Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis.

Autor:	Jensen EK; Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospitals, Copenhagen, Denmark., Bäckryd E; Pain and Rehabilitation Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden., Hilden J; Section of Biostatistics, Copenhagen University, Copenhagen, Denmark., Werner MU; Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospitals, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	Scandinavian journal of pain [Scand J Pain] 2020 Oct 09; Vol. 21 (1), pp. 70-80. Date of Electronic Publication: 2020 Oct 09 (Print Publication: 2021).
DOI:	10.1515/sjpain-2020-0104
Abstrakt:	Objectives: Severe persistent post-surgical pain (PPSP) remains a significant healthcare problem. In the third most common surgical procedure in the U.K., groin hernia repair, including 85,000 surgeries, estimated 1,500-3,000 patients will annually develop severe PPSP. While the trajectory of PPSP is generally considered a continuation of the acute post-surgery pain, recent data suggest the condition may develop with a delayed onset. This study evaluated pain-trajectories in a consecutive cohort referred from groin hernia repair-surgeons to a tertiary PPSP-center. Potential explanatory variables based on individual psychometric, sensory, and surgical profiles were analyzed. Methods: Patients completed graphs on pain trajectories and questionnaires on neuropathic pain, pain-related functional assessments, and psychometrics. Surgical records and quantitative sensory testing profiles were obtained. Pain trajectories were normalized, and pre- and post-surgical segments were analyzed by a normalized area-under-the-curve (AUC) technique. Principal component analysis (PCA) was applied to the explanatory variables. Significant PCA-components were further examined using multiple logistic regression models. Results: In 95 patients, the AUC identified groups of post-surgical pain trajectories (p<0.0001): group I (n=48), acute high-intensity pain progressing to PPSP; group II (n=28), delayed onset of PPSP; group III (n=7), repeat-surgery gradually inducing PPSP. Data from groups IV (n=3) and V (n=9) were not included in the statistical analysis due to small sample size and data heterogeneity, respectively. The PCA/logistic analyses indicated that neuropathic pain scores, composite pain scores, and pain-related functional assessments were explanatory variables for groups I and II . Conclusions: Pain trajectories in PPSP after groin hernia repair are heterogeneous but can be classified into meaningful groups. Examination of pain trajectories, mirroring the transition from acute to severe persistent post-surgical pain, has the potential of uncovering clinically relevant pathophysiological mechanisms. (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)
Databáze:	MEDLINE
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