Abstract
To investigate the role of peripheral neuropathy in the development of neuropathic
postsurgical persistent pain (N-PSPP) after surgery, this French multicentric prospective
cohort study recruited 3,112 patients prior to elective cesarean, inguinal herniorrhaphy
(open mesh/laparoscopic), breast cancer surgery, cholecystectomy, saphenectomy, sternotomy,
thoracotomy, or knee arthroscopy. Besides perioperative data collection, postoperative
postal questionnaires built to assess the existence, intensity, and neuropathic features
(with the Douleur Neuropathique 4 Questions [DN4]) of pain at the site of surgery
were sent at the third and sixth months after surgery. In the 2,397 patients who completed
follow-up, the cumulative risk of N-PSPP within the 6 months ranged from 3.2% (laparoscopic
herniorrhaphy) to 37.1% (breast cancer surgery). Pain intensity was greater if DN4
was positive and decreased with time since surgery; it depended on the type of surgery.
In pain-reporting patients, the response to the DN4 changed from time to time in about
1:4 of the cases. Older age and a low anxiety score were independent protective factors
of N-PSPP, whereas a recent negative event, a low preoperative quality of life, and
previous history of peripheral neuropathy were risk factors. The type of anesthesia
had no influence on the occurrence of N-PSPP. Trial registration: ClinicalTrials.gov, NCT00812734.
Perspective
This prospective observational study provides the incidence rate of N-PSPP occurring
within the 6 months after 9 types of elective surgical procedures. It highlights the
possible consequences of nerve aggression during some common surgeries. Finally, some
preoperative predispositions to the development of N-PSPP have been identified.
Key words
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Article info
Publication history
Accepted:
August 20,
2013
Received in revised form:
May 16,
2013
Received:
February 14,
2013
Footnotes
CHU Clermont-Ferrand, Centre de Pharmacologie Clinique (Inserm CIC 501), F-63003 Clermont-Ferrand, France.
Sources of funding for the study: French program for hospital clinical research (Programme Hospitalier de Recherche Clinique, appel d'offre national 2005) and Pfizer. C.Du., as the coordinating investigator, had support from Pfizer for the submitted work; for the conduct of the study, by subsidies paid to the University Hospital of Clermont-Ferrand; and for communication about the results of the study and neuropathic postsurgical persistent pain during the EFIC Congress in Hamburg, Germany (September 2011).
None of the other authors have relationships with any company that might have an interest in the submitted work in the previous 3 years; none of their spouses, partners, or children have financial relationships that may be relevant to the submitted work; and none of the other authors have any nonfinancial interests that may be relevant to the submitted work.
Identification
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© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
