Abstract
The present study aimed to assess the postoperative pain experience in cognitive deficit patients with special reference to sensory or affective pain quality. Nineteen patients with normal cognition up to cognitive impairments according to the DemTect screening-tool were studied regarding their postoperative pain experience after proximal femur fracture. The numerical rating scale (NRS), the cognitive DemTect questionnaire, the pain sensation questionnaire (SES), and aquantitative sensory test (QST) were used as examination instruments. The mean ± SD age of the patients was 83.8 ± 10.0years. Of the 19patients, 6(31.6%) had normal cognitive abilities. In 4patients (21.1%) there were indications of mild cognitive impairments, and in 9patients (47.4%) the suspicions of the presence of dementia arose. The mean postoperative pain intensity (NRS) was 4.0 (1.6). With comparable analgesic therapy, the reported pain intensities did not differ between the three patient groups with different cognitive impairments and the first three postoperative treatment days. There were no statistically significant differences between the groups for the sensory or affective total scores of the pain sensation scale. The QST parameters deep pain (PPT), superficial mechanical pain after needle stimulation (MPT), and the superficial sensitivity to light touch stimuli (MDT) showed asignificantly increased sensitivity of the operated side. For the sensation of vibration (VDT) no differences between operated and healthy extremities could be proven. The postoperative pain experience does not differ between patients with normal and limited cognition. The quantitative sensory testing showed mechanical hyperalgesia in the operated area. The study points to the importance of adequate postoperative pain management even in those with dementia.
Highlights
The present study aimed to assess the postoperative pain experience in cognitive deficit patients with special reference to sensory or affective pain quality
to cognitive impairments according to the DemTect screening-tool were studied regarding their postoperative pain experience
the reported pain intensities did not differ between the three patient groups with different cognitive impairments
Summary
Jens Felix Wagner1 · Henning Cuhls2 · Martin Mücke3,4 · Rupert Conrad5 · Lukas Radbruch2,6 · Roman Rolke. Jens Felix Wagner und Henning Cuhls teilen sich die Erstautorenschaft. Methodik: 19 Patienten mit normaler Kognition bis hin zu kognitiven Auffälligkeiten im Screening-Fragebogen DemTect wurden bezüglich ihres postoperativen Schmerzerlebens nach proximaler Femurfraktur untersucht. Als Untersuchungsinstrumente kamen die numerische Ratingskala (NRS), der Kognitionsfragebogen DemTect, der Schmerzempfindungsfragebogen (SES) sowie eine quantitative sensorische Testung (QST) zum Einsatz. Die berichteten Schmerzintensitäten unterschieden sich bei vergleichbarer analgetischer Therapie nicht zwischen den drei Patientengruppen mit unterschiedlicher kognitiver Beeinträchtigung und den ersten drei postoperativen Behandlungstagen. Es zeigten sich zwischen den Gruppen keine statistisch signifikanten Unterschiede für die sensorischen oder affektiven Summenscores der Schmerzempfindungsskala. Die QST-Parameter Tiefenschmerz (PPT), oberflächlicher mechanischer Schmerz nach Nadelreiz (MPT) sowie die oberflächliche Sensibilität für leichte Berührungsreize (MDT) zeigten eine signifikant gesteigerte Empfindlichkeit der operierten Seite. Diskussion: Das postoperative Schmerzerleben unterscheidet sich nicht zwischen Patienten mit normaler und deutlich eingeschränkter Kognition.
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