at six-months post-hip preservation surgery (HPS) in adolescent surgical candidates. Methods In total, 58 HPS candidates (39 female, 19 male; mean age 15.53 years (10 to 19)) were evaluated. Diagnoses included: acetabular dysplasia (34); idiopathic femoroacetabular impingement (15); Perthes disease (six); avascular necrosis (six); and slipped capital femoral epiphysis (six). All patients underwent periacetabular osteotomy (36), surgical hip dislocation (17) or arthroscopy (five). Patients completed the following: Numerical Pain Rating Scale (NPRS); Child Health Questionnaire-87 (CHQ-87); Pediatric Symptom Checklist-Youth (PSC-Y), preoperatively and six months postoperatively. A single psychologist assessed patients in clinics and one to two additional appointments. Results In all, 78% of patients reported one to three years of pain prior to HPS (modified Harris hip score). All pain scores (NPRS) significantly decreased at six months postoperatively. Preoperative mental health scores (CHQ-87) significantly predicted postoperative pain scores (F(1, 57) = 4.07; p < 0.048; R2 = 0.068). Mental health symptoms (PSC-Y) decreased significantly (p < 0.001). Patients who were seen by a psychologist two or more times reported better six-month postoperative outcomes than those seen once: usual pain (NPRS; p = 0.012); patient-reported physical function (CHQ-87; p = 0.029); and mental health (PSC-Y; p = 0.019). HPS patients seen ≥ 60 days prior to surgery showed marked improvements at six months compared with patients seen < 60 days prior to surgery. Conclusion HPS candidates evaluated preoperatively by psychology, as part of an integrated treatment approach, demonstrated statistically significant improvements in pain, health-related quality of life and mental health symptoms. Two+ visits, more than 60 days prior to surgery appears to be impactful. Preoperative pain and mental health symptoms were predictive of postoperative pain. Level of Evidence: II

scholarly journals Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

2020 ◽  
Vol 9 (06) ◽  
pp. 487-492
Author(s):  
Emil S. Vutescu ◽  
Scott W. Wolfe ◽  
Kevin Sung ◽  
Rishabh Jethanandani ◽  
Steve K. Lee
Keyword(s):  
Postoperative Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Level Of Evidence ◽  
Interosseous Ligament ◽  
Statistical Correlations ◽  
Pain Scores ◽  
Radiographic Parameters ◽  
Radiographic Measurements ◽  
Patient Reported

Abstract Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.

scholarly journals The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study

2020 ◽  
Vol 8 (2) ◽  
pp. 232596711989473
Author(s):  
Kevin J. Cronin ◽  
Brian R. Wolf ◽  
Justin A. Magnuson ◽  
Cale A. Jacobs ◽  
Shannon Ortiz ◽  
...  
Keyword(s):  
Mental Health ◽  
Back Pain ◽  
Shoulder Instability ◽  
Preoperative Imaging ◽  
Study Cohort ◽  
Preoperative Pain ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Patient Reported ◽  
Preoperative Expectations

Background: Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty. Purpose/Hypothesis: The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures. Study Design: Cross-sectional study; Level of evidence, 3. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain. Results: The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; P < .001) and were more likely to be female (25.3% vs 17.4%; P = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) ( P < .001), more frequent depression (22.2% vs 8.3%; P < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) ( P < .01), and worse preoperative expectations ( P < .01). Conclusion: Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient’s preoperative state but also postoperative pain control and/or postoperative outcomes.

scholarly journals Sex differences in outcomes after arthroscopic bankart repair

2020 ◽  
Vol 6 (1) ◽  
pp. e000965
Author(s):  
Natalie A Lowenstein ◽  
Peter J Ostergaard ◽  
Daniel B Haber ◽  
Kirsten D Garvey ◽  
Elizabeth G Matzkin
Keyword(s):  
Mental Health ◽  
Sex Differences ◽  
Patient Reported Outcomes ◽  
Strength Function ◽  
Bankart Repair ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair ◽  
Patient Reported ◽  
Males And Females

ObjectivesRisk factors for anterior shoulder dislocation include young age, contact activities and male sex. The influence of sex on patient-reported outcomes of arthroscopic Bankart repair (ABR) is unclear, with few studies reporting potential differences. This study’s purpose was to compare patient-reported outcomes of males and females following ABR.MethodsProspectively collected data was analysed for 281 patients (males: 206, females: 75) after ABR with preoperative, 1-year and 2-year follow-up responses. The Wilcoxon signed-rank and χ2 tests, preoperative, 1 year and 2 year follow-up results were examined to determine differences of scores in males versus females.ResultsNo statistically significant sex differences were observed in Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Visual Analogue Scale (VAS) or Single Assessment Numerical Evaluation (SANE) Scores at 1-year or 2-year follow-up. Females had lower Veterans RAND 12-item health survey (VR-12) mental health subscores at 2-year follow-up (females: 52.3±9.0, males: 55.8±7.6, p=0.0016). Females were more likely to report that treatment had ‘exceeded expectations’ at 2-year follow-up regarding motion, strength, function and normal sports activities.ConclusionResults of study demonstrate that ABR has similar outcomes for both males and females. There were no statistically significant sex-related differences in SST, ASES, VAS or SANE scores following ABR. VR-12 mental health subscores showed a minimal difference at 2-year follow-up, with lower scores in females.Level of evidenceRetrospective cohort study; level II.

scholarly journals Is Diagnostic Arthroscopy at the Time of Medial Patellofemoral Ligament Reconstruction Necessary?

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094565
Author(s):  
Christopher L. Shultz ◽  
Samuel N. Schrader ◽  
Benjamin D. Packard ◽  
Daniel C. Wascher ◽  
Gehron P. Treme ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Perioperative Complications ◽  
Mpfl Reconstruction ◽  
Tibial Tubercle ◽  
Level Of Evidence ◽  
Diagnostic Arthroscopy ◽  
Patient Reported ◽  
Arthroscopic Procedures

Background: Although medial patellofemoral ligament (MPFL) reconstruction is well described for patellar instability, the utility of arthroscopy at the time of stabilization has not been fully defined. Purpose: To determine whether diagnostic arthroscopy in conjunction with MPFL reconstruction is associated with improvement in functional outcome, pain, and stability or a decrease in perioperative complications. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary MPFL reconstruction without tibial tubercle osteotomy were reviewed (96 patients, 101 knees). Knees were divided into MPFL reconstruction without arthroscopy (n = 37), MPFL reconstruction with diagnostic arthroscopy (n = 41), and MPFL reconstruction with a targeted arthroscopic procedure (n = 23). Postoperative pain, motion, imaging, operative findings, perioperative complications, need for revision procedure, and postoperative Kujala scores were recorded. Results: Pain at 2 weeks and 3 months postoperatively was similar between groups. Significantly improved knee flexion at 2 weeks was seen after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and reconstruction with targeted arthroscopic procedures (58° vs 42° and 48°, respectively; P = .02). Significantly longer tourniquet times were seen for targeted arthroscopic procedures versus the diagnostic and no arthroscopic procedures (73 vs 57 and 58 min, respectively; P = .0002), and significantly higher Kujala scores at follow-up were recorded after MPFL reconstruction without arthroscopy versus reconstruction with diagnostic and targeted arthroscopic procedures (87.8 vs 80.2 and 70.1, respectively; P = .05; 42% response rate). There was no difference between groups in knee flexion, recurrent instability, or perioperative complications at 3 months. Diagnostic arthroscopy yielded findings not previously appreciated on magnetic resonance imaging (MRI) in 35% of patients, usually resulting in partial meniscectomy. Conclusion: Diagnostic arthroscopy with MPFL reconstruction may result in findings not previously appreciated on MRI. Postoperative pain, range of motion, and risk of complications were equal at 3 months postoperatively with or without arthroscopy. Despite higher Kujala scores in MPFL reconstruction without arthroscopy, the relationship between arthroscopy and patient-reported outcomes remains unclear. Surgeons can consider diagnostic arthroscopy but should be aware of no clear benefits in patient outcomes.

The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release

2019 ◽  
Vol 45 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Julian F. Maempel ◽  
Paul J. Jenkins ◽  
Jane E. McEachan
Keyword(s):  
Mental Health ◽  
Health Status ◽  
Carpal Tunnel ◽  
Mental Component Summary ◽  
Short Form ◽  
Carpal Tunnel Release ◽  
Mental Health Status ◽  
Mental Disability ◽  
Level Of Evidence ◽  
Patient Reported

We studied whether mental health status is significantly correlated to patient reported functional outcomes and satisfaction after carpal tunnel release. Over a 7-year period, 809 patients completed Short Form-12 (SF-12) questionnaires which allowed calculation of the SF-12 mental component summary 1 year postoperatively, 780 (96%) completed a satisfaction questionnaire and 777 (96%) completed a QuickDisabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Median QuickDASH score was 55 preoperatively (interquartile range [IQR] 28) and 14 postoperatively (IQR 32). A total of 674 patients were satisfied. Patients with mental disability had worse QuickDASH scores (median 34, IQR 41) and a higher incidence of dissatisfaction (52/245, 21%) than those without mental disability (n = 9, IQR 20, 10%, both p < 0.001). Regression analyses indicated scores in the SF-12 mental component summary were significantly related to postoperative QuickDASH score ( p < 0.001) and satisfaction ( p = 0.02). We concluded that patients with mental disability report poorer outcomes and lower satisfaction rates; however, the majority still exhibit significant improvements and are satisfied. Level of evidence: II

Fast Starters and Slow Starters After Hip Arthroscopy for Femoroacetabular Impingement: Correlation of Early Postoperative Pain and 2-Year Outcomes

2020 ◽  
Vol 48 (12) ◽  
pp. 2903-2909
Author(s):  
Thu Quynh Nguyen ◽  
James M. Friedman ◽  
Sergio E. Flores ◽  
Alan L. Zhang
Keyword(s):  
Postoperative Pain ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Harris Hip Score ◽  
Physical Component Score ◽  
Pain Level ◽  
Component Score ◽  
Pain Scores ◽  
Patient Reported ◽  
The Relationship

Background: Patients experience varying degrees of pain and symptoms during the early recovery period after hip arthroscopy for femoroacetabular impingement (FAI). Some “fast starters” report minimal discomfort and are eager to advance activities, while “slow starters” describe severe pain and limitations. The relationship between these early postoperative symptoms and 2-year outcomes after hip arthroscopy is unknown. Purpose: To analyze the relationship between early postoperative pain and 2-year patient-reported outcomes (PROs) after hip arthroscopy for FAI. Study Design: Cohort study; Level of evidence, 2. Methods: Patients without arthritis or dysplasia who were undergoing primary hip arthroscopy for FAI were prospectively enrolled and completed validated PROs. Scores for visual analog scale (VAS) for pain were collected preoperatively and at 1 week, 6 weeks, and 2 years postoperatively. Scores for the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and 12-Item Short Form Health Survey (SF-12) were collected preoperatively and 2 years postoperatively. Paired t tests were used to evaluate PRO score changes, and correlation analyses were used to assess relationships between early postoperative pain and 2-year postoperative outcomes. Results: A total of 166 patients were included (55% female; mean ± SD age, 35.29 ± 9.6 years; mean body mass index, 25.07 ± 3.98 kg/m2). Patients demonstrated significant improvements in PRO scores (VAS, SF-12 Physical Component Score, mHHS, and all HOOS subscales) at 2 years after hip arthroscopy for FAI ( P < .001). There was a significant correlation between lower 1-week VAS pain level (fast starters) and lower 2-year VAS pain level ( R = 0.31; P < .001) as well as higher 2-year PRO scores (SF-12 Physical Component Score, mHHS, and all HOOS subscales: R = −0.21 to −0.3; P < .001). There was no correlation between 1-week VAS pain and 2-year SF-12 Mental Component Score ( P = .17). Preoperative VAS pain levels showed positive correlations with 1-week postoperative pain scores ( R = 0.39; P < .001) and negative correlations with 2-year patient outcomes ( R = −0.15 to −0.33, P < .01). There was no correlation between 6-week postoperative pain scores and 2-year PRO scores. Conclusion: Fast starters after hip arthroscopy for FAI experience sustained improvements in outcomes at 2 years after surgery. Patient pain levels before surgery may delineate potential fast starters and slow starters.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

2018 ◽  
Vol 39 (12) ◽  
pp. 1444-1448 ◽  
Author(s):  
Kevin D. Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Preston Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Operative Procedure ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Vas Score ◽  
Pain Scores ◽  
Patient Reported ◽  
The Mean

Background: Patient-reported outcome measures (PROMs) are taking a more prominent role in orthopedics as health care seeks to define treatment outcomes. The visual analog scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in patients that do not undergo an operative procedure. We hypothesized that patients’ VAS pain scores reported to the surgeon vs the nurse would be the same. Methods: This study is a retrospective cohort of 201 consecutive nonoperative foot and ankle patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 “worst pain.” Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative foot and ankle patients. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 ( P < .001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 ( P < .001). Conclusion: This study found statistically significant differences between VAS pain scores reported to the surgeon vs the nurse in nonoperative patients. These results support the trend found in our previous study, where operative patients reported significantly higher pain scores to the surgeon vs the nurse. The mean difference between reported pain scores was significantly higher for operative patients compared to nonoperative patients. Level of Evidence: Level III, comparative study.

scholarly journals Thermography in persistent postoperative pain after knee surgery

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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