Pre‐operative pain and sensory function in groin hernia

Aasvang, Eske Kvanner; Hansen, Julie Bolvig; Kehlet, Henrik

doi:10.1016/j.ejpain.2008.11.015

Cited by 20 publications

(12 citation statements)

References 29 publications

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“…Despite advances in perioperative anaesthesia and analgesia, studies suggest that fewer than half of patients receive adequate pain relief after surgery (Rawal and Allvin, 1998). Our NRS cutoff of ⩾4 to indicate clinically relevant moderate to severe pain is comparable with other literature of breast surgery and other surgical procedures (Peters et al , 2007; Aasvang et al , 2009; Gärtner et al , 2009). Pain scores of ⩾4 have been empirically demonstrated to affect general activity, mood and postoperative mobility after surgery, and are considered clinically important for treatment (Peters et al , 2007).…”

Section: Discussionsupporting

confidence: 75%

Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

et al. 2012

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Background:Few epidemiological studies have prospectively investigated preoperative and surgical risk factors for acute postoperative pain after surgery for breast cancer. We investigated demographic, psychological, pain-related and surgical risk factors in women undergoing resectional surgery for breast cancer.Methods:Primary outcomes were pain severity, at rest (PAR) and movement-evoked pain (MEP), in the first postoperative week.Results:In 338 women undergoing surgery, those with chronic preoperative pain were three times more likely to report moderate to severe MEP after breast cancer surgery (OR 3.18, 95% CI 1.45–6.99). Increased psychological ‘robustness', a composite variable representing positive affect and dispositional optimism, was associated with lower intensity acute postoperative PAR (OR 0.63, 95% CI 0.48–0.82) and MEP (OR 0.71, 95% CI 0.54–0.93). Sentinel lymph node biopsy (SLNB) and intraoperative nerve division were associated with reduced postoperative pain. No relationship was found between preoperative neuropathic pain and acute pain outcomes; altered sensations and numbness postoperatively were more common after axillary sample or clearance compared with SLNB.Conclusion:Chronic preoperative pain, axillary surgery and psychological robustness significantly predicted acute pain outcomes after surgery for breast cancer. Preoperative identification and targeted intervention of subgroups at risk could enhance the recovery trajectory in cancer survivors.

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Section: Discussionsupporting

confidence: 75%

Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

et al. 2012

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“…Table 1 shows the QST data. Except for one, all participants had cold or warmth detection thresholds in the operated area which were more than two standard deviations different from the normative data obtained in an age‐ and sex‐matched control group of 40 subjects (Aasvang et al, 2009). However, heat pain thresholds did not differ significantly from control values and only two patients had an abnormally high cold pain threshold.…”

Section: Resultscontrasting

confidence: 58%

“… Abbreviations: CDT: cold detection threshold; WDT: warmth detection threshold; CPT: cold pain threshold; HPT: heat pain threshold; MDT: mechanical detection threshold; MPT: mechanical pain threshold; PPT: pressure pain threshold; PPTol: pressure pain tolerance; PP: pinch pain. N.D.: normative data in a group of age‐ and sex‐matched patients who did not develop chronic pain (Aasvang et al, 2009). Thermal thresholds are expressed in °C.…”

Section: Resultsmentioning

confidence: 99%

“…Participants were asked to indicate the induced sensation on a 101‐point rating scale with “0” as no pain and “100” as the most intense pain imaginable. Tactile, pressure and pinch data were log‐transformed to allow comparison with earlier normative data, acquired in an age ‐and sex‐matched control group (Aasvang et al, 2009).…”

Section: Appendix a Methods S1mentioning

confidence: 99%

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A positron emission tomography study of wind‐up pain in chronic postherniotomy pain

Kupers

Lonsdalel

Aasvang

et al. 2011

European Journal of Pain

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Many neuropathic pain conditions are characterized by abnormal responses to noxious or innocuous mechanical stimulation, including wind-up pain. Whereas previous brain imaging studies have explored the cerebral correlates of hyperalgesia and allodynia, no studies are available on mechanical-induced wind-up pain in neuropathic pain patients. We therefore used positron emission tomography (PET) to investigate the cerebral response pattern of mechanical wind-up pain in a homogenous group of 10 neuropathic pain patients with long-standing postherniotomy pain in the groin area. Patients were scanned in the following conditions: (1) rest; (2) wind-up pain, induced by 2 Hz von Frey stimulation in the painful area; (3) non-painful 2 Hz von Frey stimulation in the homologous contralateral area and (4) tonic pressure pain in the homologous contralateral area. A direct comparison between wind-up pain and non-painful von Frey stimulation revealed that the former more strongly activated contralateral secondary somatosensory cortex, insula, anterior cingulate cortex, right dorsolateral prefrontal cortex, thalamus and cerebellum. In addition, wind-up pain also activated the sublenticular extended amygdala (SLEA) and the brain stem. A direct comparison between wind-up pain and pressure pain revealed that both activated a largely overlapping network. Since no de novo brain areas were activated by wind-up pain, our data suggest that the processes specific to wind-up pain do not occur at the cerebral level.

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“…However, recent studies in postherniotomy patients without pain have also demonstrated the significant occurrence of sensory disturbances compared to the un-operated side [4], indicating that, during both open and laparoscopic groin hernia repair, most patients develop some type of nerve lesion with secondary sensory disturbances, but that only a proportion (probably around 10%) will lead to a chronic pain [32]. Although preoperative pain may be related to the risk of developing chronic pain, there are no signs of preoperative sensory dysfunction in patients with or without pain [3]. Also, it should be emphasized that symptoms and signs in suspected neuropathic pain are very unspecific [56], and previous suggested classification of post-herniorrhaphy pain syndromes [40] requires further documentation of validity and further discussion of the consequences for the choice of treatment.…”

Section: Definition and Terminologymentioning

confidence: 94%

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

Alfieri

Amid

Campanelli

et al. 2011

Hernia

346

226

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Purpose To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. Methods A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidencebased literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question.

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Pre‐operative pain and sensory function in groin hernia

Abstract: Pre-operative groin hernia pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain.

Cited by 20 publications

References 29 publications

Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

Chronic preoperative pain and psychological robustness predict acute postoperative pain outcomes after surgery for breast cancer

A positron emission tomography study of wind‐up pain in chronic postherniotomy pain

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

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