The Cold Pressor Test as a Predictor of Prolonged Postoperative Pain, a Prospective Cohort Study

Abstract

IntroductionPresently, it is difficult to predict which patients are at increased risk of ongoing pain problems postoperatively. This study followed a group of patients from the week before their operation until 3 months after it, to identify potential risk variables.MethodsFifty-four patients undergoing moderate-major gynaecological surgery at Christchurch Women’s Hospital were recruited and assessed preoperatively over an 11-week period. At this initial assessment, participants were subjected to a cold pressor test (CPT). Telephonic follow-up was conducted at 6 weeks and 3 months postoperatively, to determine pain status. Information regarding the type of operation and surgical approach was collected from hospital records.ResultsPain threshold (time taken to report the onset of pain), as measured by the CPT, was significantly predictive of prolonged pain outcomes (area under the curve = 0.80, 95 % CI 0.66, 0.95). Pain tolerance (total time taken to end the CPT voluntarily) was similarly predictive but non-significant (area under the curve = 0.69, 95 % CI 0.47, 0.90).ConclusionThe preoperative cold pressor test shows some promise for predicting ongoing postoperative pain. However, more research is needed to determine the clinical significance of these findings in larger samples and how they could be incorporated into clinical practice.

‘External timing’ of placebo analgesia in an experimental model of sustained pain

“…Participants had no history of neurological, psychiatric or other chronic medical conditions and were instructed not to consume alcohol or analgesic medication 12 hr prior to the experiment. Twenty‐nine participants had to be excluded: one participant developed muscle cramps in her arm during the experiment, while 28 participants did not withdraw their hand from the ice water within the maximum exposure time that we set for safety reasons—that is, maximum exposure time was set at 10 min during the familiarization trial and at 15 min during the test sessions (Cheung & Daanen, 2012; MacLachlan et al., 2016). Of these 28, 26 exceeded the maximum exposure time during the familiarisation trial, that is, before participants were assigned to the different groups.…”

Pain sensitivity does not differ between obese and healthy weight individuals

“…These results suggest that increased adiposity does not in-and-of-itself alter nociception. Although experimental pain sensitivity can predict chronic pain development, 17 , 21 , 75 , 78 more research is needed to determine whether experimental pain can predict chronic pain development in obese individuals.…”

The effectiveness of parental distraction during children’s acute pain: The moderating effect of socioeconomic status

“…However, the CPT is regarded as an objective measure of pain sensitivity (Oaks, Stage, Middleton, Faraone, & Johnson, 2018), one indicator that may be linked to the development of chronic pain (Nielsen, Staud, & Price, 2009). Studies among adults indicate that lower pain tolerance during a CPT predicts worse pain symptoms post‐surgery (Kasch, Qerama, Bach, & Jensen, 2005) and during recovery from injury (MacLachlan, Shipton, & Wells, 2016). Examining the predictive validity of pain‐induction tasks on child chronic pain symptoms will help to determine whether such measures should be used in the future to predict those most at risk for chronic pain.…”