Just how much does it cost? A cost study of chronic pain following cardiac surgery

Guertin, Jason R.; Pagé, M. Gabrielle; Tarride, Jean‐Éric; Talbot, Denis; Watt‐Watson, Judy; Choinière, Manon

doi:10.2147/jpr.s175090

Cited by 18 publications

(13 citation statements)

References 43 publications

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“…Key risk factors for CPSP include longer surgery times, patient demographics (eg, younger, female), perioperative factors (eg, pre-existing pain, nerve injuries, and acute postoperative pain), and psychological characteristics (eg, anxiety and catastrophizing) 3 4. Among the deleterious effects of CPSP are prolonged opioid use, impaired function, decreased quality of life, and increased healthcare costs 5 6…”

Section: Introductionmentioning

confidence: 99%

Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review

McGregor

Warner

Linde

et al. 2022

Reg Anesth Pain Med

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BackgroundIn an attempt to aggregate observations from clinical trials, several meta-analyses have been published examining the effectiveness of systemic, non-opioid, pharmacological interventions to reduce the incidence of chronic postsurgical pain.ObjectiveTo inform the design and reporting of future studies, the purpose of our study was to examine the quality of these meta-analyses.Evidence reviewWe conducted an electronic literature search in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews. Published meta-analyses, from the years 2010 to 2020, examining the effect of perioperative, systemic, non-opioid pharmacological treatments on the incidence of chronic postsurgical pain in adult patients were identified. Data extraction focused on methodological details. Meta-analysis quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) critical appraisal tool.FindingsOur search yielded 17 published studies conducting 58 meta-analyses for gabapentinoids (gabapentin and pregabalin), ketamine, lidocaine, non-steroidal anti-inflammatory drugs, and mexiletine. According to AMSTAR 2, 88.2% of studies (or 15/17) were low or critically low in quality. The most common critical element missing was an analysis of publication bias. Trends indicated an improvement in quality over time and association with journal impact factor.ConclusionsWith few individual trials adequately powered to detect treatment effects, meta-analyses play a crucial role in informing the perioperative management of chronic postsurgical pain. In light of this inherent value and despite a number of attempts, high-quality meta-analyses are still needed.PROSPERO registration numberCRD42021230941.

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Section: Introductionmentioning

confidence: 99%

Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review

McGregor

Warner

Linde

et al. 2022

Reg Anesth Pain Med

View full text Add to dashboard Cite

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“…The increasing number of cardiac surgeries represents a major public health issue with economic consequences and poses a significant impact on patients’ quality of life. 4,20–22…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort Study

et al. 2023

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Background Chronic post-surgical pain is a common complication of surgery. The role of psychological risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. We hypothesize that baseline psychological vulnerabilities have a negative influence on chronic post-surgical pain. Methods We prospectively collected demographic, psychological, and perioperative factors in a cohort of 1059 patients undergoing cardiac surgery at the Toronto General Hospital between 2012-2020. Patients were followed and completed chronic pain questionnaires at 3, 6, and 12 months after surgery. Results We included 767 patients who completed at least one follow-up questionnaire. The incidence of postsurgical pain (> 0 out of 10) at 3, 6, and 12 months after surgery was 191/663 (29%), 118/625 (19%), and 89/605 (15%), respectively. Notably, among patients reporting any pain, the incidence of pain compatible with a neuropathic phenotype increased from 56/166 (34%) at 3 months, to 38/97 (39%) at 6 months and 43/67 (64%) at 12 months. Factors associated with postsurgical pain scores at 3 months include female sex, pre-existing chronic pain, previous cardiac surgery, preoperative depression, baseline pain catastrophizing scores, and moderate-to-severe acute pain (≥4 out of 10) within 5 postoperative days. Conclusion Nearly one in three patients undergoing cardiac surgery reported pain at 3 months follow-up, with ~15% reporting persistent pain at 1 year. Female sex, pre-existing chronic pain, and baseline depression were associated with postsurgical pain scores across all three time periods.

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“…fNIRS can be adapted to measure such changes as defined in the approach suggested for auditory measures or commands in this paper. A much larger public healthcare problem relates to (1) opioid use disorder following surgery if opioids are used to limit postsurgical pain [75,76]; and (2) the evolution of surgically induced chronic pain estimated to be around 30% of all surgical patients [69,77,78], both of which cost society billions of dollars and patients and their families significant suffering [79,80]. Having an objective measure for…”

Section: Public Policymentioning

confidence: 99%

Brain-based measures of nociception during general anesthesia with remifentanil: A randomized controlled trial

et al. 2022

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Background Catheter radiofrequency (RF) ablation for cardiac arrhythmias is a painful procedure. Prior work using functional near-infrared spectroscopy (fNIRS) in patients under general anesthesia has indicated that ablation results in activity in pain-related cortical regions, presumably due to inadequate blockade of afferent nociceptors originating within the cardiac system. Having an objective brain-based measure for nociception and analgesia may in the future allow for enhanced analgesic control during surgical procedures. Hence, the primary aim of this study is to demonstrate that the administration of remifentanil, an opioid widely used during surgery, can attenuate the fNIRS cortical responses to cardiac ablation. Methods and findings We investigated the effects of continuous remifentanil on cortical hemodynamics during cardiac ablation under anesthesia. In a randomized, double-blinded, placebo (PL)-controlled trial, we examined 32 pediatric patients (mean age of 15.8 years,16 females) undergoing catheter ablation for cardiac arrhythmias at the Cardiology Department of Boston Children’s Hospital from October 2016 to March 2020; 9 received 0.9% NaCl, 12 received low-dose (LD) remifentanil (0.25 mcg/kg/min), and 11 received high-dose (HD) remifentanil (0.5 mcg/kg/min). The hemodynamic changes of primary somatosensory and prefrontal cortices were recorded during surgery using a continuous wave fNIRS system. The primary outcome measures were the changes in oxyhemoglobin concentration (NadirHbO, i.e., lowest oxyhemoglobin concentration and PeakHbO, i.e., peak change and area under the curve) of medial frontopolar cortex (mFPC), lateral prefrontal cortex (lPFC) and primary somatosensory cortex (S1) to ablation in PL versus remifentanil groups. Secondary measures included the fNIRS response to an auditory control condition. The data analysis was performed on an intention-to-treat (ITT) basis. Remifentanil group (dosage subgroups combined) was compared with PL, and a post hoc analysis was performed to identify dose effects. There were no adverse events. The groups were comparable in age, sex, and number of ablations. Results comparing remifentanil versus PL show that PL group exhibit greater NadirHbO in inferior mFPC (mean difference (MD) = 1.229, 95% confidence interval [CI] = 0.334, 2.124, p < 0.001) and superior mFPC (MD = 1.206, 95% CI = 0.303, 2.109, p = 0.001) and greater PeakHbO in inferior mFPC (MD = −1.138, 95% CI = −2.062, −0.214, p = 0.002) and superior mFPC (MD = −0.999, 95% CI = −1.961, −0.036, p = 0.008) in response to ablation. S1 activation from ablation was greatest in PL, then LD, and HD groups, but failed to reach significance, whereas lPFC activation to ablation was similar in all groups. Ablation versus auditory stimuli resulted in higher PeakHbO in inferior mFPC (MD = 0.053, 95% CI = 0.004, 0.101, p = 0.004) and superior mFPC (MD = 0.052, 95% CI = 0.013, 0.091, p < 0.001) and higher NadirHbO in posterior superior S1 (Pos. SS1; MD = −0.342, 95% CI = −0.680, −0.004, p = 0.007) during ablation of all patients. Remifentanil group had smaller NadirHbO in inferior mFPC (MD = 0.098, 95% CI = 0.009, 0.130, p = 0.003) and superior mFPC (MD = 0.096, 95% CI = 0.008, 0.116, p = 0.003) and smaller PeakHbO in superior mFPC (MD = −0.092, 95% CI = −0.680, −0.004, p = 0.007) during both the stimuli. Study limitations were small sample size, motion from surgery, indirect measure of nociception, and shallow penetration depth of fNIRS only allowing access to superficial cortical layers. Conclusions We observed cortical activity related to nociception during cardiac ablation under general anesthesia with remifentanil. It highlights the potential of fNIRS to provide an objective pain measure in unconscious patients, where cortical-based measures may be more accurate than current evaluation methods. Future research may expand on this application to produce a real-time indication of pain that will aid clinicians in providing immediate and adequate pain treatment. Trial registration ClinicalTrials.gov NCT02703090

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Just how much does it cost? A cost study of chronic pain following cardiac surgery

Cited by 18 publications

References 43 publications

Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review

Quality of meta-analyses of non-opioid, pharmacological, perioperative interventions for chronic postsurgical pain: a systematic review

Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort Study

Brain-based measures of nociception during general anesthesia with remifentanil: A randomized controlled trial

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