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

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Jensen, Elisabeth KjærCopenhagen University Hospital (författare)

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

Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

2023
17 s.

Nummerbeteckningar

LIBRIS-ID:oai:lup.lub.lu.se:ec687728-7631-4a44-b9f0-385c89b0756b
https://lup.lub.lu.se/record/ec687728-7631-4a44-b9f0-385c89b0756bURI
https://doi.org/10.2147/JPR.S384973DOI

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Språk:engelska
Sammanfattning på:engelska

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Anmärkningar

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.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
chronic post-surgical pain
groin
hernia repair
reoperation
sensory thresholds

Biuppslag (personer, institutioner, konferenser, titlar ...)

Ringsted, Thomas K.Copenhagen University Hospital (författare)
Bischoff, Joakim M.Copenhagen University Hospital (författare)
Petersen, Morten A.Bispebjerg Hospital (författare)
Møller, KirstenCopenhagen University Hospital,University of Copenhagen (författare)
Kehlet, HenrikCopenhagen University Hospital (författare)
Werner, Mads 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 Hospital(Swepub:lu)onk-mwe (författare)
Copenhagen University HospitalBispebjerg Hospital (creator_code:org_t)

Sammanhörande titlar

Ingår i:Journal of Pain Research16, s. 943-9591178-7090

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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

Artiklar i publikationen: Journal of Pain ...

Av lärosätet: Lunds universitet

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