Abstract
BackgroundVariability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency.MethodsPreoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2–5. Pain was reevaluated at six months postoperatively.ResultsPatients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = −0.005, P = 0.001).ConclusionsPreoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have important implications for developing strategies to treat or prevent acute postoperative pain in selected patients. Pain may be predicted and the malfunctioning pain inhibition mechanism as tested with CPM may be treated with suitable drugs augmenting descending inhibition.
Highlights
Pain is an expected part of surgical recovery but effective pain management remains challenging [1,2,3,4]
Endogenous pain modulation has been experimentally investigated in humans via conditioned pain modulation (CPM) paradigms, during which central inhibition of a painful stimulus is induced by applying a second painful conditioning stimulus to a remote body region [8,13]
Deficits in preoperative CPM have been found to be associated with chronic pain following thoracotomy, i.e., the chance of a patient who reported a decrease in heat pain intensity scores from 50/ 100 at baseline to 40/100 during hot water hand immersion to develop chronic postoperative pain was about one-half that of a patient who reported unchanged scores [14]
Summary
Pain is an expected part of surgical recovery but effective pain management remains challenging [1,2,3,4]. The high variability in postoperative pain experience and analgesic treatment response between patients is part of the challenge [5,6]. It has been shown that catastrophizing in response to experimental heat pain accounted significantly for the variance in pain after cesarean section [20], there are no studies on the association between preoperative situational pain catastrophizing and postoperative pain in males undergoing thoracic surgery. Variability in patients’ postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency
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