<p>Evaluation of Potential Pain Biomarkers in Saliva and Pain Perception After Corneal Advanced Surface Ablation Surgery</p>

Abstract

Purpose: To evaluate the evolution of a set of proposed pain biomarkers in the saliva of subjects following Advanced Surface Ablation (ASA), in order to determine their validity as objective pain measures. Methods: A multicenter, prospective, and descriptive study was carried out to assess the variations between biomarkers and perceived pain. The Inclusion criteria were healthy subjects who underwent a bilateral, alcohol-assisted surface ablation with epithelial removal (ASA). Pain intensity before and after surgery was assessed by Visual Analog Scale (VAS) and the Numeric Pain Rating Scale (NPRS). Cortisol, sAA, sIgA, testosterone, and sTNFαRII were assayed at four-time points (V0, baseline; V1, pre-surgery; V2, 1 hr postsurgery, and V3, 72 hrs post-surgery). Comorbidities and Hospital Anxiety and Depression (HADS) questionnaires were administrated before and at 6 hrs after the surgery. All patients were treated with cold patches, topical steroids, topical cold antibiotics, and benzodiazepines after ASA surgery. A descriptive analysis of biomarkers and pain intensity evolution and the agreement between biomarkers and pain was performed. Results: Concentration of sIgA and sTNFαRII post-surgery was significantly higher at each visit compared to baseline (p-value: 0.053, p-value: <0.001, respectively). Relations between VAS scale score and putative biomarker variations were not statistically significant except for the sIgA but only at visit 0 (p-value: 0.024). The HADS questionnaire showed anxiety scores between 0 and 7 in all patients before and at 6 hrs after surgery. Conclusion: In this study, sIgA and sTNFαRII are the two potential biomarkers that present correlation with the VAS and these salivary substances showed acceptable levels of reproducibility in healthy subjects.

Nociception related biomolecules in the adult human saliva: A scoping review with additional quantitative focus on cortisol

“…Most studies (35 of 43) involved experimentally induced pain. 13 – 46 The rest involved acute pain after surgery or a medical procedure: hysterectomy, 47 thoracic surgery, 17 skin surgery, 48 corneal surgery, 49 breast surgery, 50 gastric or bronchial tube replacement 51 and drawing blood 52 or vascular access. 53 Experimental pain induction was done by cold, heat, ischemia and mechanical, visceral, chemical or electrical stimulation ( Table 2 ).…”

“… 56 In 20 articles participants taking regular analgesia were excluded. 15 , 18 – 20 , 22 , 23 , 27 – 30 , 34 , 35 , 37 , 38 , 41 , 43 , 44 , 49 , 50 , 54 Four studies included occasional users of analgesics 16 , 21 , 31 , 33 and one included participants treated with regular analgesia including opioids. 55 16 studies did not report on analgesia intake.…”

“…Twenty articles excluded participants with psychiatric disorders 16 , 20 – 30 , 32 – 34 , 37 , 41 , 43 , 48 , 50 and two did not. 49 , 55 The remaining articles did not report on psychiatric conditions. 13 – 15 , 17 – 19 , 31 , 35 , 36 , 38 – 40 , 42 , 44 – 47 , 51 , 52 People with chronic pain were excluded in 19 studies 1 , 3 , 17 , 19 – 22 , 24 – 30 , 35 , 38 , 43 , 47 , 49 , 50 whereas in 20 studies it was not clear if any participants had chronic pain.…”

“… 49 , 55 The remaining articles did not report on psychiatric conditions. 13 – 15 , 17 – 19 , 31 , 35 , 36 , 38 – 40 , 42 , 44 – 47 , 51 , 52 People with chronic pain were excluded in 19 studies 1 , 3 , 17 , 19 – 22 , 24 – 30 , 35 , 38 , 43 , 47 , 49 , 50 whereas in 20 studies it was not clear if any participants had chronic pain. 14 – 16 , 18 , 31 – 34 , 37 , 39 , 40 , 42 , 44 – 46 , 48 , 51 – 54 Four studies enrolled participants with chronic conditions including back pain, 55 chronic fatigue, 36 fibromyalgia, 23 and temporomandibular disorder 41 as part of the study design.…”

Correlation between Biomarkers of Pain in Saliva and PAINAD Scale in Elderly People with Cognitive Impairment and Inability to Communicate

“…Specifically, some biomarkers of pain, such as salivary cortisol, salivary amylase, testosterone, secretory IgA (sIgA), or tumor necrosis factor receptor type II (sTNF-RII), have been determined in previous studies [ 21 , 22 , 23 , 24 , 25 ]. However, among these, sIgA and sTNF-RII have been shown to be the most reproducible in healthy people [ 26 ], also being used to determine pain in surgical patients [ 27 ].…”