The goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively.
The primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries
Prospective, observational study
60 patients requiring a single-level lumbar fusion surgery
Postoperative pain intensity and the amount of postoperative analgesics consumption.
In our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3.
The average age of the patients was 51.11 ± 13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<0.0016), higher PSQ (p<0.001), higher ODI scores(p<0.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for post-operative VAS at 6 hr period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (P<0.05). There was a significant correlation between algometer average scores (p<0.001) with the breakthrough analgesics.
Preoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.
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- Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery.PLoS ONE. 2016; 11 (ed)e0147972https://doi.org/10.1371/journal.pone.0147972
- Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council.The Journal of Pain. 2016; 17: 131-157https://doi.org/10.1016/j.jpain.2015.12.008
- Postoperative analgesia after total abdominal hysterectomy: Is the transversus abdominis plane block effective?.Niger J Clin Pract. 2019; 22: 478https://doi.org/10.4103/njcp.njcp_61_15
- Postoperative Pain Control.Surgical Clinics of North America. 2015; 95: 301-318https://doi.org/10.1016/j.suc.2014.10.002
- Current issues in postoperative pain management.European Journal of Anaesthesiology. 2016; 33: 160-171https://doi.org/10.1097/EJA.0000000000000366
- Individual Differences in Pain Sensitivity: Measurement, Causation, and Consequences.The Journal of Pain. 2009; 10: 231-237https://doi.org/10.1016/j.jpain.2008.09.010
- Prediction and assessment of the severity of post-operative pain and of satisfaction with management.Pain. 1998; 75: 177-185https://doi.org/10.1016/S0304-3959(97)00218-2
- Prediction of Postoperative Pain.Anesthesiology. 2010; 112: 1494-1502https://doi.org/10.1097/ALN.0b013e3181dcd5a0
- Preoperative Pain Sensitivity and Its Correlation with Postoperative Pain and Analgesic Consumption.Anesthesiology. 2011; 114: 445-457https://doi.org/10.1097/ALN.0b013e3181f85ed2
- Can we predict persistent postoperative pain by testing preoperative experimental pain?.Current Opinion in Anaesthesiology. 2009; 22: 425-430https://doi.org/10.1097/ACO.0b013e32832a40e1
- Preoperative prediction of severe postoperative pain.Pain. 2003; 105: 415-423https://doi.org/10.1016/S0304-3959(03)00252-5
- Prediction of Postoperative Pain Intensity after Lumbar Spinal Surgery Using Pain Sensitivity and Preoperative Back Pain Severity.Pain Med. 2014; 15: 2037-2045https://doi.org/10.1111/pme.12578
- Interrater Reliability of Algometry in Measuring Pressure Pain Thresholds in Healthy Humans, Using Multiple Raters.The Clinical Journal of Pain. 2007; 23: 760-766https://doi.org/10.1097/AJP.0b013e318154b6ae
- Prediction of Postoperative Pain by Preoperative Nociceptive Responses to Heat Stimulation.Anesthesiology. 2004; 100: 115-119https://doi.org/10.1097/00000542-200401000-00020
- A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery.The Spine Journal. 2019; 19: 569-577https://doi.org/10.1016/j.spinee.2018.10.010
- An Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery.Curr Pain Headache Rep. 2020; 24: 11https://doi.org/10.1007/s11916-020-0842-5
- Can quantitative sensory testing predict responses to analgesic treatment?: Prediction using sensory testing.EJP. 2013; 17: 1267-1280https://doi.org/10.1002/j.1532-2149.2013.00330.x
- The predictive value of quantitative sensory testing: a systematic review on chronic postoperative pain and the analgesic effect of pharmacological therapies in patients with chronic pain.Pain. 2021; 162: 31-44https://doi.org/10.1097/j.pain.0000000000002019
- Is Preoperative Quantitative Sensory Testing Related to Persistent Postsurgical Pain?.A Systematic Literature Review. 131. Anesthesia & Analgesia, 2020: 1146-1155https://doi.org/10.1213/ANE.0000000000004871
- Preoperative Pressure Pain Threshold Is Associated With Postoperative Pain in Short-Stay Anorectal Surgery: A Prospective Observational Study.Anesthesia & Analgesia. 2021; 132: 656-662https://doi.org/10.1213/ANE.0000000000005072
- Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis.Pain. 2015; 156: 47-54https://doi.org/10.1016/j.pain.0000000000000002
- Assessing Preoperative Pain Sensitivity Predicts the Postoperative Analgesic Requirement and Recovery after Total Knee Arthroplasty: A Prospective Study of 178 Patients.The Journal of Arthroplasty. 2020; 35: 3545-3553https://doi.org/10.1016/j.arth.2020.07.029
- Sex differences in the perception of noxious experimental stimuli: a meta-analysis.Pain. 1998; 74: 181-187https://doi.org/10.1016/S0304-3959 (97)00199-1
- Gender differences after lumbar sequestrectomy: a prospective clinical trial using quantitative sensory testing.Eur Spine J. 2017; 26: 857-864https://doi.org/10.1007/s00586-016-4891-8
- Role of Small-Fiber Afferents in Pain Mechanisms With Implications on Diagnosis and Treatment.Curr Pain Headache Rep. 2010; 14: 179-188https://doi.org/10.1007/s11916-010-0105-y
- Enhanced Presurgical Pain Temporal Summation Response Predicts Post-Thoracotomy Pain Intensity During the Acute Postoperative Phase.The Journal of Pain. 2009; 10: 628-636https://doi.org/10.1016/j.jpain.2008.12.009
- Pain Catastrophizing, Response to Experimental Heat Stimuli, and Post–Cesarean Section Pain.The Journal of Pain. 2007; 8: 273-279https://doi.org/10.1016/j.jpain.2006.09.004
- Prediction of post-operative pain after a laparoscopic tubal ligation procedure: Prediction of post-operative pain.Acta Anaesthesiologica Scandinavica. 2008; 52: 938-945https://doi.org/10.1111/j.1399-6576.2008.01641.x
Accepted: May 18, 2023
Received in revised form: April 18, 2023
Received: January 17, 2023
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