Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk
Top Cited Papers
- 15 August 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pain
- Vol. 138 (1), 22-28
- https://doi.org/10.1016/j.pain.2007.10.033
Abstract
Ing the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0 ± 16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33–0.77 95% CI, p = 0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28–2.77, p = 0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual’s ability to tackle noxious events, identifying patients ‘at risk’ to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering....Keywords
This publication has 37 references indexed in Scilit:
- Determinants of endogenous analgesia magnitude in a diffuse noxious inhibitory control (DNIC) paradigm: Do conditioning stimulus painfulness, gender and personality variables matter?Pain, 2008
- Individual differences in endogenous pain modulation as a risk factor for chronic painNeurology, 2005
- Ethnic differences in responses to multiple experimental pain stimuliPain, 2005
- Chronic postoperative pain: the case of inguinal herniorrhaphyBritish Journal of Anaesthesia, 2004
- Post-surgical neuralgiaPain, 2004
- Catastrophizing predicts changes in thermal pain responses after resolution of acute dental painThe Journal of Pain, 2004
- Individual differences in diffuse noxious inhibitory controls (DNIC): association with clinical variablesPain, 2003
- Postcesarean Section Pain Prediction by Preoperative Experimental Pain AssessmentAnesthesiology, 2003
- Characteristics and prediction of early pain after laparoscopic cholecystectomyPain, 2001
- Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomyThe Journal of Thoracic and Cardiovascular Surgery, 1998