Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data

Abstract

Although chronic postsurgical pain (CPSP) is a major health care problem, pain-related functional interference has rarely been investigated. Using the PAIN OUT registry we evaluated patients' pain-related outcomes on the first postoperative day, and their pain-related interference with daily living (Brief Pain Inventory) and neuropathic symptoms (DN4: douleur neuropathique en 4 questions) at six months after surgery. Endpoints were pain interference total scores (PITS) and their association with pain and DN4 scores. Furthermore, possible risk factors associated with impaired function at M6 were analyzed by ordinal regression analysis with PITS groups (no to mild, moderate and severe interference) as a dependent three-stage factor. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Of 2,322 patients, 15.3% reported CPSP with an average pain score ≥3 (NRS 0-10). Risk for a higher PITS group increased by 190% (OR (95%-CI): 2.9 (2.7-3.2); p<0.001) in patients with, compared to without CPSP. A positive DN4 independently increased risk by 29% (1.3 (1.12-1.45), p<0.001). Pre-existing chronic pain (3.6 (2.6-5.1); p<0.001), time spent in severe acute pain (2.9 (1.3-6.4); p=0.008), neurosurgical back surgery in males (3.6 (1.7-7.6); p<0.001) and orthopedic surgery in females (1.7 (1.0-3.0); p=0.036) were the variables with strongest association with PITS. PITS might provide more precise information about patients' outcomes than pain scores only. As neuropathic symptoms increase PITS, a suitable instrument for their routine assessment should be defined.

A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

“…Equivalent to the present study, 11% of all cases and 13% of the thyroidectomy cases in this European study developed CPSP, but thyroidectomy was no risk factor for CSPS at M12. A recent study of the PAIN OUT registry with 2322 patients reported the development of CPSP in 15.3% at M12, but did not include ORL cases 13 . In a cross-sectional survey from 2007 to 2008 in Norway with 2043 participants with surgery 3 months to 3 years preceding the survey, 18.3% reported www.nature.com/scientificreports/ persistent moderate or severe pain 9 .…”

“…All pain drugs taken were listed. Finally, German version of the Brief Pain Inventory (BPI) was used to estimate the functional interference within the last 24 h with three domains: physical interference (general activity, walking ability, and work), affective interference (mood, enjoyment of life, and relations with other persons), and sleep was assessed also using 11-point NRS (0 = no impairment; 10 = maximal impairment) 13,29 . Patient with any intensity of persistent pain (NRS ≥ 1) were differentiated from patient with CPSP: All patients who indicated average pain with NRS ≥ 3 at M6 and/ or M12 were defined as patients with CPSP.…”

Association of painful human immunodeficiency virus distal sensory polyneuropathy with aberrant expectation of pain relief: functional magnetic resonance imaging evidence

“…This outcome was chosen, as functional interference might be clinically more meaningful and better capture the functional consequences of a chronic pain state. 53 These findings cluster corrected (voxel = 0.005; cluster = 0.05).…”

Perioperative Schmerztherapie mit Nichtopioidanalgetika

“…sogar mit Opioiden eingestellt sind (z. B. Patienten zum Kniegelenksersatz bei lange vorbestehender Kniegelenksarthrose) [ 31 , 85 ]. Für solche Konstellationen sollten zusammen mit der operativen Abteilung Klinikstandards entwickelt werden.…”