Thermal QST Phenotypes Associated with Response to Lumbar Epidural Steroid
          Injections: A Pilot Study

Maher, Dermot P.; Ding, Weihua; Singh, Sarabdeep; Opalacz, Arissa; Fishman, Claire E.; Houghton, Mary; Ahmed, Shihab; Chen, Lucy; Mao, Jianren; Zhang, Yi

doi:10.1093/pm/pnw364

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…In the current aging society of our country, there are more and more elderly surgical cases, and the requirements for surgical anesthesia are becoming higher and higher. As the general physiological function of the elderly is reduced and their tolerance to anesthesia and surgery is poor, the choice of anesthesia for elderly patients undergoing lower limb surgery is a contradictory problem [ 1 , 2 ]. General anesthesia methods include epidural anesthesia, spinal anesthesia, and combined spinal epidural anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Li¹,

Fan²,

Chen³

2022

Computational and Mathematical Methods in Medicine

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Objective. Combined spinal epidural anesthesia (CSEA) is applied to lower limb orthopaedic surgery in the elderly. This study is aimed at exploring the effect of CSEA in orthopaedic surgery of elderly patients. Methods. A total of 40 elderly patients with femoral fracture needing hip replacement or femoral head replacement in our hospital from June 2021 to June 2022 were selected as the research objects. The subjects were divided into observation group ( n = 20 ) and control group ( n = 20 ) by random number table method. The control group was given epidural anesthesia, while the observation group was given CSEA. Hemodynamic indexes (heart rate (HR) and mean arterial pressure (MAP)), visual analogue scale (VAS) pain score changes, anesthetic effects, and postoperative complications were compared between the two groups. Results. After operation, the observation group had lower HR and MAP values than the control group ( P < 0.05 ). The dosage of local anesthetics in the observation group was significantly less than that in the control group ( P < 0.05 ). The onset time and improvement time of sensory block in the observation group were significantly faster than those in the control group ( P < 0.05 ). The observation group had a lower VAS score than the control group ( P < 0.05 ). There was no significant difference in Bromage score or incidence of complications between the two groups ( P > 0.05 ). Conclusion. The use of CSEA has good anesthetic effect. It has the disadvantage of no headache after traditional spinal anesthesia, is not limited by time, and can be used for postoperative analgesia, which is more suitable for the anesthesia of lower limb orthopaedic surgery in the elderly.

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Section: Introductionmentioning

confidence: 99%

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Li¹,

Fan²,

Chen³

2022

Computational and Mathematical Methods in Medicine

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“…The clinical utility of QST has been well documented in a variety of pain disorders, such as arthritis and neuropathic pain syndromes, and it has been used to characterize pain and predict prognosis and response to therapy, as described in several excellent reviews (Arendt‐Nielsen & Yarnitzky, ; Backonja et al , ; Cruz‐Almeida & Fillingim, ; Bouhassira & Attal, ; Edwards et al , ; Smith et al , ). While the majority of this work has been done in adults (Coronado et al , ; Edwards et al , ; Moss et al , , ; Maher et al , ), there is a growing body of literature in paediatric disorders (Blankenburg et al , , ; Kristensen et al , ; Cornelissen et al , ; Lieber et al , ; Teles et al , ). QST may also be used to elucidate underlying mechanisms in order to evaluate whether targeted treatments may be effective (Grosen et al , ) and to measure somatosensory profiles and changes in physiological responses over time (Geber et al , ).…”

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confidence: 99%

Quantitative sensory testing in children with sickle cell disease: additional insights and future possibilities

et al. 2019

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Summary Quantitative sensory testing (QST) is used in a variety of pain disorders to characterize pain and predict prognosis and response to specific therapies. In this study, we aimed to confirm results in the literature documenting altered QST thresholds in sickle cell disease (SCD) and assess the test–retest reliability of results over time. Fifty‐seven SCD and 60 control subjects aged 8–20 years underwent heat and cold detection and pain threshold testing using a Medoc TSAII. Participants were tested at baseline and 3 months; SCD subjects were additionally tested at 6 months. An important facet of our study was the development and use of a novel QST modelling approach, allowing us to model all data together across modalities. We have not demonstrated significant differences in thermal thresholds between subjects with SCD and controls. Thermal thresholds were consistent over a 3‐ to 6‐month period. Subjects on whom hydroxycarbamide (HC) was initiated shortly before or after baseline testing (new HC users) exhibited progressive decreases in thermal sensitivity from baseline to 6 months, suggesting that thermal testing may be sensitive to effective therapy to prevent vasoocclusive pain. These findings inform the use of QST as an endpoint in the evaluation of preventative pain therapies.

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“…Among peripheral neuropathic pain, Na‐channel blockers seem to show higher predicted efficacy in sensory phenotype showing thermal hyperalgesia than sensory loss phenotype (Baron et al., 2017). In a lower extremity radicular pain, patients with presenting thermal hypoalgesia and warm hypoesthesia may be nonresponders to lumbar epidural steroid injections (Maher et al, 2017). Reduced tolerance to heat and cold pain revealed significant association with increased postoperative analgesic requirements in patients following gynecologic surgery (Ahmad, De Oliveira, Bialek, & McCarthy, 2014).…”

Section: Discussionmentioning

confidence: 99%

Profiling thermal pain using quantitative sensory testing in patients with trigeminal nerve injury

Kim

2020

Oral Diseases

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Objectives To investigate the thermal pain phenotypes using QST in patients with unilateral trigeminal nerve injury and to explore whether these different thermal pain phenotypes are associated with clinical and psychophysical characteristics. Methods This retrospective study included 84 patients diagnosed with posttraumatic trigeminal neuropathy involving inferior alveolar nerve (IAN) and lingual nerve (LN). Data on clinical characteristics, subjective symptoms including hypoesthesia, dysesthesia, and allodynia, and objective signs using thermal QST were collected and explored. Results Three heat (heat hypoalgesia, heat hyperalgesia, and within normal range) and cold pain phenotypes (cold hypoalgesia, cold hyperalgesia, and within normal ranges) were identified, respectively. Thermal hypoalgesia was more frequently observed than thermal hyperalgesia. Heat hypoalgesia regardless of cold pain abnormalities appears to be associated with subjective negative symptoms, while thermal hyperalgesia seems to have little relationship with negative and positive symptoms. Thermal pain phenotypes were associated with loss of innocuous thermal sensation. Unlike heat pain phenotypes, cold pain phenotypes differed between IAN injury and LN injury. Conclusion The thermal pain phenotypes identified in this study seem to be related to clinical and psychophysical findings differently. These results would be a good starting point for assessing posttraumatic trigeminal neuropathy and interpreting the thermal QST results.

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Thermal QST Phenotypes Associated with Response to Lumbar Epidural Steroid Injections: A Pilot Study

Cited by 8 publications

References 29 publications

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Effects of Combined Spinal Epidural Anesthesia in Orthopaedic Surgery of Elderly Patients

Quantitative sensory testing in children with sickle cell disease: additional insights and future possibilities

Profiling thermal pain using quantitative sensory testing in patients with trigeminal nerve injury

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