Flagging the pain

Shipton, Edward A.; Tait, Brian D.

doi:10.1017/s0265021505000694

Cited by 54 publications

(10 citation statements)

References 81 publications

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“…Every time an individual undergoes surgery, the chances of having a post-operative chronic nerve pain syndrome is approximately 30%, ranging up to 50% in some common surgeries such as hernia repair (Poobalan et al, 2003; Leslie et al, 2010). The burden to the individual and society are enormous (Shipton and Tait, 2005; VanDenKerkhof et al, 2006; Haller et al, 2011). …”

Section: The Current Clinical Conundrum Of Snpp and Need For Objecmentioning

confidence: 99%

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Surgically Induced Neuropathic Pain

Borsook¹,

Kussman²,

George³

et al. 2013

Annals of Surgery

132

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Objective Nerve damage takes place during surgery. As a consequence, significant numbers (10–40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). Background The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in ‘peripheral’ and ‘central sensitization’, with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients these initial events produce chemical, structural and functional changes in the peripheral (PNS) and central nervous (CNS) systems. The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state – allodynia, sensory loss, shooting pains etc., that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed ‘centralization of pain’ and affect sensory, emotional and other (e.g., cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (e.g., depression). Conclusions Currently there are no objective measures of pain in the peri-operative period. As such intermittent pain or continuous may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition appear to provide initial opportunities for decreasing the burden of SNPP until treatments with high efficacy and low side effects that either prevent or treat pain are discovered.

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Section: The Current Clinical Conundrum Of Snpp and Need For Objecmentioning

confidence: 99%

“…Thus, SNPP is epidemic, and even by conservative estimates, the number of patients suffering from neuropathic pain is significant. SNPP results in prolonged suffering, and the burden to the individual and society are enormous (Shipton and Tait, 2005; VanDenKerkhof et al, 2006; Haller et al, 2011) (O'Connor, 2009). …”

Section: Introductionmentioning

confidence: 99%

Surgically Induced Neuropathic Pain

Borsook¹,

Kussman²,

George³

et al. 2013

Annals of Surgery

132

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“…While it is possible that pain outcomes can improve up to one year after surgery, 13 people with persistent pain at three to six months can be disappointed with their outcome, 14 and it may be possible to provide appropriate, targeted management in this early subacute phase, potentially halting progression into longer-term pain and disability. 15 Despite a good outcome for many, a considerable proportion of patients have chronic pain after TKA. In a systematic review of prospective studies of patients undergoing TKA, 10% to 34% of patients reported unfavourable pain outcomes at between three months and five years after surgery 16 ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Chronic pain after total knee arthroplasty

Wylde¹,

et al. 2018

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Despite a good outcome for many patients, approximately 20% of patients experience chronic pain after total knee arthroplasty (TKA).Chronic pain after TKA can affect all dimensions of health-related quality of life, and is associated with functional limitations, pain-related distress, depression, poorer general health and social isolation.In both clinical and research settings, the approach to assessing chronic pain after TKA needs to be in-depth and multidimensional to understand the characteristics and impact of this pain. Assessment of this pain has been inadequate in the past, but there are encouraging trends for increased use of validated patient-reported outcome measures.Risk factors for chronic pain after TKA can be considered as those present before surgery, intraoperatively or in the acute postoperative period. Knowledge of risk factors is important to guide the development of interventions and to help to target care. Evaluations of preoperative interventions which optimize pain management and general health around the time of surgery are needed.The causes of chronic pain after TKA are not yet fully understood, although research interest is growing and it is evident that this pain has a multifactorial aetiology, with a wide range of possible biological, surgical and psychosocial factors that can influence pain outcomes.Treatment of chronic pain after TKA is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristics is advocated. To ensure that optimal care is provided to patients, the clinical- and cost-effectiveness of multidisciplinary and individualized interventions should be evaluated.Cite this article: EFORT Open Rev 2018;3:461-470. DOI: 10.1302/2058-5241.3.180004

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“…[13] These findings align with those of previous studies, in which patients undergoing more extensive surgery had higher chance of developing postoperative NP in various types of surgeries. [20,22] From the data in this study, tumor size and operative time were not associated with the development of NP. Therefore, extensive dissection and complexity of anatomical structure in pelvic area may be more significant causes of NP than tumor size or operative time.…”

Section: Discussionmentioning

confidence: 70%

Neuropathic pain after sarcoma surgery

Park¹,

Kim

Yun

et al. 2018

Medicine

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Surgery for sarcoma frequently causes nerve damage as the dissection often violates the internervous plane. Nerve damage may cause neuropathic pain (NP), which can result in persistent pain after surgery. This is the first study to investigate the prevalence and associated factors of postoperative NP in patients who underwent surgery for sarcoma of the extremities or pelvis.Patients (n = 144) who underwent curative surgery at least 6 months prior to the visit for histologically confirmed sarcoma were enrolled. The presence of NP was assessed by administering PainDetect, a widely used questionnaire for detecting NP. Patients with PainDetect scores ≥13 were considered to have NP. The possible factors that might be associated with the development of NP were investigated: patient characteristics, tumor characteristics, extent of surgery, and adjuvant therapy.Out of 144 patients, 36 patients (25%) had NP. Patients with NP had significantly worse visual analog scale score (P < .001), Toronto Extremity Salvage Score (P < .001), and Musculoskeletal Tumor Society Rating Scale score (P < .001) than patients without NP. Among the possible factors associated with NP, patients with NP were more likely to have undergone pelvic surgery (P = .002) and multiple surgeries (P = .014) than patients without NP. In logistic regression analysis, pelvic surgery (odds ratio = 5.05, P = .005) and multiple surgeries (odds ratio = 2.33, P = .038) were independent factors associated with NP after sarcoma surgery.This study suggests that the prevalence of NP after surgery for sarcoma is considerable. Surgery of the pelvis and multiple surgeries are predictive of postoperative persistent NP.

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Flagging the pain

Cited by 54 publications

References 81 publications

Surgically Induced Neuropathic Pain

Surgically Induced Neuropathic Pain

Chronic pain after total knee arthroplasty

Neuropathic pain after sarcoma surgery

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