The long-term incidence of chronic post-surgical pain after coronary artery bypass surgery - A prospective observational study.
Journal
European journal of pain (London, England)
ISSN: 1532-2149
Titre abrégé: Eur J Pain
Pays: England
ID NLM: 9801774
Informations de publication
Date de publication:
Apr 2024
Apr 2024
Historique:
revised:
17
10
2023
received:
04
05
2023
accepted:
03
11
2023
pubmed:
16
11
2023
medline:
16
11
2023
entrez:
16
11
2023
Statut:
ppublish
Résumé
Chronic post-surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long-term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery. This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL). CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft-SVG) 11/37 [29.7%]; χ This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long-term follow-up of CABG patients. This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long-term follow-up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.
Sections du résumé
BACKGROUND
BACKGROUND
Chronic post-surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long-term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery.
METHODS
METHODS
This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL).
RESULTS
RESULTS
CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft-SVG) 11/37 [29.7%]; χ
CONCLUSIONS
CONCLUSIONS
This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long-term follow-up of CABG patients.
SIGNIFICANCE
CONCLUSIONS
This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long-term follow-up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
599-607Informations de copyright
© 2023 European Pain Federation - EFIC ®.
Références
Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J., Cunin, G., Fermanian, J., Ginies, P., Grun-Overdyking, A., Jafari-Schluep, H., Lanteri-Minet, M., Laurent, B., Mick, G., Serrie, A., Valade, D., & Vicaut, E. (2005). Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain, 114, 29-36. https://doi.org/10.1016/j.pain.2004.12.010
Bruce, J., Drury, N., Poobalan, A. S., Jeffrey, R. R., Smith, W. C., & Chambers, W. A. (2003). The prevalence of chronic chest and leg pain following cardiac surgery: A historical cohort study. Pain, 104, 265-273. https://doi.org/10.1016/s0304-3959(03)00017-4
Cavalli, E., Mammana, S., Nicoletti, F., Bramanti, P., & Mazzon, E. (2019). The neuropathic pain: An overview of the current treatment and future therapeutic approaches. International Journal of Immunopathology and Pharmacology, 33. https://doi.org/10.1177/2058738419838383
Choiniere, M., Watt-Watson, J., Victor, J. C., Baskett, R. J., Bussieres, J. S., Carrier, M., Cogan, J., Costello, J., Feindel, C., Guertin, M. C., Racine, M., & Taillefer, M. C. (2014). Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: A 2-year prospective multicentre study. CMAJ, 186, E213-E223. https://doi.org/10.1503/cmaj.131012
De Kock, M. (2009). Expanding our horizons: Transition of acute postoperative pain to persistent pain and establishment of chronic postsurgical pain services. Anesthesiology, 111, 461-463. https://doi.org/10.1097/ALN.0b013e3181afde28
Doleman, B., Leonardi-Bee, J., Heinink, T. P., Bhattacharjee, D., Lund, J. N., & Williams, J. P. (2018). Pre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery. Cochrane Database of Systematic Reviews, 12, CD012624. https://doi.org/10.1002/14651858.CD012624.pub2
Eisenberg, E., Pultorak, Y., Pud, D., & Bar-El, Y. (2001). Prevalence and characteristics of post coronary artery bypass graft surgery pain (PCP). Pain, 92, 11-17. https://doi.org/10.1016/s0304-3959(00)00466-8
Evered, L. A., Silbert, B. S., Scott, D. A., Maruff, P., & Ames, D. (2016). Prevalence of dementia 7.5 years after coronary artery bypass graft surgery. Anesthesiology, 125, 62-71. https://doi.org/10.1097/ALN.0000000000001143
Gjeilo, K. H., Klepstad, P., Wahba, A., Lydersen, S., & Stenseth, R. (2010). Chronic pain after cardiac surgery: A prospective study. Acta Anaesthesiologica Scandinavica, 54, 70-78. https://doi.org/10.1111/j.1399-6576.2009.02097.x
Gjeilo, K. H., Stenseth, R., & Klepstad, P. (2014). Risk factors and early pharmacological interventions to prevent chronic postsurgical pain following cardiac surgery. American Journal of Cardiovascular Drugs, 14, 335-342. https://doi.org/10.1007/s40256-014-0083-2
Gjeilo, K. H., Stenseth, R., Wahba, A., Lydersen, S., & Klepstad, P. (2017). Chronic postsurgical pain in patients 5 years after cardiac surgery: A prospective cohort study. European Journal of Pain, 21, 425-433.
Glare, P., Aubrey, K. R., & Myles, P. S. (2019). Transition from acute to chronic pain after surgery. Lancet, 393, 1537-1546. https://doi.org/10.1016/S0140-6736(19)30352-6
Guimaraes-Pereira, L., Reis, P., Abelha, F., Azevedo, L. F., & Castro-Lopes, J. M. (2017). Persistent postoperative pain after cardiac surgery: A systematic review with meta-analysis regarding incidence and pain intensity. Pain, 158, 1869-1885. https://doi.org/10.1097/j.pain.0000000000000997
Harrogate, S. R., Cooper, J. A., Zawadka, M., & Anwar, S. (2021). Seven-year follow-up of persistent postsurgical pain in cardiac surgery patients: A prospective observational study of prevalence and risk factors. European Journal of Pain, 25, 1829-1838. https://doi.org/10.1002/ejp.1794
Kalso, E., Mennander, S., Tasmuth, T., & Nilsson, E. (2001). Chronic post-sternotomy pain. Acta Anaesthesiologica Scandinavica, 45, 935-939.
Katz, J., & Seltzer, Z. (2009). Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert Review of Neurotherapeutics, 9, 723-744. https://doi.org/10.1586/ern.09.20
Kehlet, H., Jensen, T. S., & Woolf, C. J. (2006). Persistent postsurgical pain: Risk factors and prevention. Lancet, 367, 1618-1625. https://doi.org/10.1016/S0140-6736(06)68700-X
Koenig, H. G., Meador, K. G., Cohen, H. J., & Blazer, D. G. (1988). Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. Journal of the American Geriatrics Society, 36, 699-706. https://doi.org/10.1111/j.1532-5415.1988.tb07171.x
Kwanten, L. E., O'Brien, B., & Anwar, S. (2019). Opioid-based anesthesia and analgesia for adult cardiac surgery: History and narrative review of the literature. Journal of Cardiothoracic and Vascular Anesthesia, 33, 808-816. https://doi.org/10.1053/j.jvca.2018.05.053
Meyerson, J., Thelin, S., Gordh, T., & Karlsten, R. (2001). The incidence of chronic post-sternotomy pain after cardiac surgery-A prospective study. Acta Anaesthesiologica Scandinavica, 45, 940-944. https://doi.org/10.1034/j.1399-6576.2001.450804.x
Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: A review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia, 123, e273-e283. https://doi.org/10.1016/j.bja.2019.03.023
Peters, M. L., Sommer, M., van Kleef, M., & Marcus, M. A. (2010). Predictors of physical and emotional recovery 6 and 12 months after surgery. The British Journal of Surgery, 97, 1518-1527. https://doi.org/10.1002/bjs.7152
Phillips, C. J. (2009). The cost and burden of chronic pain. Reviews in Pain, 3, 2-5. https://doi.org/10.1177/204946370900300102
Rocket, M., & Scott, D. A. (2020). Progression of acute to chronic pain. In S. A. Schug, D. A. Scott, J. F. Mott, R. Halliwell, G. M. Palmer, & M. Alcock (Eds.), Acute pain management: Scientific evidence (5th ed., pp. 21-32). ANZCA & FPM.
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin, E. J., Berry, J. D., Borden, W. B., Bravata, D. M., Dai, S., Ford, E. S., Fox, C. S., Fullerton, H. J., Gillespie, C., Hailpern, S. M., Heit, J. A., Howard, V. J., Kissela, B. M., Kittner, S. J., Lackland, D. T., Lichtman, J. H., … Turner, M. B. (2012). American Heart Association statistics C, stroke statistics S. Heart disease and stroke statistics-2012 update: A report from the American Heart Association. Circulation, 125, e2-e220. https://doi.org/10.1161/CIR.0b013e31823ac046
Schneider, L. S., Clark, C. M., Doody, R., Ferris, S. H., Morris, J. C., Raman, R., Reisberg, B., & Schmitt, F. A. (2006). ADCS prevention instrument project: ADCS-clinicians' global impression of change scales (ADCS-CGIC), self-rated and study partner-rated versions. Alzheimer Disease and Associated Disorders, 20, S124-S138. https://doi.org/10.1097/01.wad.0000213878.47924.44
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric depression scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165-173. https://doi.org/10.1300/J018v05n01_09
Silbert, B. S., Scott, D. A., Evered, L. A., Lewis, M. S., Kalpokas, M., Maruff, P., Myles, P. S., & Jamrozik, K. (2006). A comparison of the effect of high- and low-dose fentanyl on the incidence of postoperative cognitive dysfunction after coronary artery bypass surgery in the elderly. Anesthesiology, 104, 1137-1145.
Wilmot, V. V., & Evans, D. J. (2013). Categorizing the distribution of the saphenous nerve in relation to the great saphenous vein. Clinical Anatomy, 26, 531-536. https://doi.org/10.1002/ca.22168
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37-49. https://doi.org/10.1016/0022-3956(82)90033-4