Neuropathic Aspects of Persistent Postsurgical Pain: A French Multicenter Survey With a 6-Month Prospective Follow-Up

Dualé, Christian; Ouchchane, Lemlih; Schoeffler, P.; Dubray, Claude

doi:10.1016/j.jpain.2013.08.014

Cited by 124 publications

(111 citation statements)

References 77 publications

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“…This information adds to the debate about the optimal technique for herniorrhaphy, as a neuropathic mechanism is considered a factor of severity and chronicization of postsurgical persistent pain. 4,9 In addition, the role of preoperative history of peripheral neuropathy in the occurrence of persistent neuropathic pain, as shown previously, 5 was confirmed in our subcohorts. In addition, we observed no protective role of locoregional anesthesia, probably because this technique acts to block central sensitization rather than neuropathic processes.…”

Section: Discussionsupporting

confidence: 90%

“…5 Ten patients were taking medication for pain 6 months after surgery, and 4 of them were considered to have neuropathic pain based on positive responses to the DN4 diagnostic questionnaire. When graded according to the World Health Organization's (WHO) analgesic ladder, 4 patients had a first-step and 3 had a second-step treatment, and 1 was treated for neuropathic pain (antidepressant plus gabapentin).…”

Section: Resultsmentioning

confidence: 99%

“…4 In a recently published prospective open-ended French multicentric cohort study, the risk of persistent neuropathic pain in the 6 months following inguinal hernia repair was estimated at 12.4% for open mesh surgery and 3.2% for laparoscopic surgery. 5 We further studied these 2 subcohorts to assess the risk of persistent neuropathic pain associated with laparoscopic and open inguinal hernia repair. Our observational nonrandomized design resulted in unequal distributions of relevant covariates between comparison groups, but the level of evidence was improved by using an analysis based on propensity score.…”

Section: Discussionmentioning

confidence: 99%

“…The covariates to be considered in the multivariate analyses were first defined on the basis of their likelihood to influence the dependent outcome. These covariates were age, sex, body mass index (BMI), the centre at which the surgery took place, Pain Catastrophizing Scale score, 7 type of surgery, location of preoperative pain (if any), history of peripheral neuropathy, report of a putative neurotoxic condition (see Dualé and colleagues 5 for a detailed description of these 2 preceding composite outcomes), the use and time of use of locoregional anesthesia, the use of intraoperative opioids and of intra-or postoperative ketamine, and the report of any early postoperative complications. Owing to the large number of centres, the centre where surgery was performed was not retained in the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…5 Briefly, this multicentric French study was approved by the appropriate institutional research ethics boards (CCPPRB d'Auvergne and CPP Sud-Est VI for amendments), and the trial was registered on ClinicalTrials.gov (NCT00812734). In each centre, the study was coordinated by a referent anaesthetist and conducted by the anesthesiology team.…”

Section: Methodsmentioning

confidence: 99%

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Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Niccolai

Ouchchane²,

Libier

et al. 2015

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Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysisBackground: A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified. Methods:We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensitymatched analysis with the propensity score built from a multivariable analysis using a generalized linear model. Results:Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5-30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective. Conclusion:We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed.Contexte : On soupçonne que l'incidence de la douleur persistante à la suite d'une hernioplastie inguinale est plus élevée avec la mise en place d'un filet par voie ouverte qu'avec la laparoscopie (transabdominale prépéritonéale), mais encore faut-il clarifier le rôle de la neuropathie.Méthodes : Nous avons mesuré l'incidence cumulative de la douleur neuropathique persistante, décrite comme une douleur au site opératoire accompagnée d'éléments neuropathiques déclarés par le patient dans les 6 mois suivant la chirurgie, auprès de 2 sous-cohortes prospectives d'une étude multicentrique. Nous avons comparé la mise en place d'un filet par voie ouverte et la laparoscopie à l'aide de différentes analyses, dont une analyse avec appariement des scores de propension, les scores de propension découlant d'une analyse multivariée générée à partir d'un modèle linéaire généralisé.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Niccolai

Ouchchane²,

Libier

et al. 2015

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Neuropathic pain after thoracotomy: Tracking signs and symptoms before and at monthly intervals following surgery

Gandhi

Pomares

Naso

et al. 2020

European Journal of Pain

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Predicting long‐term postsurgical pain by examining the evolution of acute pain

Smith

Baharloo

Nickerson

et al. 2020

European Journal of Pain

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Background Increased acute postoperative pain intensity has been associated with the development of persistent postsurgical pain (PPP) in mechanistic and clinical investigations, but it remains unclear which aspects of acute pain explain this linkage. Methods We analysed clinical postoperative pain intensity assessments using symbolic aggregate approximations (SAX), a graphical way of representing changes between pain states from one patient evaluation to the next, to visualize and understand how pain intensity changes across sequential assessments are associated with the intensity of postoperative pain at 1 (M1) and 6 (M6) months after surgery. SAX‐based acute pain transition patterns were compared using cosine similarity, which indicates the degree to which patterns mirror each other. Results This single‐centre prospective cohort study included 364 subjects. Patterns of acute postoperative pain sequential transitions differed between the ‘None’ and ‘Severe’ outcomes at M1 (cosine similarity 0.44) and M6 (cosine similarity 0.49). Stratifications of M6 outcomes by preoperative pain intensity, sex, age group, surgery type and catastrophising showed significant heterogeneity of pain transition patterns within and across strata. Severe‐to‐severe acute pain transitions were common, but not exclusive, in patients with moderate or severe pain intensity at M6. Conclusions Clinically, these results suggest that individual pain‐state transitions, even within patient or procedural strata associated with PPP, may not alone offer good predictive information regarding PPP. Longitudinal observation in the immediate postoperative period and consideration of patient‐ and surgery‐specific factors may help indicate which patients are at increased risk of PPP. Significance Symbolic aggregate approximations of clinically obtained, acute postoperative pain intraday time series identify different motifs in patients suffering moderate to severe pain 6 months after surgery.

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Neuropathic Aspects of Persistent Postsurgical Pain: A French Multicenter Survey With a 6-Month Prospective Follow-Up

Cited by 124 publications

References 77 publications

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Neuropathic pain after thoracotomy: Tracking signs and symptoms before and at monthly intervals following surgery

Predicting long‐term postsurgical pain by examining the evolution of acute pain

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