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