Somatosensory Outcomes Following Re-Surgery in Persistent Severe Pain After Groin Hernia Repair : A Prospective Observational Study

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Fältnamn	Indikatorer	Metadata
000		04457naa a2200421 4500
001		oai:lup.lub.lu.se:ec687728-7631-4a44-b9f0-385c89b0756b
003		SwePub
008		230524s2023 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://lup.lub.lu.se/record/ec687728-7631-4a44-b9f0-385c89b0756b2 URI
024	7	a https://doi.org/10.2147/JPR.S3849732 DOI
040		a (SwePub)lu
041		a engb eng
042		9 SwePub
072	7	a art2 swepub-publicationtype
072	7	a ref2 swepub-contenttype
100	1	a Jensen, Elisabeth Kjæru Copenhagen University Hospital4 aut
245	1 0	a Somatosensory Outcomes Following Re-Surgery in Persistent Severe Pain After Groin Hernia Repair : A Prospective Observational Study
264	1	c 2023
300		a 17 s.
520		a Purpose: After groin hernia repair (globally more than 20 million/year) 2–4% will develop persistent severe pain (PSPG). Pain management is challenging and may require multimodal interventions, including re-surgery. Quantitative somatosensory testing (QST) is an investigational psychophysiological tool with the potential to uncover the pathophysiological mechanisms behind the pain, ie, revealing neuropathic or inflammatory components. The primary objective was to examine and describe the underlying pathophysiological changes in the groin areas by QST before and after re-surgery with mesh removal and selective neurectomy. Patients and Methods: Sixty patients with PSPG scheduled for re-surgery and with an inflammatory “component” indicated by blunt pressure algometry were examined in median (95% CI) 7.9 (5.8–11.5) months before and 4.0 (3.5–4.6) months after re-surgery. The QST-analyses included standardized assessments of cutaneous mechanical/thermal detection and pain thresholds. Suprathreshold heat stimuli were applied. Deep tissue sensitivity was tested by pressure algometry. Testing sites were the groin areas and the lower arm. Before/after QST data were z-transformed. Results: Re-surgery resulted in median changes in rest, average, and maximal pain intensity scores of −2.0, −2.5, and −2.0 NRS (0/ 10) units, respectively (P = 0.0001), and proportional increases in various standardized functional scores (P = 0.0001). Compared with the control sites, the cutaneous somatosensory detection thresholds of the painful groin were increased before re-surgery and increased further after re-surgery (median difference: 1.28 z-values; P = 0.001), indicating a successive post-surgical loss of nerve fiber function (“deafferentation”). Pressure algometry thresholds increased after re-surgery (median difference: 0.30 z-values; P = 0.001). Conclusion: In this subset of patients with PSPG who underwent re-surgery, the procedure was associated with improved pain and functional outcomes. While the increase in somatosensory detection thresholds mirrors the surgery-induced cutaneous deafferentation, the increase in pressure algometry thresholds mirrors the removal of the deep “pain generator”. The QST-analyses are useful adjuncts in mechanism-based somatosensory research.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653		a chronic post-surgical pain
653		a groin
653		a hernia repair
653		a reoperation
653		a sensory thresholds
700	1	a Ringsted, Thomas K.u Copenhagen University Hospital4 aut
700	1	a Bischoff, Joakim M.u Copenhagen University Hospital4 aut
700	1	a Petersen, Morten A.u Bispebjerg Hospital4 aut
700	1	a Møller, Kirstenu University of Copenhagen,Copenhagen University Hospital4 aut
700	1	a Kehlet, Henriku Copenhagen University Hospital4 aut
700	1	a Werner, Mads U.u Lund University,Lunds universitet,Tumörmikromiljö,Sektion I,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Tumor microenvironment,Section I,Department of Clinical Sciences, Lund,Faculty of Medicine,Copenhagen University Hospital4 aut0 (Swepub:lu)onk-mwe
710	2	a Copenhagen University Hospitalb Bispebjerg Hospital4 org
773	0	t Journal of Pain Researchg 16, s. 943-959q 16<943-959x 1178-7090
856	4	u http://dx.doi.org/10.2147/JPR.S384973x freey FULLTEXT
856	4 8	u https://lup.lub.lu.se/record/ec687728-7631-4a44-b9f0-385c89b0756b
856	4 8	u https://doi.org/10.2147/JPR.S384973

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Av författaren/redakt...: Jensen, Elisabet ...; Ringsted, Thomas ...; Bischoff, Joakim ...; Petersen, Morten ...; Møller, Kirsten; Kehlet, Henrik; visa fler...; Werner, Mads U.; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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Av lärosätet: Lunds universitet

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