Preoperative susceptibility to developing secondary hyperalgesia is associated with post-thoracotomy pain at 2 months

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-12-09 DOI:10.1002/ejp.4768

Solenn Gousset, Maximilien Cappe, Cedric Lenoir, Arnaud Steyaert, Patricia Lavand'homme, André Mouraux, Valérie Lacroix, Emanuel N. van den Broeke

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Abstract

Background

Identifying the subset of patients at risk for developing persistent pain after surgery is clinically important as they could benefit from targeted prevention measures. In this prospective study, we investigated if the preoperative assessment of the individual susceptibility to developing experimentally induced secondary hyperalgesia is associated with post-thoracotomy pain at 2 months.

Methods

Forty-one patients scheduled to undergo a posterolateral thoracotomy were recruited before surgery and followed prospectively for 2 months. The day before surgery, we experimentally induced secondary hyperalgesia at one of the two forearms and measured the change of perception to mechanical pinprick stimuli and the area of hyperalgesia. On postoperative Day 4, Day 15 and at the 2-month follow-up, patients were asked about their pain intensity at rest and during coughing and the area of secondary hyperalgesia around the scar as well as the change in perception to mechanical pinprick stimuli was measured.

Results

Of the 41 patients that were recruited only 20 could be analysed. Forty per cent reported pain at the 2-month follow-up. All of them reported cough-evoked pain and 10 per cent also reported pain at rest. A binary logistic regression model with both the magnitude and extent of experimentally induced secondary hyperalgesia was statistically significant (chi-squared = 12.439, p = 0.002, McFadden R² = 0.462) and showed excellent discriminative power (AUC = 0.938) for the presence or absence of cough-evoked pain at the 2 month follow-up.

Conclusion

Our findings indicate that the individual susceptibility to developing experimentally induced secondary hyperalgesia preoperatively may identify patients who are potentially vulnerable to develop persistent post-thoracotomy pain.

Significance

Our data suggests that preoperatively assessed experimentally induced secondary hyperalgesia displays excellent discriminative power for the presence or absence of cough-evoked pain 2 months after thoracotomy.

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术前发生继发性痛觉过敏的易感性与开胸术后2个月疼痛相关。

背景：确定有术后持续疼痛风险的患者亚群在临床上很重要，因为他们可以从有针对性的预防措施中受益。在这项前瞻性研究中，我们调查了术前评估个体对实验性继发性痛觉过敏的易感性是否与开胸术后2个月的疼痛有关。方法：择期行后外侧开胸手术的患者41例，术前随访2个月。手术前一天，我们通过实验在其中一只前臂处诱导继发性痛觉过敏，并测量对机械针刺刺激的感知变化和痛觉过敏的面积。术后第4天、第15天及2个月随访时，询问患者休息时和咳嗽时的疼痛强度、瘢痕周围继发性痛觉过敏面积以及对机械针刺刺激的感知变化。结果：在招募的41例患者中，只有20例可以进行分析。在2个月的随访中，40%的患者报告疼痛。他们都报告咳嗽引起的疼痛，10%的人也报告休息时疼痛。二值logistic回归模型对实验诱发继发性痛觉过敏的大小和程度均有统计学意义（χ 2 = 12.439, p = 0.002, McFadden R2 = 0.462），对随访2个月有无咳嗽引起的疼痛表现出极好的判别能力（AUC = 0.938）。结论：我们的研究结果表明，术前发生实验性继发性痛觉过敏的个体易感性可以识别出可能容易发生持续开胸术后疼痛的患者。意义：我们的数据表明，术前评估实验诱导的继发性痛觉过敏对开胸2个月后咳嗽引起的疼痛的存在或不存在有很好的鉴别能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.