Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk
Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk
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DOI：
10.1016/j.pain.2007.10.033
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发表时间：
2008-08-15
期刊：
影响因子：
7.4
通讯作者：
Granot, Michal
中科院分区：
文献类型：
--
作者：
Yarnitsky, David;Crispel, Yonathan;Granot, Michal
手术和医疗程序，主要是与神经损伤有关的程序，可能导致慢性持续性疼痛。目前，人们无法预测哪些接受此类手术的患者有“风险”发展为慢性疼痛。我们假设内源性镇痛系统是决定处理有害事件模式的关键，因此测试弥漫性有害抑制控制（DNIC）将预测慢性开胸术后疼痛（CPTP）的易感性。对62例患者进行术前心理物理测试，包括DNIC评估（在身体远端区域暴露于另一种有害刺激时的疼痛减轻）。术后随访29.0 ± 16.9周。Logistic回归分析显示，术前评估的DNIC效率和术后急性疼痛强度是CPTP的两个独立预测因素。有效的DNIC预测CPTP的风险较低，OR为0.52（0.33-0.77 95% CI，p = 0.0024）。也就是说，10点数字疼痛量表（NH3）减少一半的机会，发展为慢性疼痛。较高的急性疼痛强度表明OR为1.80（1.28-2.77。p = 0.0024），预测每增加10分，发生慢性疼痛的机会几乎增加一倍。其他心理物理措施，疼痛阈值和阈上疼痛幅度，没有预测CPTP。用于预测术后急性疼痛强度。DNIC效率不显着。因此，在无痛状态下获得的内源性镇痛系统的有效性似乎反映了个体应对有害事件的能力，确定了患者发生干预后慢性疼痛的"风险“。在可能产生疼痛的程序之前应用这种诊断方法可以允许个性化的疼痛预防和管理，这可以大大减少痛苦。(c)2007年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are 'at risk' to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients. who were followed 29.0 +/- 16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33-0.77 95% CI, p = 0.0024). i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28-2.77. p = 0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity. DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual's ability to tackle noxious events, identifying patients 'at risk' to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering. (c) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.