Pain Symptoms Accompanying Chronic Poststernotomy Pain: A Pilot Study

Leersum, N.J. van; Leersum, Rutger L. van; Verwey, Harriëtte F.; Klautz, Robert J.M.

doi:10.1111/j.1526-4637.2010.00975.x

Cited by 34 publications

(25 citation statements)

References 25 publications

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“…Although most frequently affecting the thorax, chronic pain associated with cardiac surgery may also involve the upper and lower extremities, neck, and back, potentially explaining the difficulty in properly diagnosing chronic pain resulting from median sternotomy. 4,5,8 Thoracic pain following coronary artery bypass grafting (CABG) may be further divided into 3 different subcategories: (1) anterior chest wall pain on the left side, (2) midline scar pain, and (3) right-sided chest wall pain. Like the location of pain, descriptors are also varied, with some patients experiencing intermittent pain, whereas others describe constant pain.…”

Section: Diagnosismentioning

confidence: 99%

“…2 Previous studies may have underestimated the incidence of chronic pain because of its variable presentation, accounting for some of the large variation in incidence between groups. 8 In addition, the diagnosis of chronic pain after sternotomy can be made only when reported. Given the considerable anxiety and fear surrounding cardiac surgery, patients may underreport pain as they are simply happy to have survived surgery and do not wish to complain about what they may consider comparatively trivial.…”

Section: Diagnosismentioning

confidence: 99%

“…18,19 More recent studies including several prospective trials failed to show a higher incidence of chronic pain with IMA grafting. 3,8,9,[20][21][22] Improvements in methods of internal mammary harvest with less injury may be responsible for the changes seen in more recent studies. However, in 2014, another study showed a higher rate of chronic pain with IMA harvest.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] In the United States, more than 280,000 patients undergo cardiac surgery annually according to the Society of Thoracic Surgeons Database, with up to 156,800 patients suffering chronic poststernotomy pain at 1 year following cardiac surgery. 8 The incidence of chronic poststernotomy pain, however, may be underestimated. Without proper diagnosis and treatment, chronic sternal pain can reduce quality of life affecting sleep, mood, activity level, and overall satisfaction.…”

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confidence: 99%

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Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

mentioning

confidence: 99%

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Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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“…The 2013 Canadian prospective Cardiac (CARD) pain study (n=1010) [11] reported more modestly varying CPSP prevalence rates of 40%, 22%, and 17% at 3, 6, and 12 months following surgery, respectively; pain was most commonly located along the sternal incision and saphenous vein harvesting sites. But other studies have reported 1-year CPSP prevalence rates as high as 39% [39] and 45% [40]. Rates of CPSP following vascular surgery are similar in range (25%), with moderate to severe pain typically presenting along the femoropopliteal bypass tunnel [42].…”

Section: Introductionmentioning

confidence: 99%

Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

McGillion¹,

Yost²,

Turner³

et al. 2016

JMIR Res Protoc

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BackgroundTens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT—VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom.ObjectiveOur objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT).MethodsCaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise—death, myocardial infarction, and nonfatal stroke— all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups.ResultsStudy start-up is underway and usability testing is scheduled to begin in the fall of 2016.ConclusionsGiven our experience, dedicated industry partners, an...

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Persistent Postoperative Pain after Cardiac Surgery: Incidence, Characterization, Associated Factors and its impact in Quality of Life

Guimarães‐Pereira

Farinha

Azevedo

et al. 2016

European Journal of Pain

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This is the first study comprehensively describing PPP after CS and identifying NP in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower QoL, which deserves the attention of health care professionals in order to improve prevention, assessment and treatment of these patients. WHAT DOES THIS STUDY ADD?: This study comprehensively describes persistent postoperative pain (PPP) after cardiac surgery (CS) and identifies neuropathic pain (NP) in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower quality of life.

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Pain Symptoms Accompanying Chronic Poststernotomy Pain: A Pilot Study

Abstract: CPSP is an extensive pain syndrome. Sternal pain is frequently accompanied by pain of the head, neck, back, and upper extremities. Further research on the possible etiology is warranted.

Cited by 34 publications

References 25 publications

Chronic Poststernotomy Pain

Chronic Poststernotomy Pain

Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol

Persistent Postoperative Pain after Cardiac Surgery: Incidence, Characterization, Associated Factors and its impact in Quality of Life

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