Background & Aims
Studies often focus on evaluating pain-related patient-reported outcomes and treatments up until the first postoperative day and then from the 3rd month after surgery, the first time point for classifying chronic pain after surgery (CPSP). The sub-acute phase, roughly 7 days after surgery and up until the 3rd month after surgery, is studied less often. This phase has been described as a ‘grey zone’, a period when most patients recover functionally from their surgery, yet, some may transition from experiencing ‘acute’ to ‘chronic’ pain. It, thus, deserves attention as a period for identifying those patients who experience poor recovery and whose condition may progress to CPSP. [1]
In this study, we aimed to characterize pain intensity, pain-related interference and screen for neuropathic pain (NeuP) in the acute and sub-acute phase after surgery in a large cohort of patients undergoing mixed surgical procedures. Here we report finding from the sub-acute phase.
Methods
PAIN OUT, a perioperative pain registry (www.pain-out.eu), provided tools for assessing pain and function on post-operative day 7 (POD7) & post-operative month 1 (POM1), using the Brief Pain Inventory (BPI). Pain Interference Total Scores (PITS) were assessed from the 7 interference questions in the BPI, and evaluated as no/mild/moderate/severe PITS. [2]
NeuP in the area of the surgical incision was screened for using the DN2 (Douleur Neuropathique) questionnaire. A score of ?3/7 items indicates suspect NeuP. [3]
The cohort consisted of patients from 10 hospitals in Mexico. All patients provided consent to participate in the study.
The primary endpoints were: (i) the difference in PITS scores between POD7 and POM1; (ii) the number of patients with severe PITs on POD7. Secondary enpoints included: (i) proportion of patients reporting symptoms of NeuP on POD7 vs POM1 in the cohort and by surgical discipline; (ii) the proportion of patients taking analgesics on POD7 vs POM1.
Results
The cohort included 1153 patients, 57% female, 49 (35; 63) (median [Q1; Q3]) years old. Of the cohort, 38% patients underwent general surgery, 25% obstetrics & gynecology (OBGYN), 16% thoracic surgery and 9% urological.
All PITS variables were reduced on POM1 compared to POD7; differences were at least medium effect sizes (ES). On POD7, 12% of patients reported severe PITS vs 27%/37%/25% reporting none/mild/moderate PITS, respectively. By POM1, 6% of patients reported severe PITS vs 44%/36%/15% reporting none/mild/moderate PITS, respectively. At both time points, PITS was most common in orthopedic & OBGYN patients, but the differences between the disciplines were a small ES.
On POD7 & POM1, 20% & 16% of the cohort reported symptoms of NeuP. At both time points, it was most common in orthopedic & OBGYN patients.
On POD7, 77% of patients were taking a non-opioid analgesic, 29% an opioid, 6% medication for neuropathic pain. By M1 it was 34%, 11% & 5%, respectively.
Conclusions
By one month after undergoing mixed surgical procedures, the majority of patients in this large cohort reported none or mild pain-related interference, no suspected symptoms of neuropathic pain in the surgical incision, and were not taking analgesics. However, a sub-group(s) of patients reported that pain continued to interfere with their function, they continued to experience symptoms of suspected neuropathic pain and continued to take analgesics.
The next steps in the analysis will aim to elucidate features of patients who reported recovery compared to those whose recovery was less favorable.
References
[1] Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol. 2011 Oct;24(5):545-50.
[2] Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory.Ann Acad Med Singapore 23(2): 129-138, 1994.
[3] Beloeil H, Sion B, Rousseau C, Albaladejo P, Raux M, Aubrun F, Martinez V; SFAR research network. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol. 2017 Oct;34(10):652-657
Presenting Author
Ruth Zaslansky
Poster Authors
Ruth Zaslansky
DSc
Jena University Hospital
Lead Author
Ana Lilia. Garduño López. MD
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán
Lead Author
Philipp Baumbach
PhD
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Lisette Castro Garcés
MD
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán
Lead Author
Frida Verdugo
MD
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán
Lead Author
Jorge Jimenez Tornero
MD
Hospital San Javier Guadalajara
Lead Author
Dulce Maria Rascón-Martínez
MD
Centro Médico Nacional Siglo XXI-IMSS
Lead Author
Juan de la Cruz Pineda Pérez
MD
Hospital Aranda de La Parra
Lead Author
Mariana Calderon Vidal
MD
Hospital fundación Medica Sur
Lead Author
Maria Esther Flores Villanueva
MD
Hospital General de Villacoapa
Lead Author
Gabriela Josefina Vidaña
MD
Hospital Central Morones Prieto San Luis Potosi
Lead Author
Luis Felipe Cuellar Gúzman
MD
Instituto Nacional de Cancerología
Lead Author
Elizabeth Villegas Sotelo
MD
Hospital General Dr Rubén Leñero
Lead Author
Gabriela Islas-Lagunas
MD
Instituto Nacional de Enfermedades Respiratorias Cosio Villegas
Lead Author
Mónica Dominguez Cid
MD
Hospital Angeles Puebla
Lead Author
Victor Manuel Acosta Nava
MD
Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán
Lead Author
Winfried Meissner
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Claudia Weinmann
MSc
Jena University Hospital
Lead Author
Marcus Komann
Dr.-Ing
Jena University Hospital
Lead Author
Christin Arnold
PhD
Jena University Hospital
Lead Author
Ulrike Stamer
MD
Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Lead Author
Eldeli Molina Niño
MD
Hospital Central Morones Prieto San Luis Potosi
Lead Author
Belem Aurora García-Herrera
MD
Instituto Nacional de Cancerología
Lead Author
Jesus Cano García
MD
Hospital Aranda de La Parra
Lead Author
Oscar López Hernández
MD
Hospital San Javier, Guadalajara
Lead Author
Topics
- Assessment and Diagnosis