BACKGROUND: Chronic posttraumatic/postsurgical pain (CPSP) is common after traumatic or surgical damage. Exposure to both trauma and surgery, with the potential for repeated bone and nerve damage, may increase the risk of CPSP after fracture-related surgery. But the (long-term) incidences of CPSP and neuropathic CPSP and the ensuing burdens are unknown. Therefore, the patients were prospectively assessed within 1 year, and the patient-specific characteristics were explored. METHODS: Between 2017 and 2018, 127 patients (age: 52.9 ± 17.1 years, male: 55.1%) with traumatic fractures needing osteosynthesis (extremities: 91.3%) were assessed posttrauma (before surgery), postsurgery at days 1 to 5, 6 weeks, 3 and 12 months. The primary outcomes are as follows: incidence at 3 and 12 months of CPSP (defined as pain intensity on a numerical rating scale [NRS: 0–10] ≥3), secondary exploration: neuropathic CPSP (NRS ≥3 and Douleur Neuropathique 4 interview [DN4i] score ≥3 [Douleur Neuropathique interview: 0–7]); burden: quality of life (QoL, the EuroQOL five dimensions questionnaire [EQ-5D-3L] descriptive system); and inter alia, the number of analgesics (trial registration: DRKS00011601). RESULTS: The incidence of CPSP was 57.1% (52/91, n/N) at 3 and 42.7% (35/82) at 12 months postsurgery, including neuropathic CPSP 7.7% (4/52) and 17.1% (6/35), respectively. Descriptively, posttraumatic higher pain intensity at rest (difference of 0.9 ± 1.8 NRS) and the need for more frequent analgesics (by 34.3%) were associated with CPSP a year after surgery compared to those without. As soon as week 6, these patients had developed descriptively a 15% more impaired QoL, with 25% more impairment after 1 year. The patients with CPSP presented with at least 1 neuropathic symptom 12 months later in 68.6% (24/35) of cases, mainly with an early posttraumatic occurrence (without fulfilling the definition of neuropathic CPSP). CONCLUSIONS: After early fracture-related surgery, high incidences of CPSP (43%) were prospectively observed 1 year postsurgery, up to approximately 1 in 5 patients who had neuropathic CPSP. At the same time, CPSP was accompanied with an impacted QoL and analgesic dependence, both indicating clinical relevance. Moreover, the high incidence and the early posttraumatic occurrence of more intense pain suggest that the initial fracture-related trauma, rather than the surgical trauma, may predominantly trigger CPSP at Y1 (1 year). Therefore, these exploratory results set the direction of required future research. A future clinical hypothesis might be: treat first what hurts first.
Zusammenfassung Hintergrund In letzter Zeit finden zunehmend digitale Tools wie Smartphone-basierte Applikationen und der Einsatz künstlicher Intelligenz Einzug in die Schmerzmedizin. Dies könnte im postoperativen Schmerzmanagement neue Therapieansätze ermöglichen. Der vorliegende Beitrag gibt einen Überblick über verschiedene digitale Tools und deren Einsatzmöglichkeiten in der postoperativen Schmerztherapie. Material und Methoden Es wurde eine orientierende Literaturrecherche in den Datenbanken MEDLINE und Web of Science durchgeführt und eine gezielte Auswahl von Publikationen getroffen, um eine strukturierte Darstellung verschiedener aktueller Einsatzmöglichkeiten vorzunehmen und auf Basis neuester Erkenntnisse zu diskutieren. Ergebnisse Heute gehören zu den Einsatzmöglichkeiten digitaler Tools – wenn auch meist nur mit Modellcharakter – die Schmerzdokumentation und -erfassung, das Selbstmanagement sowie die Edukation der Patient:innen, die Schmerzprädiktion, Entscheidungsunterstützung für das Fachpersonal sowie die supportive Schmerztherapie, beispielsweise in Form von virtueller Realität und Videos. Dies bietet Vorteile wie individualisierte Behandlungskonzepte, das Adressieren bestimmter Patient:innengruppen, Reduktion von Schmerzen und Analgetika sowie das Potenzial der Frühwarnung oder -erkennung von postoperativen Schmerzen. Im vorliegenden Beitrag werden ebenso die Herausforderungen der technischen Umsetzung und angemessenen Schulung der Nutzer:innen thematisiert. Schlussfolgerung Der Einsatz digitaler Tools, wenngleich bisher eher punktuell und modellhaft im klinischen Alltag integriert, verspricht zukünftig eine innovative, personalisierte postoperative Schmerztherapie. Künftige Studien und Projekte sollten dazu beitragen, die vielversprechenden Forschungsansätze in den klinischen Alltag zu integrieren.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.