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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... 176 Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188 follow up, after the patients had taken part in a CBT-ACT based 4 the conditioning stimulus was assessed on a numeric rating scale weeks in-hospital pain rehabilitation program (PRP). (NRS). Data were analyzed with repeated-measures ANOVA. Methods: Blood samples were collected from 52 well char- Results: No difference was found comparing the four PDTs acterized chronic pain patients. Plasma from matched healthy assessed before CSs for the fixed and the adaptive paradigms. The CS pressure intensity for the adaptive paradigm was increasing dur- blood donors were used as controls. At one year after the treat- ment program, 28 of the patients were available for follow up. ing the four repeated assessments (P < 0.01). The pain intensity was Instead of only analyzing single inflammation-related substances, similar during the fixed (NRS: 5.8 ± 0.5) and the adjusted paradigm we used a new multiplex panel enabling the simultaneous anal- (NRS: 6.0 ± 0.4). The CPM-effect was higher using the fixed condi- ysis of 92 inflammation-related proteins, mainly cytokines and tion compared with the adaptive condition (P < 0.05). chemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Mul- Conclusions: The current study found that sequential CPM tivariate statistics were used for analysis. paradigms using a fixed conditioning stimulus produced an Results: Clear signs of increased inflammatory activity were increased CPM-effect compared with adaptive and increasing con- detected in the pain patients. Accepting a false discovery rate ditioning intensities. (FDR) of 5%, there were significant differences in 43 of the 92 inflammatory biomarkers. The expression of 8 biomarkers were 4 http://dx.doi.org/10.1016/j.sjpain.2017.04.034 times higher in patients compared to controls. Three biomarkers, CXCL5, SIRT2, AXIN1 were more than 8 times higher. The con- Combined treatment (Norspan, Gabapentin and ventional marker for inflammation, CRP, did not differ. Of the 28 Oxynorm) was found superior in pain patients available for follow up one year after the intervention, management after total knee arthroplasty all showed lower levels of the inflammatory biomarker initially M.B. Jensen , M.M. Andersen, B. Boesen, M.B. raised. Jørgensen, O. Simonsen Conclusions: The results indicate that CPP suffer from a low E-mail address: mikkel.jensen@rn.dk (M.B. Jensen). grade of chronic systemic inflammation, not detectable by CRP Background: Gabapentin (GAB) has recently been introduced analysis. This may have implications for the general pain hyper- for postoperative pain treatment in orthopedic surgery. As per- sensitivity, and other symptoms, often described in this group of sistent postoperative pain is still a major problem in total patients. We conclude that inflammatory plasma proteins may be knee arthroplasty (TKA), studies on the effect and side effects measureable molecular markers to distinguishes CPP from pain free of Gabapentin in addition to the commonly used morphine controls, and that a CBT-ACT pain rehab program seem to decrease (MOR), Oxynorm (OXY) and Norspan (NOR) are highly warran- this inflammatory activity. ted. In the present study, four relevant treatment algorithms, gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm References (GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm and Norspan (GAB/OXY/NOR) were examined. [1] Moen A, Lind AL, Thulin M, Kamali-Moghaddam M, Røe C, Gjerstad J, Gordh T. Inflammatory serum protein profiling of patients with lumbar radicu- Patients and methods: A total of 241 patients were fol- lar pain one year after disc herniation. Int J Inflam 2016;2016:3874964, lowed systematically during one month following TKA in four http://dx.doi.org/10.1155/2016/3874964. consecutive series: 60 patients were treated with GAB/MOR, 62 [2] Bäckryd E, Tanum L, Lind A-L, Larsson A, Gordh T. Evidence of both systemic patients with GAB/OXY, 59 patients with OXY, and 60 patients with inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. J Pain GAB/OXY/MOR. On the day before surgery and on postoperative day Res 2017;10:1–11. 1, 14, and 30, pain during rest, pain during walking and side effects (constipation, dizziness, and nausea) were reported (VAS). http://dx.doi.org/10.1016/j.sjpain.2017.04.033 Results: After 30 days, pain greatly decreased in all groups, with a superior effect of GAB/OXY/NOR for pain during rest and only Fixed or adapted conditioning intensity for slightly more side effects at day 1. repeated conditioned pain modulation Conclusions: In management of postoperative pain following TKA, data indicated that GAB/OXY/NOR was superior, compared to a,∗ b a M. Hoegh , K.K. Petersen , T. Graven-Nielsen GAB/MOR, GAB/OXY, and OXY. Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark http://dx.doi.org/10.1016/j.sjpain.2017.04.035 SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Effects of conditioned pain modulation on the Denmark withdrawal pattern to nociceptive stimulation E-mail address: msh@hst.aau.dk (M. Hoegh). in humans – Preliminary results Aims: Conditioned pain modulation (CPM) is used to assess a,∗ b F.A. Jure , F.G. Arguissain , J.A. Biurrun descending pain modulation through a test stimulation (TS) and a a,c a Manresa , O.K. Andersen conditioning stimulation (CS). Due to potential carry-over effects, sequential CPM paradigms might alter the intensity of the CS, which Center for Neuroplasticity and Pain (CNAP), SMI , potentially can alter the CPM-effect. This study aimed to investi- Department of Health Science and Technology, gate the difference between a fixed and adaptive CS intensity on Aalborg University, Denmark CPM-effect. Hammel Neurorehabilitation and Research Centre, Methods: On the dominant leg of 20 healthy subjects the cuff Aarhus University Hospital, Hammel, Denmark pressure detection threshold (PDT) was recorded as TS and the pain Centro de Investigaciones y Transferencia de Entre tolerance threshold (PTT) was assessed on the non-dominant leg Ríos (CITER), CONICET-UNER, Entre Ríos, Argentina for estimating the CS. The difference in PDT before and during CS E-mail address: faj@hst.aau.dk (F.A. Jure). defined the CPM-effect. The CPM-effect was assessed four times Aims: Conditioned pain modulation (CPM) is a paradigm using a CS with intensities of 70% of baseline PTT (fixed) or 70% of employed to assess descending control of spinal nociception. PTT measured throughout the session (adaptive). Pain intensity of 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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Publisher
de Gruyter
Copyright
© 2017 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
DOI
10.1016/j.sjpain.2017.04.035
Publisher site
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Abstract

176 Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188 follow up, after the patients had taken part in a CBT-ACT based 4 the conditioning stimulus was assessed on a numeric rating scale weeks in-hospital pain rehabilitation program (PRP). (NRS). Data were analyzed with repeated-measures ANOVA. Methods: Blood samples were collected from 52 well char- Results: No difference was found comparing the four PDTs acterized chronic pain patients. Plasma from matched healthy assessed before CSs for the fixed and the adaptive paradigms. The CS pressure intensity for the adaptive paradigm was increasing dur- blood donors were used as controls. At one year after the treat- ment program, 28 of the patients were available for follow up. ing the four repeated assessments (P < 0.01). The pain intensity was Instead of only analyzing single inflammation-related substances, similar during the fixed (NRS: 5.8 ± 0.5) and the adjusted paradigm we used a new multiplex panel enabling the simultaneous anal- (NRS: 6.0 ± 0.4). The CPM-effect was higher using the fixed condi- ysis of 92 inflammation-related proteins, mainly cytokines and tion compared with the adaptive condition (P < 0.05). chemokines (Proseek Inflammation, Olink, Uppsala, Sweden). Mul- Conclusions: The current study found that sequential CPM tivariate statistics were used for analysis. paradigms using a fixed conditioning stimulus produced an Results: Clear signs of increased inflammatory activity were increased CPM-effect compared with adaptive and increasing con- detected in the pain patients. Accepting a false discovery rate ditioning intensities. (FDR) of 5%, there were significant differences in 43 of the 92 inflammatory biomarkers. The expression of 8 biomarkers were 4 http://dx.doi.org/10.1016/j.sjpain.2017.04.034 times higher in patients compared to controls. Three biomarkers, CXCL5, SIRT2, AXIN1 were more than 8 times higher. The con- Combined treatment (Norspan, Gabapentin and ventional marker for inflammation, CRP, did not differ. Of the 28 Oxynorm) was found superior in pain patients available for follow up one year after the intervention, management after total knee arthroplasty all showed lower levels of the inflammatory biomarker initially M.B. Jensen , M.M. Andersen, B. Boesen, M.B. raised. Jørgensen, O. Simonsen Conclusions: The results indicate that CPP suffer from a low E-mail address: mikkel.jensen@rn.dk (M.B. Jensen). grade of chronic systemic inflammation, not detectable by CRP Background: Gabapentin (GAB) has recently been introduced analysis. This may have implications for the general pain hyper- for postoperative pain treatment in orthopedic surgery. As per- sensitivity, and other symptoms, often described in this group of sistent postoperative pain is still a major problem in total patients. We conclude that inflammatory plasma proteins may be knee arthroplasty (TKA), studies on the effect and side effects measureable molecular markers to distinguishes CPP from pain free of Gabapentin in addition to the commonly used morphine controls, and that a CBT-ACT pain rehab program seem to decrease (MOR), Oxynorm (OXY) and Norspan (NOR) are highly warran- this inflammatory activity. ted. In the present study, four relevant treatment algorithms, gabapentin and morphine (GAB/MOR), gabapentin and Oxynorm References (GAB/OXY), Oxynorm (OXY) and Gabapentin, Oxynorm and Norspan (GAB/OXY/NOR) were examined. [1] Moen A, Lind AL, Thulin M, Kamali-Moghaddam M, Røe C, Gjerstad J, Gordh T. Inflammatory serum protein profiling of patients with lumbar radicu- Patients and methods: A total of 241 patients were fol- lar pain one year after disc herniation. Int J Inflam 2016;2016:3874964, lowed systematically during one month following TKA in four http://dx.doi.org/10.1155/2016/3874964. consecutive series: 60 patients were treated with GAB/MOR, 62 [2] Bäckryd E, Tanum L, Lind A-L, Larsson A, Gordh T. Evidence of both systemic patients with GAB/OXY, 59 patients with OXY, and 60 patients with inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. J Pain GAB/OXY/MOR. On the day before surgery and on postoperative day Res 2017;10:1–11. 1, 14, and 30, pain during rest, pain during walking and side effects (constipation, dizziness, and nausea) were reported (VAS). http://dx.doi.org/10.1016/j.sjpain.2017.04.033 Results: After 30 days, pain greatly decreased in all groups, with a superior effect of GAB/OXY/NOR for pain during rest and only Fixed or adapted conditioning intensity for slightly more side effects at day 1. repeated conditioned pain modulation Conclusions: In management of postoperative pain following TKA, data indicated that GAB/OXY/NOR was superior, compared to a,∗ b a M. Hoegh , K.K. Petersen , T. Graven-Nielsen GAB/MOR, GAB/OXY, and OXY. Center for Neuroplasticity and Pain (CNAP), SMI, Aalborg University, Aalborg, Denmark http://dx.doi.org/10.1016/j.sjpain.2017.04.035 SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Effects of conditioned pain modulation on the Denmark withdrawal pattern to nociceptive stimulation E-mail address: msh@hst.aau.dk (M. Hoegh). in humans – Preliminary results Aims: Conditioned pain modulation (CPM) is used to assess a,∗ b F.A. Jure , F.G. Arguissain , J.A. Biurrun descending pain modulation through a test stimulation (TS) and a a,c a Manresa , O.K. Andersen conditioning stimulation (CS). Due to potential carry-over effects, sequential CPM paradigms might alter the intensity of the CS, which Center for Neuroplasticity and Pain (CNAP), SMI , potentially can alter the CPM-effect. This study aimed to investi- Department of Health Science and Technology, gate the difference between a fixed and adaptive CS intensity on Aalborg University, Denmark CPM-effect. Hammel Neurorehabilitation and Research Centre, Methods: On the dominant leg of 20 healthy subjects the cuff Aarhus University Hospital, Hammel, Denmark pressure detection threshold (PDT) was recorded as TS and the pain Centro de Investigaciones y Transferencia de Entre tolerance threshold (PTT) was assessed on the non-dominant leg Ríos (CITER), CONICET-UNER, Entre Ríos, Argentina for estimating the CS. The difference in PDT before and during CS E-mail address: faj@hst.aau.dk (F.A. Jure). defined the CPM-effect. The CPM-effect was assessed four times Aims: Conditioned pain modulation (CPM) is a paradigm using a CS with intensities of 70% of baseline PTT (fixed) or 70% of employed to assess descending control of spinal nociception. PTT measured throughout the session (adaptive). Pain intensity of

Journal

Scandinavian Journal of Pain – de Gruyter

Published: Jul 1, 2017

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