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

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Jensen, Elisabeth KjaerRigshosp, Denmark (author)

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

Article/chapterEnglish2021

Publisher, publication year, extent ...

2020-10-09
WALTER DE GRUYTER GMBH,2021
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LIBRIS-ID:oai:DiVA.org:liu-173414
https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-173414URI
https://doi.org/10.1515/sjpain-2020-0104DOI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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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.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
chronic pain; groin; herniorrhaphy; physiopathology; postoperative

Added entries (persons, corporate bodies, meetings, titles ...)

Bäckryd, EmmanuelLinköpings universitet,Avdelningen för prevention, rehabilitering och nära vård,Medicinska fakulteten,Region Östergötland, Smärt och rehabiliteringscentrum(Swepub:liu)emmba63 (author)
Hilden, JorgenUniv Copenhagen, Denmark (author)
Werner, Mads U.Copenhagen Univ Hosp, Denmark (author)
Rigshosp, DenmarkAvdelningen för prevention, rehabilitering och nära vård (creator_code:org_t)

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In:Scandinavian Journal of Pain: WALTER DE GRUYTER GMBH21:1, s. 70-801877-88601877-8879

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