Factors Associated With Acute Pain Estimation, Postoperative Pain Resolution, Opioid Cessation, and Recovery

Hah, Jennifer M.; Cramer, Eric; Hilmoe, Heather E.; Schmidt, Peter P.; McCue, Rebecca; Trafton, Jodie A.; Clay, Debra; Sharifzadeh, Yasamin; Ruchelli, Gabriela; Goodman, Stuart B.; Huddleston, James I.; Maloney, William J.; Dirbas, Frederick M.; Shrager, Joseph B.; Costouros, John G.; Curtin, Catherine; Mackey, Sean; Carroll, Ian

doi:10.1001/jamanetworkopen.2019.0168

Cited by 89 publications

(99 citation statements)

References 32 publications

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“…In our study, female patients were found to have higher baseline pain scores than males after major surgery, consistent with some prior studies 4 6 18. However, the sex difference in the postoperative pain intensity and analgesic consumption remained controversial in previous literature.…”

Section: Discussionsupporting

confidence: 91%

“…Besides, analyses for temporal domain of pain revealed a meaningful link between psychosocial modulators of postoperative pain and pain chronification 14. A variety of analytical methods have been used to assess the pain trajectory in previous studies, including latent curve model,9 13 14 25 Bayesian change-point model,25 and cluster analysis for trajectory classification 10 12 16–18. Compared with change-point model and cluster analysis, latent curve model is useful in distinguishing between pain intensity and pain resolution and identifying potential influential factors for these two important parameters of pain.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have reported the association between postoperative pain trajectories and important clinical outcomes, including chronic postsurgical pain after knee arthroplasty,11 breast cancer surgery,12 and other types of surgery,13 14 functional disabilities in arthritis patients,15 risk of postoperative readmission,16 and oncological outcomes of colorectal cancer 17. A recent post-hoc analysis of randomised trial showed the high pain cluster of pain trajectory significantly predicted prolonged postoperative pain and delayed opioid cessation, further highlighting the clinical implications of time course analysis of acute pain 18…”

Section: Introductionmentioning

confidence: 99%

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Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

Tai

Lin

et al. 2019

BMJ Open

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ObjectivesWe aimed to investigate the factors associated with variations in postoperative pain trajectories over time in patients using intravenous patient-controlled analgesia (IV-PCA) for postoperative pain.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsPatients receiving IV-PCA after surgery.Primary and secondary outcome measuresPrimary outcome was the postoperative pain scores.ResultsA total of 3376 patients and 20 838 pain score observations were analysed using latent curve models. Female and longer anaesthesia time increased the baseline level of pain (p=0.004 and 0.003, respectively), but abdominal surgery and body weight decreased it (both p<0.001). Regarding the trend of pain resolution, lower abdominal surgery steepened the slope (p<0.001); older age, American Society of Anesthesiologists (ASA) class ≥3 and longer anaesthesia time tended to flatten the slope (p<0.001, =0.019 and <0.001, respectively). PCA settings did not affect the variations in postoperative pain trajectories.ConclusionsPatient demographics, ASA class, anaesthesia time and surgical sites worked together to affect postoperative pain trajectories in patients receiving IV-PCA. Latent curve models provided valuable information about the dynamic and complex relationships between the pain trajectories and their influential factors.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

Tai

Lin

et al. 2019

BMJ Open

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“…In a metaanalysis of 29 993 patients who had undergone total knee arthroplasty that exclusively examined preoperative risk factors, preoperative pain was most commonly signi cantly associated with persistent postsurgical pain. 30 The present study demonstrated that the VAS scores before surgery and at 7 days after surgery were signi cantly higher in the chronic pain group than in the nonchronic pain group. Compared with the patients without early POCD, the patients who developed POCD had signi cantly higher VAS scores 3 days after surgery and more often requested additional opioids as rescue analgesia postoperatively.…”

Section: Discussionsupporting

confidence: 47%

Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Huai¹,

Jiao²,

Gu³

et al. 2020

Preprint

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Background: Although there is high overall success rate of major joint replacement surgery, postoperative cognitive dysfunction (POCD) is a very common complication after surgery, increasing morbidity and mortality. Identifying POCD risk factors would be helpful to prevent and decrease the occurrence of POCD. We hypothesised that preoperative chronic pain increases the risk of POCD.Methods: A single-centre, observational, prospective cohort study was conducted from January 2018 to March 2020. All consecutive elderly patients (>65 years) who underwent elective hemiarthroplasty or total hip arthroplasty with general anaesthesia by the same surgeon were enrolled. The patients underwent neuropsychological testing preoperatively and at 7 days and 2 months postoperatively. To determine POCD, a nonsurgical control group was recruited from the general community.Results: Of the 141 patients who finished the neuropsychological testing 7 days after surgery, 61 (43.2%) had preoperative chronic pain. Of the 61 patients, 17 (27.9%) developed POCD; of the 79 patients with no chronic pain, 10 (12.7%) had developed POCD by 7 days after surgery. Multivariate logistic regression analysis identified preoperative chronic pain as a risk factor of POCD assessed 7 days after surgery (odds ratio, 3.335; p = 0.022). There was no significant difference in the POCD incidence 2 months after surgery between patients with and without preoperative chronic pain.Conclusions: Preoperative chronic pain was a risk factor of developing POCD within 7 days after surgery in elderly patients following hip joint replacement surgery.Clinical trial registration: NCT03393676. Registered 10 January 2018, https://register.clinicaltrials.gov/prs/app/action/SelectProtocolsid=S0006RLL&selectaction=Edit&uid=U0003WPM&ts=79&cx=llo35x

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“…Considering its apparent reliability as a pain sensitivity biomarker, as well as its ease of obtainment, 516 pain-free PAF holds real promise as a pain management and prophylaxis tool. This may be especially 517 true in cases of planned surgery, where post-operative pain sensitivity is consistently found to be an 518 important risk factor for chronic pain development (Hah et al, 2019). For example, identification of high 519 pain sensitivity with PAF could be used to inform clinician decision making about surgical alternatives.…”

Section: Sensorimotor Paf Can Identify the Most Pain Sensitive Indivimentioning

confidence: 99%

Sensorimotor peak alpha frequency is a reliable biomarker of pain sensitivity

Furman

Prokhorenko

Keaser

et al. 2019

Preprint

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26Previous research has observed that individuals with chronic pain demonstrate slower alpha band 27 oscillations (8-12 Hz range) during resting electroencephalography (EEG) than do age-matched, healthy 28 controls. While this slowing may reflect pathological changes within the brain that occur during the 29 chronification of pain, an alternative explanation is that healthy individuals with slower alpha 30 frequencies are more sensitive to prolonged pain, and by extension, more susceptible to developing 31 chronic pain. To formally test this hypothesis, we examined the relationship between the pain-free, 32resting alpha frequency of healthy individuals and their subsequent sensitivity to two experimental 33 models of prolonged pain, Phasic Heat Pain and Capsaicin Heat Pain, at two testing visits separated by 8 34 weeks on average (n = 61 Visit 1, n = 46 Visit 2). We observed that the speed of an individual's pain-free 35 alpha oscillations was negatively correlated with sensitivity to both prolonged pain tests and that this 36 relationship was reliable across short (minutes) and long (weeks) timescales. Furthermore, we used the 37 speed of pain-free alpha oscillations to successfully identify those individuals most sensitive to 38prolonged pain, which we also validated on data from a separate, independent study. These results 39suggest that alpha oscillation speed is a reliable biomarker of prolonged pain sensitivity with the 40 potential to become a tool for prospectively identifying pain sensitivity in the clinic. 41

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Factors Associated With Acute Pain Estimation, Postoperative Pain Resolution, Opioid Cessation, and Recovery

Cited by 89 publications

References 32 publications

Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

Preoperative Chronic Pain as a Risk Factor for Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Hip Joint Replacement Surgery: A Prospective Observational Cohort Study

Sensorimotor peak alpha frequency is a reliable biomarker of pain sensitivity

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