Prediction of post‐operative pain by an electrical pain stimulus

Nielsen, Per Peetz; Nørgaard, Lone Nikoline; Rasmussen, Lars S.; Kehlet, Henrik

doi:10.1111/j.1399-6576.2007.01271.x

Cited by 91 publications

(88 citation statements)

References 21 publications

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“…Pain Matcher ® has been validated when assessing post-operative pain after gynaecological surgery [25] and for predicting pain after caesarean section [26]. Our cold pressor test was not identical with that of Pickering's, but it was still validated [22,23], and these small differences do not explain the different results.…”

Section: Discussionmentioning

confidence: 81%

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

Tiippana

Hamunen

Kontinen

et al. 2012

Basic Clin Pharma Tox

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Experimental studies suggest that paracetamol-induced analgesia is mediated via central serotonergic pathways and attenuated by 5-HT3-antagonists. However, clinical studies do not support this, and 5-HT3-antagonists are expected to reduce pain by blocking the descending pronociceptive pathway. The current project tested whether tropisetron attenuates analgesia by paracetamol. Two randomized, double-blind, crossover studies with 18 healthy male volunteers in each were performed. Pain stimuli were cold water immersion (cold pressor test), contact heat pain (study 1) and electrical stimulation (study 2). In both studies, tropisetron 5 mg i.v. or saline was administered, followed by paracetamol 2 g i.v. 30 min. later. Individual changes in heat and cold pain intensity, cold pain tolerance and unpleasantness were recorded. The same thresholds were also expressed as scores (% of the individual score at baseline). Additionally, previously published findings on the effects of paracetamol and its interaction with 5HT3-antagonists in human experimental pain models were reviewed. After calculation of the sensory and pain scores (%), tropisetron seemed to amplify the analgesic action of paracetamol. Paracetamol 2 g i.v. did not show any statistically significant analgesia in thermal tests (study 1), or differences in sensory, pain detection or moderate pain thresholds of the electrical stimulus (study 2). As paracetamol did not have a measurable analgesic effect in these tests, no conclusions can be drawn about the interaction between paracetamol and tropisetron. However, tropisetron may have an analgesic effect of its own. Clinicians should not avoid using these drugs together, unless larger clinical studies indicate otherwise.

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Section: Discussionmentioning

confidence: 81%

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

Tiippana

Hamunen

Kontinen

et al. 2012

Basic Clin Pharma Tox

View full text Add to dashboard Cite

show abstract

“…Pain thresholds after electric stimulation did not differ between genotypic groups; however, there was a difference in pain tolerance with this experimental model of pain, and the pain tolerance threshold was lower in women carrying the minor G118 allele. This noxious stimulus was chosen because a previous study [35] had found this modality to be associated with the prediction of acute postcesarean pain. There was no difference in postoperative pain scores; however, i.v.…”

Section: Response To Systemic Fentanyl For Postoperative Analgesiamentioning

confidence: 99%

Pharmacogenetics in obstetric anesthesia

Landau

Kraft

2010

Current Opinion in Anaesthesiology

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“…Trois études récentes ont tenté d'élaborer un modèle prédictif de la douleur aiguë spécifiquement après césarienne [15,29,34]. Dans la première étude, Granot et al ont pu identifier par des tests quantitatifs simples (tests de stimulation thermique, suprathreshold pain stimuli) effectués en pré-opératoire, que les femmes à risque de douleurs sévères après césarienne pouvaient être identifiées facilement, puisque les scores de douleurs après césarienne au repos et au mouvement étaient bien corrélés avec les seuils douloureux rapportés par le test [15].…”

Section: Douleurs Aiguës Sévères Du Post-partumunclassified

“…Dans la deuxième étude, Pan et al rapportent un modèle prédictif relativement élaboré combinant plusieurs tests pré-opératoires associant des mesures sensorielles et des tests psychologiques corrélant bien avec les besoins postopératoires antalgiques [34]. Dans une étude scandinave toute récente, c'est un test par stimulation électrique qui est utilisé avant césarienne et qui semble bien corrélé avec les douleurs au repos post-césarienne [29]. Malheureusement dans ces études, les évaluations se sont limitées à la période postopératoire immédiate, et l'évolution vers une douleur neuropathique dans le long terme n'a pas été évaluée.…”

Section: Douleurs Aiguës Sévères Du Post-partumunclassified

Analgésie obstétricale et douleurs du post-partum

Landau

2007

Douleur analg.

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Les douleurs sévères aiguës du post-partum sont plus fréquentes qu'on ne le croit que ce soit après un accouchement par voie vaginale ou une césarienne. De plus, l'incidence rapportée dans la littérature de douleurs chroniques post-césarienne est relativement élevée et avec l'augmentation constante du taux de césariennes, risque de devenir un problème tangible. Quand on interroge les femmes sur leurs craintes et angoisses les plus importantes pendant l'accouchement, celles-ci rapportent que la douleur pendant la césarienne est ce qui les effraie le plus. La variabilité interindividuelle dans la sévérité de la douleur post-accouchement ou césarienne est influencée par de multiples facteurs tels que la sensibilité à la douleur, des facteurs psychologiques, l'âge et la variabilité géné-tique entre autres. Cette revue tente de revoir le concept de modèles permettant de prédire le risque de douleur aiguë sévère et douleur neuropathique résiduelle après accouchement vaginal ou césarienne, ainsi que de présenter les modalités antalgiques efficaces dans le contexte de la césarienne, avec une mention particulière pour les stratégies visant à prévenir la chronicisation de la douleur du post-partum.Abstract: Acute severe post-partum pain occurs more often than is thought both after vaginal and cesarean deliveries. Furthermore, the incidence of chronic pain after cesarean section has been reported to be relatively high and with the constant increase in cesarean section rates this could become a significant clinical problem. When questioning women's fear and expectations, pain during and after cesarean section is the greatest concern. Individual variability in severity of post vaginal or operative delivery pain is influenced by multiple factors including sensitivity to pain, psychological factors, age, and genetics and leads to variability in postdelivery pain experience as well as requirements for analgesics. This review attempts to report on predictive models for the incidence of severe acute pain and chronic residual pain after both vaginal and cesarean deliveries, as well as present effective analgesic regimens for acute pain after cesarean deliveries with some focus on strategies to prevent chronicization of pain.

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Prediction of post‐operative pain by an electrical pain stimulus

Abstract: Electrical pain threshold before caesarean section seems to predict the intensity of post-operative pain. This method may be used as a screening tool to identify patients at high risk of post-operative pain.

Cited by 91 publications

References 21 publications

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

The Effect of Paracetamol and Tropisetron on Pain: Experimental Studies and a Review of Published Data

Pharmacogenetics in obstetric anesthesia

Analgésie obstétricale et douleurs du post-partum

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