Cognitive flexibility and persistent post-surgical pain: the FLEXCAPP prospective observational study.
Adult
Aged
Arthroplasty, Replacement, Knee
/ adverse effects
Chronic Pain
/ etiology
Cognition Disorders
/ etiology
Executive Function
/ physiology
Female
Follow-Up Studies
Humans
Male
Mastectomy
/ adverse effects
Middle Aged
Neuropsychological Tests
Pain, Postoperative
/ etiology
Prospective Studies
Risk Factors
Sensitivity and Specificity
Thoracic Surgical Procedures
/ adverse effects
arthroplasty
chronic pain
cognition
mastectomy
postoperative pain
thoracotomy
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
08
07
2019
revised:
15
01
2020
accepted:
05
02
2020
pubmed:
15
3
2020
medline:
10
5
2020
entrez:
15
3
2020
Statut:
ppublish
Résumé
Impaired performance on tasks assessing executive function has been linked to chronic pain. We hypothesised that poor performance on tests assessing the ability to adjust thinking in response to changing environmental stimuli (cognitive flexibility) would be associated with persistent post-surgical pain. We conducted a single-centre prospective observational study in two perioperative cohorts: patients undergoing total knee arthroplasty or noncardiac chest surgical procedures. The co-primary outcome measures compared preoperative performance on the Trail Making Test and the colour-word matching Stroop test between patients who developed persistent post-surgical pain and those who did not. Secondary outcome measures included the associations between these test scores and pain severity at 6 months. Of 300 participants enrolled, 198 provided 6 month follow-up data. There were no significant differences in preoperative Trail Making Test B minus A times (33 vs 34 s; P=0.59) or Stroop interference T-scores (47th vs 48th percentile; P=0.50) between patients with and without persistent post-surgical pain (primary outcome). Of those who reported persistent post-surgical pain, poorer baseline performance on the colour-word matching Stroop test was associated with higher pain scores at 6 months in both knee arthroplasty (r=-0.32; P=0.04) and chest (r=-0.44; P=0.02) surgeries (secondary outcome). Preoperative cognitive flexibility test performance was not predictive of overall persistent post-surgical pain incidence 6 months after surgery. However, poor performance on the colour-word matching Stroop test was independently associated with more severe persistent post-surgical pain in both cohorts. NCT02579538.
Sections du résumé
BACKGROUND
Impaired performance on tasks assessing executive function has been linked to chronic pain. We hypothesised that poor performance on tests assessing the ability to adjust thinking in response to changing environmental stimuli (cognitive flexibility) would be associated with persistent post-surgical pain.
METHODS
We conducted a single-centre prospective observational study in two perioperative cohorts: patients undergoing total knee arthroplasty or noncardiac chest surgical procedures. The co-primary outcome measures compared preoperative performance on the Trail Making Test and the colour-word matching Stroop test between patients who developed persistent post-surgical pain and those who did not. Secondary outcome measures included the associations between these test scores and pain severity at 6 months.
RESULTS
Of 300 participants enrolled, 198 provided 6 month follow-up data. There were no significant differences in preoperative Trail Making Test B minus A times (33 vs 34 s; P=0.59) or Stroop interference T-scores (47th vs 48th percentile; P=0.50) between patients with and without persistent post-surgical pain (primary outcome). Of those who reported persistent post-surgical pain, poorer baseline performance on the colour-word matching Stroop test was associated with higher pain scores at 6 months in both knee arthroplasty (r=-0.32; P=0.04) and chest (r=-0.44; P=0.02) surgeries (secondary outcome).
CONCLUSIONS
Preoperative cognitive flexibility test performance was not predictive of overall persistent post-surgical pain incidence 6 months after surgery. However, poor performance on the colour-word matching Stroop test was independently associated with more severe persistent post-surgical pain in both cohorts.
CLINICAL TRIAL REGISTRATION
NCT02579538.
Identifiants
pubmed: 32169255
pii: S0007-0912(20)30080-5
doi: 10.1016/j.bja.2020.02.002
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02579538']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
614-622Informations de copyright
Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.