Identifying risk factors for chronic postsurgical pain and preventive measures: a comprehensive update

Pergolizzi, Joseph V.; LeQuang, Jo Ann; Magnusson, Peter; Varrassi, Giustino

doi:10.1080/14737175.2023.2284872

Cited by 4 publications

(1 citation statement)

References 154 publications

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“…Nonetheless, it requires an effective postoperative analgesia plan, as TKA is considered one of the most painful procedures in orthopedic surgery [3][4][5]. As much as 50% of TKA patients report severe pain after surgery, leading to prolongation of the rehabilitation period, reduced cooperation during physiotherapy sessions, and increased risk of chronic postsurgical pain development [6][7][8][9][10]. The aforementioned aspects contribute to longer hospital stays, higher costs, and an adverse socioeconomic impact [11,12].…”

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confidence: 99%

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

Sarridou,

Gkiouliava,

Argiriadou

et al. 2024

Cureus

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Background and aim: The optimal strategy for the management of postoperative pain after total knee arthroplasty (TKA) remains challenging, while its treatment is crucial to increase patients’ outcomes. This study aimed to investigate the effects of parecoxib as add-on therapy, in a standard postoperative pain management protocol, represented by the continuous femoral nervous block. We studied its influence on rehabilitation indices and pain scores in patients undergoing TKA. Material and methods: This is a single-center, prospective, double-blind, randomized, placebo-controlled trial. All patients were operated with the use of subarachnoid anesthesia, and divided into two groups for postoperative analgesia. Both groups received a continuous femoral nerve block. One of the groups received intravenous parecoxib, while the other received a placebo. The primary investigated outcome was the range of motion (ROM). Recordings were noted at different times postoperatively. Bromage score (BS), visual analog scale (VAS), and the State-Trait Anxiety Inventory (STAI) were also studied. Results: A total of 90 patients were included and analyzed. ROM was significantly better (p<0.001) and pain scores were significantly lower (p=0.007) in the parecoxib group. No statistically significant difference was found with regard to BS between the two groups. A significant correlation was found between ROM and VAS pain scores at 12 hours (p=0.02), while ROM was inversely correlated with STAI postoperatively. Conclusions: The use of intravenous parecoxib is effective in improving rehabilitation indices and provides decreased postoperative pain scores after TKA.

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Section: Introductionmentioning

confidence: 99%

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

Sarridou,

Gkiouliava,

Argiriadou

et al. 2024

Cureus

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Hyperbaric Oxygen Attenuates Chronic Postsurgical Pain by Regulating the CD73/Adenosine/A1R Axis of the Spinal Cord in Rats

Yin,

Liu,

Zhang

et al. 2024

The Journal of Pain

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Impaired Basal Forebrain Cholinergic Neuron GDNF Signaling Contributes to Perioperative Sleep Deprivation–Induced Chronicity of Postsurgical Pain in Mice Through Regulating Cholinergic Neuronal Activity, Apoptosis, and Autophagy

Wang,

Wei,

Zhang

et al. 2024

CNS Neurosci Ther

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AimsThis study investigated the roles of lateral basal forebrain glial cell line–derived neurotrophic factor (GDNF) signaling and cholinergic neuron activity, apoptosis, and autophagy dysfunction in sleep deprivation–induced increased risk of chronic postsurgical pain (CPSP) in mice.MethodsSleep deprivation (6 h per day from −1 to 3 days postoperatively) was administered to mice receiving skin/muscle incision and retraction (SMIR) to determine whether perioperative sleep deprivation induces mechanical and thermal pain hypersensitivity, increases the risk of chronic pain, and causes changes of basal forebrain neurons activity (c‐Fos immunostaining), apoptosis (cleaved Caspase‐3 expression), autophagy (LC3 and p62 expression) and GDNF expression. Adeno‐associated virus (AAV)‐GDNF was microinjected into the basal forebrain to see whether increased GDNF expression could reverse sleep deprivation–induced changes in pain duration and cholinergic neuron apoptosis and autophagy. Cholinergic neurons were further depleted by mu p75‐SAP to examine whether the pain‐prolonging effects of sleep deprivation still exist.ResultsPerioperative sleep deprivation enhanced pain sensation and prolonged pain duration in SMIR mice, which was accompanied by decreased cholinergic neuron activity and GDNF expression, increased apoptosis, and autophagy dysfunction in the substantia innominata (SI), magnocellular preoptic nucleus (MCPO), and horizontal diagonal band Broca (HDB) (hereafter lateral basal forebrain). Normalizing cholinergic neuron GDNF expression by AAV‐GDNF in the lateral basal forebrain inhibited apoptosis and autophagy dysfunction and mitigated sleep deprivation–induced pain maintenance. Mice with selective lesion of lateral basal forebrain cholinergic neurons were resistant to the pain‐enhancing and prolonging effects of sleep deprivation and the pain‐alleviating effects of AAV‐GDNF therapy.ConclusionsPerioperative sleep deprivation promotes chronicity of postsurgical pain possibly through decreasing basal forebrain GDNF signaling and causing cholinergic neuronal apoptosis and autophagy dysfunction.

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Identifying risk factors for chronic postsurgical pain and preventive measures: a comprehensive update

Cited by 4 publications

References 154 publications

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

The Efficacy of the Combination of Continuous Femoral Nerve Block and Intravenous Parecoxib on Rehabilitation in Patients Undergoing Total Knee Arthroplasty: A Double-Blind, Randomized Clinical Trial

Hyperbaric Oxygen Attenuates Chronic Postsurgical Pain by Regulating the CD73/Adenosine/A1R Axis of the Spinal Cord in Rats

Impaired Basal Forebrain Cholinergic Neuron GDNF Signaling Contributes to Perioperative Sleep Deprivation–Induced Chronicity of Postsurgical Pain in Mice Through Regulating Cholinergic Neuronal Activity, Apoptosis, and Autophagy

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