CLINICAL AND LABORATORY PREDICTORS OF PAIN SYNDROME PERSISTENCE IN ELDERLY AND SENILE PATIENTS DURING LATE POSTOPERATIVE PERIOD

Abstract

Changes in neurohumoral regulation and emotional perception of nociceptive impulses in elderly and senile patients result in some clinical peculiarities of pain syndrome manifestation. Recent studies have shown that more than 10% of geriatric patients experience pain not only as an irritant but also as a psychosomatic condition. Persistence of pain in the postoperative period in the elderly and senile patients can turn into its catastrophic and chronic character in the future thus impacting the quality of life of patients and increasing the health care economic expenses to provide the proper chronic pain management. Therefore, the aim of this study is to determine the main predictors of pain persistence in the elderly and senile patients in the late postoperative period. The study included 201 male and female patients who underwent surgery regardless of surgical profile. All patients were divided into 3 groups according to age: group 1 (n = 82) included the elderly individuals, group 2 (n = 21) included senile individuals, and the control group (n = 98) included the adult patients.
 To evaluate the presence and severity of pain syndrome, pain assessment was performed by applying 100-score visual-analog scale in 1 and 7 days. A detailed study of the perception of postoperative pain was performed by the McGill questionnaire, which was used only on day 7, because on day 1 patients could be weakened after surgery, and the results distorted by the action of drugs. All examined patients were measured for fasting cortisol in the morning on the 1st and 7th day. The blood collection procedure was performed according to the general requirements for medical and biological tests. Blood was drawn from a vein by a nurse in the direct presence of a doctor. The serum cortisol content was determined using a set of reagents for quantitative enzyme-linked immunosorbent assay. The study has demonstrated that age, score on the visual-analog scale and the evaluation scale of the McGill questionnaire for day 7, as well as blood cortisol concentration in day 1 after surgery are of definite prognostic value for the risk of persistence of postoperative pain syndrome. The chance of persistence of postoperative pain increases in 1.1 times for each year in older patients, 1.3 times for each score according to the visual-analog scale for 7 days, and in 11.4 times for each score on the evaluation scale of the McGill questionnaire, and in 2.4 times for each nmol/l of cortisol concentration in 1 day after surgery. Thus, the determined risk factors for persistence of postoperative pain include the patient's age, assessment of pain by applying a visual-analog scale, and the evaluation scale by the McGill questionnaire for 7 days and the concentration of blood cortisol in 1 day after surgery.