Dolor crónico postoperatorio
Chronic post-surgical pain
RD Searle FRCA
KH Simpson FRCA FFPMRCA
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 10 Number 1 2010
http://ceaccp.oxfordjournals.org/content/10/1/12.full.pdf
La analgesia epidural no es superior a la analgesia sistémica postoperatoria para la prevención de dolor crónico o neuropático después de toracotomía
Epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy.
Kampe S, Lohmer J, Weinreich G, Hahn M, Stamatis G, Welter S.
J Cardiothorac Surg. 2013 May 13;8(1):127. [Epub ahead of print]
Abstract
BACKGROUND:To assess prospectively the incidence of chronic and neuropathic pain in patients undergoing anteroaxillary thoracotomy withpostoperative epidural analgesia or controlled-release oxycodone pain regimen. METHODS: 77 patients who underwent anteroaxillary thoracotomy were enrolled in our observational study. 40 patients received postoperatively a standardized oral analgesic protocol with controlled-release oxycodone and IV non opioid (CRO Group), and 37 patients received epidural analgesia with ropivacaine 0.1% + 1 mug/ml sufentanil (EDA Group) and IV non opioid. The painDETECT questionnaire was completed from the patients with one of the authors (JL) on the 7th postoperative day and six months postoperatively. RESULTS: The data of 60 patients were eligible for statistical analysis, 28 patients in the CRO Group and 32 patients in the EDA Group. 17 patients did not reach the 6-months follow-up interval (12 drop outs in the CRO Group and 5 drop outs in the EDA Group).79% percent of patients in the CRO Group and 74% percent of patients in the EDA Group had a numeric rating scale score (NRS) = 0 after 6 months. 22% percent of patients in the CRO Group and 16% percent of patients in the EDA Group experienced a NRS 1--3 6-months postoperatively. No patient in the CRO Group and 9% percent of patients in the EDA Group had 6-months postoperatively a NRS 4--6. Neither in the CRO Group nor in the EDA Group we could detect a neuropathic pain 6 months postoperatively corresponding to a painDETECT score > 18. Overall, with regard to NRS, there was no statistical difference between the two groups (p = 0.13). 90% percent of patients in the CRO Group and 90% percent of patients in the EDA Group showed 6-months postoperatively a painDETECT score < 13 (definitely no neuropathic pain), and 9% percent in the EDA Group and 11% in the CRO Group had a 6-months painDETECt score 13--18 (p = not significant). CONCLUSION: These pilot data indicate that epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronicor neuropathic pain after thoracotomy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662590/pdf/1749-8090-8-127.pdf
Dolor crónico después de cirugía abdominal baja: ¿Contribuye el polimorfismo del receptor catecol-O-metil transferasa/opioide?
Chronic pain after lower abdominal surgery: do catechol-O-methyl transferase/opioid receptor μ-1 polymorphisms contribute?
Kolesnikov Y1, Gabovits B, Levin A, Veske A, Qin L, Dai F, Belfer I.
Mol Pain. 2013 Apr 8;9:19. doi: 10.1186/1744-8069-9-19.
Abstract
BACKGROUND: Preoperative pain, type of operation and anesthesia, severity of acute postoperative pain, and psychosocial factors have been identified as risk factors for chronic postsurgical pain (CPP). Recently, it has been suggested that genetic factors also contribute to CPP. In this study, we aimed to determine whether the catechol-O-methyl transferase (COMT) and opioid receptor μ-1 (OPRM1) common functional polymorphisms rs4680 and rs1799971 were associated with the incidence, intensity, or duration of CPP in patients after lower abdominal surgery. METHODS: One hundred and two patients with American Society of Anesthesiologists (ASA) physical status I/II underwent either abdominal radical prostatectomy (n = 45) or hysterectomy (n = 57). The incidences of CPP in the pelvic and scar areas were evaluated in all patients three months after surgery. RESULTS: Thirty-five (34.3%) patients experienced CPP after lower abdominal surgery. Within this group, six (17.1%) patients demonstrated symptoms of neuropathic pain. For COMT rs4680, 22 (21.6%) patients had Met158Met, 55 (53.9%) patients had Val158Met, and 25 (24.5%) patients had Val158Val. No association was found between CPP phenotypes (incidence, intensity, and duration) and different rs4680 genotypes. For OPRM1 rs1799971, only CPP patients carrying at least one copy of the G allele had higher pain intensity than A118A carriers (p=0.02). No associations with other phenotypes were found. No combined effect of COMT/OPRM1 polymorphisms on CPP phenotypes was observed. CONCLUSIONS: OPRM1 genotype influences CPP following lower abdominal surgery. COMT didn't affect CPP, suggesting its potential modality-specific effects on human pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623849/pdf/1744-8069-9-19.pdf
Dolor persistente en postmastectomía: comparación de las características psicológicas, médicas, quirúrgicas y psicosociales entre los pacientes con y sin dolor
Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.
Schreiber KL1, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, Taylor LN, McLaughlin M, Brufsky A, Ahrendt G, Bovbjerg D, Edwards RR, Belfer I.
Pain. 2013 May;154(5):660-8. doi: 10.1016/j.pain.2012.11.015. Epub 2012 Dec 5.
Abstract
Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863788/pdf/nihms532216.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Chronic post-surgical pain
RD Searle FRCA
KH Simpson FRCA FFPMRCA
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 10 Number 1 2010
http://ceaccp.oxfordjournals.org/content/10/1/12.full.pdf
La analgesia epidural no es superior a la analgesia sistémica postoperatoria para la prevención de dolor crónico o neuropático después de toracotomía
Epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy.
Kampe S, Lohmer J, Weinreich G, Hahn M, Stamatis G, Welter S.
J Cardiothorac Surg. 2013 May 13;8(1):127. [Epub ahead of print]
Abstract
BACKGROUND:To assess prospectively the incidence of chronic and neuropathic pain in patients undergoing anteroaxillary thoracotomy withpostoperative epidural analgesia or controlled-release oxycodone pain regimen. METHODS: 77 patients who underwent anteroaxillary thoracotomy were enrolled in our observational study. 40 patients received postoperatively a standardized oral analgesic protocol with controlled-release oxycodone and IV non opioid (CRO Group), and 37 patients received epidural analgesia with ropivacaine 0.1% + 1 mug/ml sufentanil (EDA Group) and IV non opioid. The painDETECT questionnaire was completed from the patients with one of the authors (JL) on the 7th postoperative day and six months postoperatively. RESULTS: The data of 60 patients were eligible for statistical analysis, 28 patients in the CRO Group and 32 patients in the EDA Group. 17 patients did not reach the 6-months follow-up interval (12 drop outs in the CRO Group and 5 drop outs in the EDA Group).79% percent of patients in the CRO Group and 74% percent of patients in the EDA Group had a numeric rating scale score (NRS) = 0 after 6 months. 22% percent of patients in the CRO Group and 16% percent of patients in the EDA Group experienced a NRS 1--3 6-months postoperatively. No patient in the CRO Group and 9% percent of patients in the EDA Group had 6-months postoperatively a NRS 4--6. Neither in the CRO Group nor in the EDA Group we could detect a neuropathic pain 6 months postoperatively corresponding to a painDETECT score > 18. Overall, with regard to NRS, there was no statistical difference between the two groups (p = 0.13). 90% percent of patients in the CRO Group and 90% percent of patients in the EDA Group showed 6-months postoperatively a painDETECT score < 13 (definitely no neuropathic pain), and 9% percent in the EDA Group and 11% in the CRO Group had a 6-months painDETECt score 13--18 (p = not significant). CONCLUSION: These pilot data indicate that epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronicor neuropathic pain after thoracotomy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662590/pdf/1749-8090-8-127.pdf
Dolor crónico después de cirugía abdominal baja: ¿Contribuye el polimorfismo del receptor catecol-O-metil transferasa/opioide?
Chronic pain after lower abdominal surgery: do catechol-O-methyl transferase/opioid receptor μ-1 polymorphisms contribute?
Kolesnikov Y1, Gabovits B, Levin A, Veske A, Qin L, Dai F, Belfer I.
Mol Pain. 2013 Apr 8;9:19. doi: 10.1186/1744-8069-9-19.
Abstract
BACKGROUND: Preoperative pain, type of operation and anesthesia, severity of acute postoperative pain, and psychosocial factors have been identified as risk factors for chronic postsurgical pain (CPP). Recently, it has been suggested that genetic factors also contribute to CPP. In this study, we aimed to determine whether the catechol-O-methyl transferase (COMT) and opioid receptor μ-1 (OPRM1) common functional polymorphisms rs4680 and rs1799971 were associated with the incidence, intensity, or duration of CPP in patients after lower abdominal surgery. METHODS: One hundred and two patients with American Society of Anesthesiologists (ASA) physical status I/II underwent either abdominal radical prostatectomy (n = 45) or hysterectomy (n = 57). The incidences of CPP in the pelvic and scar areas were evaluated in all patients three months after surgery. RESULTS: Thirty-five (34.3%) patients experienced CPP after lower abdominal surgery. Within this group, six (17.1%) patients demonstrated symptoms of neuropathic pain. For COMT rs4680, 22 (21.6%) patients had Met158Met, 55 (53.9%) patients had Val158Met, and 25 (24.5%) patients had Val158Val. No association was found between CPP phenotypes (incidence, intensity, and duration) and different rs4680 genotypes. For OPRM1 rs1799971, only CPP patients carrying at least one copy of the G allele had higher pain intensity than A118A carriers (p=0.02). No associations with other phenotypes were found. No combined effect of COMT/OPRM1 polymorphisms on CPP phenotypes was observed. CONCLUSIONS: OPRM1 genotype influences CPP following lower abdominal surgery. COMT didn't affect CPP, suggesting its potential modality-specific effects on human pain.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623849/pdf/1744-8069-9-19.pdf
Dolor persistente en postmastectomía: comparación de las características psicológicas, médicas, quirúrgicas y psicosociales entre los pacientes con y sin dolor
Persistent pain in postmastectomy patients: comparison of psychophysical, medical, surgical, and psychosocial characteristics between patients with and without pain.
Schreiber KL1, Martel MO, Shnol H, Shaffer JR, Greco C, Viray N, Taylor LN, McLaughlin M, Brufsky A, Ahrendt G, Bovbjerg D, Edwards RR, Belfer I.
Pain. 2013 May;154(5):660-8. doi: 10.1016/j.pain.2012.11.015. Epub 2012 Dec 5.
Abstract
Persistent postmastectomy pain (PPMP) is a major individual and public health problem. Increasingly, psychosocial factors such as anxiety and catastrophizing are being revealed as crucial contributors to individual differences in pain processing and outcomes. Furthermore, differences in patients' responses to standardized quantitative sensory testing (QST) may aid in the discernment of who is at risk for acute and chronic pain after surgery. However, characterization of the variables that differentiate those with PPMP from those whose acute postoperative pain resolves is currently incomplete. The purpose of this study was to investigate important surgical, treatment-related, demographic, psychophysical, and psychosocial factors associated with PPMP by comparing PPMP cases with PPMP-free controls. Pain was assessed using the breast cancer pain questionnaire to determine the presence and extent of PPMP. Psychosocial and demographic information were gathered via phone interview, and women underwent a QST session. Consistent with most prior research, surgical and disease-related variables did not differ significantly between cases and controls. Furthermore, treatment with radiation, chemotherapy, or hormone therapy was also not more common among those with PPMP. In contrast, women with PPMP did show elevated levels of distress-related psychosocial factors such as anxiety, depression, catastrophizing, and somatization. Finally, QST in nonsurgical body areas revealed increased sensitivity to mechanical stimulation among PPMP cases, while thermal pain responses were not different between the groups. These findings suggest that an individual's psychophysical and psychosocial profile may be more strongly related to PPMP than their surgical treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863788/pdf/nihms532216.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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