Presence Of Preoperative Pain Research Articles

Efficacy of azasetron on postoperative chronic pain after pulmonary surgery: a randomized triple-blind controlled trial

BackgroundInhibition of 5-HT3 (5-Hydroxyl Tryptamine) receptors is known to enhance morphine analgesia in animal models. We tested the efficacy of azasetron, a 5-HT3 receptor antagonist, on postoperative chronic pain after pulmonary surgery in a randomized triple-blind controlled study.MethodsA total of 250 patients who were scheduled to receive pulmonary surgery were randomized to patient-controlled analgesia (PCA) using 200 µg sufentanil with normal saline or 200 µg sufentanil with 20 mg azasetron. The numerical rating scale of pain (NRS) was recorded at baseline, postoperative day (POD) 1, 2, 3, 90, and 180. Negative binomial regression was used to identify associated factors for postoperative NRS six months after surgery.ResultsThe results showed that azasetron did not affect the primary outcomes: the incidence of postoperative chronic pain on POD90 and 180. However, azasetron decreased postoperative NRS at rest and activity on POD1, 2, and 3. Furthermore, azasetron decreased postoperative nausea and vomiting on POD1 and 2. Univariate and multivariate negative binomial regression analysis identified preoperative pain, smoking, drinking and open surgery are risk factors of chronic pain six months after surgery.ConclusionsAzasetron did not affect the incidence of chronic pain after pulmonary surgery. The presence of preoperative pain, smoking, drinking, and open surgery were found to be associated with chronic pain six months after surgery.Clinical trial registrationThe trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry (ChiCTR2200060139), 20/05/2022; the site url is https://www.chictr.org.cn/.

OUTCOMES OF TENOSYNOVIAL GIANT CELL TUMOUR OF THE FOOT AND ANKLE

BackgroundTenosynovial giant cell tumour (TGCT) is a benign proliferative disease affecting synovial membranes. There are two forms, localised and diffuse, which although histologically similar are managed differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess outcomes from the largest single-centre experience to date in patients with this condition.MethodsA retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data was collected on age at presentation, radiological pattern of disease, location of disease, treatment provided and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years.Results47 male and 76 female patients with a mean age at diagnosis of 39 (range, 11–76) years were identified. 85 (69.1%) cases were categorised as localised and 38 (30.9%) were diffuse. Half of the cases presented in the ankle (62/123, 50.4%). 89% (110) of patients underwent open operative excision of the lesion. Radiotherapy was used in 2 cases for recurrent disease. Pain was the most common postoperative symptom which developed in 20% (22/110) of cases). 13 cases were managed nonoperatively where symptoms were minimal, with one case requiring surgery at a later date. Disease recurrence was 3.5% (3/85) in localised disease and 36.8% (14/38) in diffuse disease giving an overall recurrence rate of 13.8% (17/123).ConclusionThe outcomes of TGCT management are dependent on the type of disease, the extent of preoperative erosive changes and the presence of pre-operative pain. We present a summary of recommended management based on the experience from this single tertiary centre.

A longitudinal study of the prevalence of post-surgical inguinodynia and the factors responsible for the development of chronic pain among the patients undergoing open hernioplasty at a tertiary care center

Background: Chronic groin pain (Inguinodynia) is a potential complication following inguinal hernia mesh repair and has a significant impact on the quality of life. The incidence varies among studies ranging between 0% and 62.9%. Aims and Objectives: The present study was conducted with the objectives of estimating the prevalence of post-surgical inguinodynia among the patients undergoing open hernioplasty. The secondary objective was to assess the factors associated with the development of post-surgical inguinodynia. Materials and Methods: A longitudinal study was carried out in a tertiary care center in Bangalore, Karnataka among the hernia patients attending the outpatient department of General Surgery department. A pro forma prepared with expert validation was used to collect details regarding pre-operative characteristics, type of anesthesia, intraoperative findings, and post-operative complications. The pain was assessed by the visual analog scale. Descriptive statistics and Chi-square test were used to identify the risk factors. Results: A total of 112 patients underwent hernioplasty. Out of this, 108 were males and 4 were females. The mean age of the patients was 48±10.8 years. Majority of them (84, 77.7%) presented with indirect inguinal hernia. The prevalence of inguinodynia at 3-month post-hernia surgery was 21.4% (n=24). Patients with significant pre-operative pain had higher chances of developing chronic pain (P=0.000). It was found that post-operative surgical site infection was associated with increased chances of development of chronic pain (P=0.000). Conclusion: Our study found that around one-fifth of the hernia patients had developed chronic post-surgical inguinal pain following open hernioplasty. There was no significant relationship between patients’ characteristics and development of chronic post-operative pain. The presence of pre-operative pain and post-operative infection in the patients was significantly associated with the development of chronic pain. Intraoperative nerve identification and chronic post-operative pain did not have a significant relationship in our study. Most of the patients who developed chronic pain had experienced only mild pain and none of them had severe inguinal pain. From the findings of our study, we would like to recommend that all measures must be taken to prevent and treat post-operative surgical site infection which leads to the development of chronic pain in patients.

Outcomes of Tenosynovial Giant Cell Tumor of the Foot and Ankle.

Tenosynovial giant cell tumor (TGCT) is a benign proliferative disease affecting synovial membranes. There are 2 forms, localized (L-TGCT) and diffuse (D-TGCT), which although histologically similar behave differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess current practice, how the patients' presentation affected their outcome, as well as review the recurrence rates and complications. A retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data were collected on age at presentation, radiologic pattern of disease, location of disease, treatment provided, and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years. There were 61.7% female patients with a mean age of 39 (range, 11-76) years. L-TGCT accounted for 85 (69.1%) cases and D-TGCT for 38 (30.9%). The most prevalent preoperative symptoms were a palpable mass (78/123) and pain (65/123). Radiologically confirmed recurrence in the operative group was noted in 14.5% (16/110) cases. This comprised 4% (3/75) of operatively treated L-TGCT and 37% (13/35) of operatively treated D-TGCT. Patients with pain on presentation and those with erosive changes on presenting magnetic resonance imaging (MRI) were more likely to have persistent postoperative pain (P < .001 for both). Where patients had both preoperative pain and erosive changes, 57.1% had postoperative pain. Thirteen cases were managed nonoperatively where symptoms were minimal, with 1 case requiring surgery at a later date. Outcomes of TGCT management are dependent on the disease type, extent of preoperative erosive changes, and presence of preoperative pain. These data are useful for counseling patients regarding the outcomes of surgical intervention and help guide the timing of intervention. Level III, retrospective cohort study.

Eight-year retrospective study investigating tooth survival after primary non-surgical root canal treatment in a UK military cohort

IntroductionRoot canal treatment (RCT) plays an important role in preserving the dentition by deferring other invasive treatments. Data on tooth survival and predictive factors for tooth loss after RCT in...

Present status and future directions of intracanal medicaments

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

The relationship between pre-operative pain characteristics and periacetabular osteotomy outcomes in patients with acetabular dysplasia.

ABSTRACTThe aims of this study were to determine if pre-operative pain characteristics (location of maximum severity of pain, presence of non-groin pain, maximum severity of pain and number of pain locations) affect patient-reported outcome measures in patients undergoing periacetabular osteotomy (PAO) for acetabular dysplasia. We reviewed 52 hips (48 patients) treated with PAO for acetabular dysplasia from February 2017 to July 2020 using modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) and international Hip Outcome Tool (iHOT-12) score, radiographic analysis and pain location/severity questionnaires. Descriptive statistics, analysis of covariance and Spearman partial correlation coefficients were implemented. Twenty-six hips experienced the most severe pre-operative pain in the groin, and 26 hips experienced equal or greater pain in a non-groin location. Outcome scores between these groups were not significantly different (mHHS P = 0.59, HOS P = 0.48, iHOT-12 P = 0.99). Additionally, the presence of pre-operative pain in any non-groin location had no significant relationship with PROM (all P-values ≥0.14). Furthermore, the maximum severity of pre-operative pain and number of pain locations showed no significant relationship with PROM (maximum severity: mHHS P = 0.82, HOS P = 0.99, iHOT-12 P = 0.36; number of pain locations: mHHS P = 0.56, HOS P = 0.10, iHOT-12 P = 0.62). Varying pre-operative pain characteristics do not appear to have any significant impact on outcomes. Therefore, a wide array of patients with acetabular dysplasia might expect similar, favourable outcomes from PAO regardless of pre-operative pain characteristics.

Factors Affecting the Outcome of Periapical Surgery; a Prospective Longitudinal Clinical Study

Wound healing following periapical surgery is influenced by age, gender, smoking, periapical lesion size, type of root-end filling, method of root-end cavity preparation and the use of microsurgical or conventional technique. This study aimed to evaluate the influence of various preoperative factors such as age, gender, smoking, preoperative pain, and preoperative periapical lesion size on the outcome of surgical endodontic treatment. A thorough history, examination, and investigation were performed to establish patient age, gender, smoking status, periapical lesion size, and the presence of preoperative pain. Forty patients aged between 15–57 years presented with persistent chronic apical periodontitis of single-rooted anterior teeth after conventional re-root canal treatment were enrolled for periapical surgery. Following periapical surgery, all patients were recalled for evaluation of periapical healing after 12 months based on clinical and periapical X-ray examination due to inaccessibility of an advanced imaging system (CBCT). Chi-squared and Fisher’s exact test were applied, which revealed a statistically significant association of periapical healing with age (p = 0.025), smoking (p = 0.029), and lesion size (p &lt; 0.001). Although, the success of periapical healing was higher in males 78.6% (22/28) compared to females 58.3% (7/12) however, no statistically significant relationship was found between gender and healing (p = 0.254). Patient age, smoking status, and size of the preoperative lesion had a strong influence on periapical healing after surgical endodontic treatment.

A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study

BackgroundBreast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients.MethodsA prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression.ResultsA total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021).ConclusionsUpper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery.Trial registrationThe study was registered in Clinical trial with the ID number: NCT03389204.

The Effect of Speed and Rotation for Protaper File Systems on Postobturation Pain in a Single Visit and Multiple (Two) Visits in Root Canal Therapy: An In Vivo Study.

ABSTRACTIntroduction:The basic idea of a root canal treatment is to alleviate the pain and heal the infection within the infected tooth, which can be resolved in a single visit or multiple visits in root canal therapy. Therefore, in this article, an in vivo comparison of single visits and multiple visits using different rotation and speed for two Protaper universal design file systems is done on the basis of time taken and incidence of pain.Materials and Methods:One hundred single-rooted premolars with irreversible symptomatic pulpitis were assigned to two groups of 50 patients each using the odd–even method, GA to be treated endodontically in a single visit and GB to be treated endodontically in multiple visits. Each group was further divided into two subgroups of 25 patients each on the basis of two different variations of speed and rotation for two Protaper file systems of the same design, GA1 (Hand Protapers) and GA2 (Rotary Protapers), GB1 (Hand Protapers) and GB2 (Rotary Protapers), respectively. After proper biomechanical shaping and cleaning, obturation was done with Gutta-percha cones and Ah plus sealer using Fast Pack obturation pen for warm vertical compaction. The pain was measured by a 100 mm modified visual analogue scale, and time was measured using a stopwatch.Results:At 6-h intervals, post-obturation pain was more in single-visit root canal therapy than multiple-visit root canal therapy (P < 0.01). Single-visit rotary Protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1) (P < 0.05). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2) (P > 0.05). Preoperative pain significantly influences the post-obturation pain. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 statistical Analysis Software.Conclusions:The presence of preoperative pain can significantly influence the presence of postoperative pain. Most of the pain in both single-visit and multiple-visits root canal therapy occurred in the first 48 h after obturation, which decreases thereafter. Single-visit rotary protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2). Presence of sealer puff influences the duration of pain.

Patterns of Root Morphology of Mandibular Third Molars and Their Clinical Implications in a Cohort of Sri Lankan Patients

Background: Mandibular third molar surgeries garnered recognition as one of the common treatment procedures provided by Oral & Maxillofacial practices across the globe. Mandibular third molars are not only impacted, often giving rise to bothering issues to patients ranging from pain to difficulty in opening mouth but create challenges in their surgical removal. Postoperative complications of those surgeries such as pain, swelling, trismus and alveolar osteitis (dry socket) could be prevented and controlled by meticulous preoperative assessment of tooth-related and patient-related factors. Pattern of root morphology could be one important tooth- related factor connected to difficulties and subsequent postoperative complications of mandibular third molar surgeries. Aim: Against this backdrop, the aim of this study was to explore the patterns of root morphology of mandibular third molars and to elucidate their associations with selected attributes of the surgeries, self-reported preoperative pain and selected postoperative complications among a cohort of Sri Lankan patients. Materials & Methods: A hospital based, descriptive cross-sectional study was conducted among 715 patients (represented wider age range from adolescents to older adults) who underwent surgical removal of mandibular third molars at the Department of Oral & Maxillofacial Surgery, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. Of extensive socio-demographic, clinical and radiological investigation data collected, those data on root morphology and numbers of roots, inferior dental canal relationship, self-reported preoperative pain, duration of the surgery, flap design, tooth sectioning and postoperative pain and swelling complications were used for the present analysis. Data entry and analysis was done using SPSS-21 Statistical Software Package. Results: Based on our findings on patterns of root morphology, straight two roots were the most common (34.4%) across all age groups, followed by convergent two- roots (19.3%) fused straight- roots (16.3%) and distally curved two- roots (13.8) among Sri Lankan patients. Almost half (46.8%), of patients had inferior dental nerve canal placed away from mandibular third molar roots. Moreover, root morphology was significantly associated with presence of preoperative pain, duration of the surgery as well as occurrence of postoperative swelling (p<0.05). Conclusions: Patterns of root morphology of mandibular third molars may implicate on certain processes of their surgical removal and its outcomes. Therefore, careful preoperative assessment of root morphology and related factors of those teeth becomes useful in tailored patient care for minimal postoperative complications, better patient experience and quality-of-life.

Influence of Tooth Factors and Procedural Errors on the Incidence and Severity of Post-Endodontic Pain: A Prospective Clinical Study.

The objective of this prospective study was to assess tooth-related factors that play a role in the incidence of postoperative pain (PP) and determining if procedural errors influence PP occurrence. A total of 442 patients referred for root canal treatment met the inclusion criteria and were included in this prospective study. The same protocol was used in all root canal treatments. Patient, tooth, treatment related factors and the occurrence of procedural errors were registered. Incidence and intensity of PP was assessed at 24 and 48 h by telephonic interview and in person seven and 15 days after treatment. A logistic and ordinal regression analysis was used to assess the role of patient, tooth and treatment related factors in the incidence and intensity of PP, respectively. Preoperative and intraoperative factors differently affected the incidence of PP at the different time intervals. The presence of procedural errors did not significantly influence PP occurrence. The presence of preoperative pain and the need of additional anesthesia during treatment were associated with higher incidence of PP 24 and 48 h after treatment; the extent of apical enlargement played a significant role in the presence of PP after seven days of treatment; and the excessive occlusal load induced by the absence of a contralateral tooth was the only factor related to the maintenance of PP up to 15 days. In conclusion, the presence of preoperative pain, the need of additional anesthesia during treatment, the extent of apical enlargement and the excessive occlusal load induced by the absence of a contralateral tooth were related to a higher incidence of PP.

Postoperative pain after glide path preparation using manual, reciprocating and continuous rotary instruments: a randomized clinical trial.

To compare the incidence, intensity and prediction of postoperative pain after glide path preparation with manual, continuous rotary and a novel reciprocating glide path instrument. The study included 240 patients, who were treated by four specialists according to a planned treatment protocol. Following access cavity preparation and prior to glide path preparation, the subjects were randomly assigned to one of the three groups according to the glide path instrument by choosing a sealed envelope containing the group name: R-Pilot (VDW, Munich, Germany), ProGlider (Dentsply Sirona, Ballaigues, Switzerland) and stainless steel K-files (Dentsply Sirona; n=80). Following glide path preparation, the teeth underwent standardized single visit root canal treatment procedures. The root canals were chemomechanically prepared using the ProTaper Next rotary system (Dentsply Sirona) under copious irrigation with 5.25% NaOCl. Final irrigation was performed with 17% EDTA and distilled water. Root fillings were placed using an epoxy resin sealer and gutta-percha with a cold lateral compaction technique. After coronal restorations were placed, the patients were discharged with a questionnaire about the incidence and intensity of pain at 6, 12, 18, 24, 48 and 72h postoperatively. The data were analysed using chi-square, anova and Tukey tests and logistic regression analysis. The presence of preoperative pain (OR ranged between 3.5 and 14.3) and the glide path preparation techniques (OR between 2.2 and 4.1) were associated with significant effects on the incidence of postoperative pain when comparing manual versus engine-driven glide path preparation (P<0.05). Patients in the R-Pilot (Mean VAS ranged between 1.57-0.21) and ProGlider (1.97-0.28) groups reported significantly less postoperative pain scores than those in the manual group (2.82-1.32; P<0.05). There was no significant difference between R-Pilot and ProGlider groups regarding the postoperative pain scores (P>0.05). Preparation of glide paths with rotating or reciprocating NiTi instruments was associated with less postoperative pain levels and incidence compared to manual glide path preparation with no significant difference between rotating and reciprocating instruments. Preoperative pain was the most significant predictor for the occurrence of postoperative pain.

The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master's program.

Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF). Patients treated by postgraduate students in an Endodontics Master's Program (2006-2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as "healthy" (PAI ≤ 2 in absence of signs/symptoms), "endodontically diseased" (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or "non-endodontically diseased" (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05). At 10years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered "endodontically diseased"). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483-30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043-8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as "healthy." Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370-11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388-41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366-372.555) decreased the odds of healing, respectively. After 10years, teeth filled with Thermafil in a specialist master's program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques. Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.

Factors associated with postobturation pain following single-visit nonsurgical root canal treatment: A systematic review.

Reducing the pain after root canal therapy is a key aspect in endodontic practice. The present systematic review aimed to identify the factors that influence postobturation pain (POP) in patients receiving single-visit nonsurgical root canal treatment. A literature search was performed manually and in Pubmed (Medline) database to identify relevant articles. A data extraction form was constructed and data were collected from the identified articles. In total, 24 articles were identified for the systematic review, and factors associated with POP were tabulated. Specific preoperative factors (old age, sex, molar teeth, mandibular teeth, presence of preoperative pain, and absence of periapical radiolucency) and procedures (administration of prophylactic drug, bupivicaine anesthetic agent, radiograph or apex locator working length determination methods, instrumentation, irrigating system, laser, cold lateral compaction obturation technique, reducing the occlusion, and postoperative drugs) were associated with POP.

Clinical evaluation of maintenance of apical patency in postendodontic pain: An in vivo study

Aim: The purpose of this study was to compare the incidence of postoperative pain in 80 endodontically treated teeth, with and without apical patency, in relation to some diagnostic factors (vitality, presence of preoperative pain, group of treated teeth). Materials and Methodology: Apical patency was maintained during shaping procedures with a #10 K-file in one group (n = 40) and not in the other (n = 40). Root canal treatment was done in single visit. Pain was recorded 1st day, 2nd day and 7th day using VAS scale. Results: There were no statistically significant differences between patency and non patency groups regarding incidence and degree of postoperative pain. Only preoperative pain has significant effect on postoperative pain. Conclusion: Our study concluded that maintenance of apical patency did not increase the incidence of postoperative pain when considering all variables together.

Influence of preoperative pain in the success rate of indirect pulp capping: a retrospective study.

The association of preoperative pain and indirect pulp treatment in permanent teeth is still unknown. This study aimed to evaluate the influence of preoperative pain in the success rate of indirect pulp capping. The sample of this retrospective study was constituted for 133 teeth treated in a Private clinic in Joinvile, Brazil, by one experienced dentist between 2007 and 2012. Data related to clinical and demographic variables that could influence in the success rate of indirect pulp capping were also collected, such patient age and sex, type of teeth and arch. Chi‑square test was used to evaluate the association between preoperative pain with postoperative one and success of the treatment. Logistic regression was performed to identify significant clinical and demographical factors associated with the success of the indirect pulp capping. The overall success rate was 100% in the absence of preoperative pain. However, when the preoperative pain was present, the failure rate was 18.3%. Statistical analysis showed significant association between preoperative pain and postoperative one and failure rate of the indirect pulp capping. The other independent variables were not associated with the success rate of the treatment. The presence of preoperative pain is associated with the decrease of the success rate of indirect pulp capping.

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies.

Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. We searched the MEDLINE, Embase, CINAHL and PsycINFO databases from inception to Mar. 12, 2015, to identify cohort or case-control studies that explored the association between risk factors and persistent pain (lasting ≥ 2 mo) after breast cancer surgery. We pooled estimates of association using random-effects models, when possible, for all independent variables reported by more than 1 study. We reported relative measures of association as pooled odds ratios (ORs) and absolute measures of association as the absolute risk increase. Thirty studies, involving a total of 19 813 patients, reported the association of 77 independent variables with persistent pain. High-quality evidence showed increased odds of persistent pain with younger age (OR for every 10-yr decrement 1.36, 95% confidence interval [CI] 1.24-1.48), radiotherapy (OR 1.35, 95% CI 1.16-1.57), axillary lymph node dissection (OR 2.41, 95% CI 1.73-3.35) and greater acute postoperative pain (OR for every 1 cm on a 10-cm visual analogue scale 1.16, 95% CI 1.03-1.30). Moderate-quality evidence suggested an association with the presence of preoperative pain (OR 1.29, 95% CI 1.01-1.64). Given the 30% risk of pain in the absence of risk factors, the absolute risk increase corresponding to these ORs ranged from 3% (acute postoperative pain) to 21% (axillary lymph node dissection). High-quality evidence showed no association with body mass index, type of breast surgery, chemotherapy or endocrine therapy. Development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection provides the only high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.

Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean.

Patients with high anxiety states in the preoperative period often have more intense postoperative pain, despite adequate pain control during the intraoperative period. This study aimed to determine the relationship between the preoperative psychological status and the pain experienced postoperatively in a sample of Caribbean patients. A prospective study was conducted in elective surgical adult patients at a teaching hospital in the Caribbean. Patients' preoperative psychological status was assessed using Hospital Anxiety and Depression Scale (HADS), and a preoperative 'expected' pain score was recorded. Postoperatively, 'observed' pain scores at 4 and 24 hours and the maximum pain score during 24 hours were recorded. Demographic data and clinical details including data regarding postoperative analgesia were collected. Expected and observed pain scores were compared between patients with and without anxiety and depression. A total of 304 patients were enrolled. The overall prevalence of anxiety and depression was 43% and 27%, respectively, based on the HADS scores. There were significant associations between the postoperative pain scores and factors such as preoperative anxiety and depression (HADS) scores, preoperative expected pain scores, patient educational level, presence of preoperative pain and surgical duration. Age, gender, ethnicity and type of anaesthesia did not impact postoperative pain scores. The presence of preoperative anxiety and depression as indicated by HADS score may significantly influence postoperative pain. Other factors such as educational level, presence of preoperative pain and surgical duration may also impact postoperative pain. Some of these factors may be modifiable and must be addressed in the preoperative period.

Preoperative Distress Factors Predicting Postoperative Pain in Adolescents Undergoing Surgery: A Preliminary Study

The purpose of this study was to determine if preoperative distress factors could be used as predictors of postoperative pain in adolescents scheduled for spinal fusion surgery. Patients reporting the presence of pain before surgery reported greater pain intensity at postoperative day (POD) 1 (p = .033), POD 2 (p = .008) and at follow-up 6 weeks after surgery (p = .0001). Preoperative trait anxiety was associated with pain intensity before surgery (p = .002) but not with postoperative pain intensity (p > .05). Salivary cortisol concentrations did not differentiate between anxious and nonanxious patients based on anxiety trait (p = .21) and was not associated with postoperative pain intensity (p > .05). These findings suggest that preoperative distress factors do not predict postoperative pain intensity in the acute and intermediate period. The presence of preoperative pain was the best predictor of postoperative pain intensity, suggesting that preoperative pain assessment will identify patients at an elevated risk for intense postoperative pain.