Christopher W Liu1, M Gabrielle Page2, Aliza Weinrib3, Dorothy Wong4, Alexander Huang5,4, Karen McRae5,4, Joseph Fiorellino5,4, Diana Tamir5,4, Michael Kahn5,4, Rita Katznelson5,4, Karim Ladha6, Faraj Abdallah7, Marcelo Cypel8, Kazuhiro Yasufuku8, Vincent Chan9, Monica Parry10, James Khan11, Joel Katz12, Hance Clarke13,14. 1. Department of Pain Medicine, Singapore General Hospital, Outram, Singapore. 2. Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. 3. Pain Research Unit and Transitional Pain Service, Department of Anesthesia, Toronto General Hospital, Toronto, ON, Canada. 4. Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada. 5. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. 6. Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada. 7. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 8. Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada. 9. Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada. 10. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. 11. Department of Anesthesiology, Mount Sinai Hospital, Toronto, ON, Canada. 12. Department of Psychology, York University, Toronto, ON, Canada. 13. Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. hance.clarke@utoronto.ca. 14. Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada. hance.clarke@utoronto.ca.
Abstract
PURPOSE: Chronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery METHODS: Two hundred and seventy nine patients undergoing elective thoracic surgery were enrolled. Participants filled out a preoperative questionnaire containing questions about their sociodemographic information, comorbidities as well as several psychological and pain-related statuses. They were then followed-up during their immediate postoperative period and at the three, six and 12 month time-points to track their postoperative pain, complications and pain-related outcomes. Growth mixture modeling was used to construct pain trajectories. RESULTS: The first trajectory is characterized by 185 patients (78.1%) with mild pain intensity across the 12 month period. The second is characterized by 32 patients (7.5%) with moderate pain intensity immediately after surgery which decreases markedly by 3 months and remains low at the 12 month follow-up. The final trajectory is characterized by 20 patients (8.4%) with moderate pain intensity immediately after surgery which persists at 12 months. Patients with moderate to severe postoperative pain intensity were much more likely to develop CPSP compared to patients with mild pain intensity. Initial pain intensity levels immediately following surgery as well as levels of pain catastrophizing at baseline were predicting pain trajectory membership. None of the surgical or anesthetic-related variables were significantly associated with pain trajectory membership. CONCLUSION: Patients who undergo thoracic surgery can have postoperative pain that follows one of the three different types of trajectories. Higher levels of immediate postoperative pain and preoperative pain catastrophizing were associated with moderately severe CPSP.
PURPOSE: Chronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery METHODS: Two hundred and seventy nine patients undergoing elective thoracic surgery were enrolled. Participants filled out a preoperative questionnaire containing questions about their sociodemographic information, comorbidities as well as several psychological and pain-related statuses. They were then followed-up during their immediate postoperative period and at the three, six and 12 month time-points to track their postoperative pain, complications and pain-related outcomes. Growth mixture modeling was used to construct pain trajectories. RESULTS: The first trajectory is characterized by 185 patients (78.1%) with mild pain intensity across the 12 month period. The second is characterized by 32 patients (7.5%) with moderate pain intensity immediately after surgery which decreases markedly by 3 months and remains low at the 12 month follow-up. The final trajectory is characterized by 20 patients (8.4%) with moderate pain intensity immediately after surgery which persists at 12 months. Patients with moderate to severe postoperative pain intensity were much more likely to develop CPSP compared to patients with mild pain intensity. Initial pain intensity levels immediately following surgery as well as levels of pain catastrophizing at baseline were predicting pain trajectory membership. None of the surgical or anesthetic-related variables were significantly associated with pain trajectory membership. CONCLUSION:Patients who undergo thoracic surgery can have postoperative pain that follows one of the three different types of trajectories. Higher levels of immediate postoperative pain and preoperative pain catastrophizing were associated with moderately severe CPSP.
Authors: Wilson W L Li; T W Lee; Shirley S Y Lam; Calvin S H Ng; Alan D L Sihoe; Innes Y P Wan; Anthony P C Yim Journal: Chest Date: 2002-08 Impact factor: 9.410
Authors: Nabil P Rizk; Amanda Ghanie; Meier Hsu; Manjit S Bains; Robert J Downey; Inderpal S Sarkaria; David J Finley; Prasad S Adusumilli; James Huang; Camelia S Sima; Jack E Burkhalter; Bernard J Park; Valerie W Rusch Journal: Ann Thorac Surg Date: 2014-07-31 Impact factor: 4.330
Authors: Monique A H Steegers; Daphne M Snik; Ad F Verhagen; Miep A van der Drift; Oliver H G Wilder-Smith Journal: J Pain Date: 2008-07-16 Impact factor: 5.820