Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after total knee arthroplasty

Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after... 176Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188follow up, after the patients had taken part in a CBT-ACT based 4weeks in-hospital pain rehabilitation program (PRP).Methods: Blood samples were collected from 52 well characterized chronic pain patients. Plasma from matched healthyblood donors were used as controls. At one year after the treatment program, 28 of the patients were available for follow up.Instead of only analyzing single inflammation-related substances,we used a new multiplex panel enabling the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines andchemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Multivariate statistics were used for analysis.Results: Clear signs of increased inflammatory activity weredetected in the pain patients. Accepting a false discovery rate(FDR) of 5%, there were significant differences in 43 of the 92inflammatory biomarkers. The expression of 8 biomarkers were 4times higher in patients compared to controls. Three biomarkers,CXCL5, SIRT2, AXIN1 were more than 8 times higher. The conventional marker for inflammation, CRP, did not differ. Of the 28patients available for follow up one year after the intervention,all showed lower levels of the inflammatory biomarker initiallyraised.Conclusions: The results indicate that CPP suffer from a lowgrade of chronic systemic inflammation, not detectable by CRPanalysis. This may have implications for the general pain hypersensitivity, and other symptoms, often described in this group ofpatients. We conclude that inflammatory plasma proteins may bemeasureable molecular markers to distinguishes CPP from pain freecontrols, and that a CBT-ACT pain rehab program seem to decreasethis inflammatory activity.References[1] Moen A, Lind AL, Thulin M, Kamali-Moghaddam M, Røe C, Gjerstad J, GordhT. Inflammatory serum protein profiling of patients with lumbar radicular pain one year after disc herniation. Int J Inflam 2016;2016:3874964,http://dx.doi.org/10.1155/2016/3874964.[2] Bäckryd E, Tanum L, Lind A-L, Larsson A, Gordh T. Evidence of both systemicinflammation and neuroinflammation in fibromyalgia patients, as assessed by amultiplex protein panel applied to the cerebrospinal fluid and to plasma. J PainRes 2017;10:1–11.http://dx.doi.org/10.1016/j.sjpain.2017.04.033Fixed or adapted conditioning intensity forrepeated conditioned pain modulationM. Hoegh a,∗ , K.K. Petersen b , T. Graven-Nielsen athe conditioning stimulus was assessed on a numeric rating scale(NRS). Data were analyzed with repeated-measures ANOVA.Results: No difference was found comparing the four PDTsassessed before CSs for the fixed and the adaptive paradigms. TheCS pressure intensity for the adaptive paradigm was increasing during the four repeated assessments (P < 0.01). The pain intensity wassimilar during the fixed (NRS: 5.8 ± 0.5) and the adjusted paradigm(NRS: 6.0 ± 0.4). The CPM-effect was higher using the fixed condition compared with the adaptive condition (P < 0.05).Conclusions: The current study found that sequential CPMparadigms using a fixed conditioning stimulus produced anincreased CPM-effect compared with adaptive and increasing conditioning intensities.http://dx.doi.org/10.1016/j.sjpain.2017.04.034Combined treatment (Norspan, Gabapentin andOxynorm) was found superior in painmanagement after total knee arthroplastyM.B. Jensen ∗ , M.M. Andersen, B. Boesen, M.B.Jørgensen, O. SimonsenE-mail address: mikkel.jensen@rn.dk (M.B. Jensen).Background: Gabapentin (GAB) has recently been introducedfor postoperative pain treatment in orthopedic surgery. As persistent postoperative pain is still a major problem in totalknee arthroplasty (TKA), studies on the effect and side effectsof Gabapentin in addition to the commonly used morphine(MOR), Oxynorm (OXY) and Norspan (NOR) are highly warranted. In the present study, four relevant treatment algorithms,gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm(GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm andNorspan (GAB/OXY/NOR) were examined.Patients and methods: A total of 241 patients were followed systematically during one month following TKA in fourconsecutive series: 60 patients were treated with GAB/MOR, 62patients with GAB/OXY, 59 patients with OXY, and 60 patients withGAB/OXY/MOR. On the day before surgery and on postoperative day1, 14, and 30, pain during rest, pain during walking and side effects(constipation, dizziness, and nausea) were reported (VAS).Results: After 30 days, pain greatly decreased in all groups, witha superior effect of GAB/OXY/NOR for pain during rest and onlyslightly more side effects at day 1.Conclusions: In management of postoperative pain followingTKA, data indicated that GAB/OXY/NOR was superior, compared toGAB/MOR, GAB/OXY, and OXY.aCenter for Neuroplasticity and Pain (CNAP), SMI,Aalborg University, Aalborg, Denmarkb SMI, Department of Health Science and Technology,Faculty of Medicine, Aalborg University, Aalborg,DenmarkE-mail address: msh@hst.aau.dk (M. Hoegh).Aims: Conditioned pain modulation (CPM) is used to assessdescending pain modulation through a test stimulation (TS) and aconditioning stimulation (CS). Due to potential carry-over effects,sequential CPM paradigms might alter the intensity of the CS, whichpotentially can alter the CPM-effect. This study aimed to investigate the difference between a fixed and adaptive CS intensity onCPM-effect.Methods: On the dominant leg of 20 healthy subjects the cuffpressure detection threshold (PDT) was recorded as TS and the paintolerance threshold (PTT) was assessed on the non-dominant legfor estimating the CS. The difference in PDT before and during CSdefined the CPM-effect. The CPM-effect was assessed four timesusing a CS with intensities of 70% of baseline PTT (fixed) or 70% ofPTT measured throughout the session (adaptive). Pain intensity ofhttp://dx.doi.org/10.1016/j.sjpain.2017.04.035Effects of conditioned pain modulation on thewithdrawal pattern to nociceptive stimulationin humans – Preliminary resultsF.A. Jure a,∗ , F.G. Arguissain b , J.A. BiurrunManresa a,c , O.K. Andersen aa®Center for Neuroplasticity and Pain (CNAP), SMI ,Department of Health Science and Technology,Aalborg University, Denmarkb Hammel Neurorehabilitation and Research Centre,Aarhus University Hospital, Hammel, Denmarkc Centro de Investigaciones y Transferencia de EntreRíos (CITER), CONICET-UNER, Entre Ríos, ArgentinaE-mail address: faj@hst.aau.dk (F.A. Jure).Aims: Conditioned pain modulation (CPM) is a paradigmemployed to assess descending control of spinal nociception. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Combined treatment (Norspan, Gabapentin and Oxynorm) was found superior in pain management after total knee arthroplasty

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De Gruyter
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© 2017 Scandinavian Association for the Study of Pain
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1877-8860
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10.1016/j.sjpain.2017.04.035
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Abstract

176Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188follow up, after the patients had taken part in a CBT-ACT based 4weeks in-hospital pain rehabilitation program (PRP).Methods: Blood samples were collected from 52 well characterized chronic pain patients. Plasma from matched healthyblood donors were used as controls. At one year after the treatment program, 28 of the patients were available for follow up.Instead of only analyzing single inflammation-related substances,we used a new multiplex panel enabling the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines andchemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Multivariate statistics were used for analysis.Results: Clear signs of increased inflammatory activity weredetected in the pain patients. Accepting a false discovery rate(FDR) of 5%, there were significant differences in 43 of the 92inflammatory biomarkers. The expression of 8 biomarkers were 4times higher in patients compared to controls. Three biomarkers,CXCL5, SIRT2, AXIN1 were more than 8 times higher. The conventional marker for inflammation, CRP, did not differ. Of the 28patients available for follow up one year after the intervention,all showed lower levels of the inflammatory biomarker initiallyraised.Conclusions: The results indicate that CPP suffer from a lowgrade of chronic systemic inflammation, not detectable by CRPanalysis. This may have implications for the general pain hypersensitivity, and other symptoms, often described in this group ofpatients. We conclude that inflammatory plasma proteins may bemeasureable molecular markers to distinguishes CPP from pain freecontrols, and that a CBT-ACT pain rehab program seem to decreasethis inflammatory activity.References[1] Moen A, Lind AL, Thulin M, Kamali-Moghaddam M, Røe C, Gjerstad J, GordhT. Inflammatory serum protein profiling of patients with lumbar radicular pain one year after disc herniation. Int J Inflam 2016;2016:3874964,http://dx.doi.org/10.1155/2016/3874964.[2] Bäckryd E, Tanum L, Lind A-L, Larsson A, Gordh T. Evidence of both systemicinflammation and neuroinflammation in fibromyalgia patients, as assessed by amultiplex protein panel applied to the cerebrospinal fluid and to plasma. J PainRes 2017;10:1–11.http://dx.doi.org/10.1016/j.sjpain.2017.04.033Fixed or adapted conditioning intensity forrepeated conditioned pain modulationM. Hoegh a,∗ , K.K. Petersen b , T. Graven-Nielsen athe conditioning stimulus was assessed on a numeric rating scale(NRS). Data were analyzed with repeated-measures ANOVA.Results: No difference was found comparing the four PDTsassessed before CSs for the fixed and the adaptive paradigms. TheCS pressure intensity for the adaptive paradigm was increasing during the four repeated assessments (P < 0.01). The pain intensity wassimilar during the fixed (NRS: 5.8 ± 0.5) and the adjusted paradigm(NRS: 6.0 ± 0.4). The CPM-effect was higher using the fixed condition compared with the adaptive condition (P < 0.05).Conclusions: The current study found that sequential CPMparadigms using a fixed conditioning stimulus produced anincreased CPM-effect compared with adaptive and increasing conditioning intensities.http://dx.doi.org/10.1016/j.sjpain.2017.04.034Combined treatment (Norspan, Gabapentin andOxynorm) was found superior in painmanagement after total knee arthroplastyM.B. Jensen ∗ , M.M. Andersen, B. Boesen, M.B.Jørgensen, O. SimonsenE-mail address: mikkel.jensen@rn.dk (M.B. Jensen).Background: Gabapentin (GAB) has recently been introducedfor postoperative pain treatment in orthopedic surgery. As persistent postoperative pain is still a major problem in totalknee arthroplasty (TKA), studies on the effect and side effectsof Gabapentin in addition to the commonly used morphine(MOR), Oxynorm (OXY) and Norspan (NOR) are highly warranted. In the present study, four relevant treatment algorithms,gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm(GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm andNorspan (GAB/OXY/NOR) were examined.Patients and methods: A total of 241 patients were followed systematically during one month following TKA in fourconsecutive series: 60 patients were treated with GAB/MOR, 62patients with GAB/OXY, 59 patients with OXY, and 60 patients withGAB/OXY/MOR. On the day before surgery and on postoperative day1, 14, and 30, pain during rest, pain during walking and side effects(constipation, dizziness, and nausea) were reported (VAS).Results: After 30 days, pain greatly decreased in all groups, witha superior effect of GAB/OXY/NOR for pain during rest and onlyslightly more side effects at day 1.Conclusions: In management of postoperative pain followingTKA, data indicated that GAB/OXY/NOR was superior, compared toGAB/MOR, GAB/OXY, and OXY.aCenter for Neuroplasticity and Pain (CNAP), SMI,Aalborg University, Aalborg, Denmarkb SMI, Department of Health Science and Technology,Faculty of Medicine, Aalborg University, Aalborg,DenmarkE-mail address: msh@hst.aau.dk (M. Hoegh).Aims: Conditioned pain modulation (CPM) is used to assessdescending pain modulation through a test stimulation (TS) and aconditioning stimulation (CS). Due to potential carry-over effects,sequential CPM paradigms might alter the intensity of the CS, whichpotentially can alter the CPM-effect. This study aimed to investigate the difference between a fixed and adaptive CS intensity onCPM-effect.Methods: On the dominant leg of 20 healthy subjects the cuffpressure detection threshold (PDT) was recorded as TS and the paintolerance threshold (PTT) was assessed on the non-dominant legfor estimating the CS. The difference in PDT before and during CSdefined the CPM-effect. The CPM-effect was assessed four timesusing a CS with intensities of 70% of baseline PTT (fixed) or 70% ofPTT measured throughout the session (adaptive). Pain intensity ofhttp://dx.doi.org/10.1016/j.sjpain.2017.04.035Effects of conditioned pain modulation on thewithdrawal pattern to nociceptive stimulationin humans – Preliminary resultsF.A. Jure a,∗ , F.G. Arguissain b , J.A. BiurrunManresa a,c , O.K. Andersen aa®Center for Neuroplasticity and Pain (CNAP), SMI ,Department of Health Science and Technology,Aalborg University, Denmarkb Hammel Neurorehabilitation and Research Centre,Aarhus University Hospital, Hammel, Denmarkc Centro de Investigaciones y Transferencia de EntreRíos (CITER), CONICET-UNER, Entre Ríos, ArgentinaE-mail address: faj@hst.aau.dk (F.A. Jure).Aims: Conditioned pain modulation (CPM) is a paradigmemployed to assess descending control of spinal nociception.

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Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

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