Identification of pre-operative of risk factors associated with persistent post-operative pain by self-reporting tools in lower limb amputee patients – A feasibility study

Identification of pre-operative of risk factors associated with persistent post-operative pain by... 174Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188of the patella; 3 cm lateral to the mid-point of the lateral edge ofthe patella; and centre of the patella), (ii) tibialis anterior muscle,and (iii) extensor carpi radialis longus muscle. The PPT values fromtibialis anterior and extensor carpi radialis longus muscles wereused to divide the patients in high and low sensitization groups(two-steps clustering).Results: PPT values at bilateral knees sites were lower in thehigh sensitivity [median (range) of all sites: 423 (153, 1129) kPa]compared with low sensitivity group [822 (305, 2051) kPa](P < 0.05). CoP range in the anterior–posterior direction wasreduced in high sensitivity group (41 ± 16 mm) compared with thelow sensitivity group (51 ± 16 mm) during the SS with CE (P < 0.05)condition.Conclusions: The lower CoP Range suggests stiffer posturalstrategy in patients with higher widespread pain sensitivity compared with low sensitivity patients during sensory restrictions.The lack of mobility found in high sensitivity patients under suchrestrictions might be related to the impaired integration of sensory information due to the parallel processing of the nociceptiveinformation.http://dx.doi.org/10.1016/j.sjpain.2017.04.028Efficacy of dry needling on latent myofascialtrigger points in male subjects withneck/shoulders musculoskeletal pain. A caseseriesA.M. Heredia-Rizo a,∗ , I. Navarro-Carmona a , F.b˜Pina-PozoaPhysiotherapy Department, Faculty of Nursing,Physiotherapy and Podiatry, University of Sevilla,Sevilla, Spainb Physiotherapy Department, Francisco MaldonadoUniversity School of Osuna, Sevilla, SpainE-mail address: amheredia@us.es (A.M. Heredia-Rizo).Aims: To assess the impact of dry needling on neuralmechanosensitivity and grip strength in male subjects with a history of persistent pain in the neck/shoulder area.Methods: Case series study. Eight male subjects (mean age25 ± 6.24 years) with a recurrent history of bilateral neck/shoulderpain for at least 6 months, and with symptoms provoked byneck/shoulder postures or movement were recruited from aUniversity-based clinical research center. Measurements weretaken at baseline, immediately after intervention, and fifteen dayslater, of the pressure pain threshold (PPT) over the median, ulnar,and radial nerves, and the tibialis anterior (TA) muscle. Secondary measures included free-pain grip strength with a hydraulicdynamometer. A therapist assessed the presence of latent (notspontaneously painful, but painful upon palpation) myofascial trigger points (MTrP) over the scalene, subclavius, pectoralis minor,infraspinatus and serratus posterior superior muscles, on the mostpainful side. Deep dry needling was then performed on the latentMtrP by quickly inserting and partially removing the needle fromthe MTrP until 2 local twitch responses were provoked.Results: PPT over the nerve trunks significantly increased afterintervention (p < 0.05 for all locations). These changes remainedconstant in the second assessment, both in the treated (p < 0.001for median and ulnar nerves, and p = 0.004 for radial nerve), andthe non-treated upper limb (median nerve p < 0.001, ulnar nervep = 0.003, and radial nerve p = 0.006). No statistical significance wasfound for PPT over the TA muscle (p > 0.05) or for grip strength(p = 0.153 on the treated side, and p = 0.564 on the non-treatedupper limb).Conclusions: Dry needling on the cervicothoracic and shoulder areas may help to improve peripheral neural features overthe brachial plexus nerve trunks in subjects with recurrentneck/shoulder pain. No effect was observed for grip strength.http://dx.doi.org/10.1016/j.sjpain.2017.04.029Identification of pre-operative of risk factorsassociated with persistent post-operative painby self-reporting tools in lower limb amputeepatients – A feasibility studyM.B. Houlind a,∗ , H. Rømer b , W. Schmelling c , T.Palsson d , K.K. Petersen daOptimed, Clinical Research Center, HvidovreHospital, The Capital Region of Denmark,Copenhagen, Denmarkb Department of Ortopedic Anaesthesiology, AalborgUniversity Hospital, The North Denmark Region,Aalborg, Denmarkc Department of Orthopedic Surgery, BispebjergHospital, The Capital Region of Denmark,Copenhagen, Denmarkd SMI, Department of Health Science and Technology,Aalborg University, Aalborg, DenmarkE-mail address: morten.baltzer.houlind@regionh.dk (M.B. Houlind).Aims: The incidence of persistent post-operative pain (PPP) is30–85% in lower limb amputee (LLA) patients and identification ofpreoperative risk factors are warranted. Preoperative levels of anxiety, depression, pain catastrophizing, neuropathic pain and severepreoperative pain have previously been linked with PPP but suchscreening tools are not used in the clinical hospital setting. Theaim of this study was to assess feasibility of using questionnairesfor anxiety, depression, pain catastrophizing, neuropathic pain andpreoperative pain levels in a clinical preoperative setting.Methods: Patients scheduled for non-traumatic amputation ofthe lower leg or femur were recruited from three Danish hospitals. Exclusion criteria were surgery 4-weeks prior to LLA, sameleg re-amputation, or inability to participate. Pre-operative values of anxiety, depression and catastrophizing were assessed usingthe Hospital Anxiety (A) and Depression(D) Scale (HADS) (cutoff:8) and Pain Catastrophizing Scale (PCS) (cutoff = 32). Neuropathicpain was assessed preoperatively using Pain-Detect-Questionnaire(PD-Q) (cutoff: 19). The maximum preoperative pain intensity wasassessed using the Numeric Rating Scale (NRS; 0: no pain and 10:worst imaginable pain). Scores are presented as median values withinterquartile range (Q1–Q3).Results: Eight of 18 patients (5 females) completed this pilotstudy: median age 71 (range 56–83), 6 femur and two lower legamputees. Nine of ten excluded patients were unable to completethe questionnaires and one patient was operated acutely. Medianpre-operative HADS-D and -A scores were 7 (3–9, 50% ≥ cutoff)and 4 (1–8, 25% ≥ cutoff), pre-operative PCS score was 24 (18–28,13% ≥ cutoff), pre-operative PD-Q score was 16 (8–22, 50% ≥ cutoff)and NRS score was 9.5 (8–10).Conclusions: This study indicates that it is possible to implement preoperative questionnaires in a clinical setting. However,more than 50% of the patients are unable to complete the questionnaires.http://dx.doi.org/10.1016/j.sjpain.2017.04.030 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Identification of pre-operative of risk factors associated with persistent post-operative pain by self-reporting tools in lower limb amputee patients – A feasibility study

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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.2017.04.030
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Abstract

174Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188of the patella; 3 cm lateral to the mid-point of the lateral edge ofthe patella; and centre of the patella), (ii) tibialis anterior muscle,and (iii) extensor carpi radialis longus muscle. The PPT values fromtibialis anterior and extensor carpi radialis longus muscles wereused to divide the patients in high and low sensitization groups(two-steps clustering).Results: PPT values at bilateral knees sites were lower in thehigh sensitivity [median (range) of all sites: 423 (153, 1129) kPa]compared with low sensitivity group [822 (305, 2051) kPa](P < 0.05). CoP range in the anterior–posterior direction wasreduced in high sensitivity group (41 ± 16 mm) compared with thelow sensitivity group (51 ± 16 mm) during the SS with CE (P < 0.05)condition.Conclusions: The lower CoP Range suggests stiffer posturalstrategy in patients with higher widespread pain sensitivity compared with low sensitivity patients during sensory restrictions.The lack of mobility found in high sensitivity patients under suchrestrictions might be related to the impaired integration of sensory information due to the parallel processing of the nociceptiveinformation.http://dx.doi.org/10.1016/j.sjpain.2017.04.028Efficacy of dry needling on latent myofascialtrigger points in male subjects withneck/shoulders musculoskeletal pain. A caseseriesA.M. Heredia-Rizo a,∗ , I. Navarro-Carmona a , F.b˜Pina-PozoaPhysiotherapy Department, Faculty of Nursing,Physiotherapy and Podiatry, University of Sevilla,Sevilla, Spainb Physiotherapy Department, Francisco MaldonadoUniversity School of Osuna, Sevilla, SpainE-mail address: amheredia@us.es (A.M. Heredia-Rizo).Aims: To assess the impact of dry needling on neuralmechanosensitivity and grip strength in male subjects with a history of persistent pain in the neck/shoulder area.Methods: Case series study. Eight male subjects (mean age25 ± 6.24 years) with a recurrent history of bilateral neck/shoulderpain for at least 6 months, and with symptoms provoked byneck/shoulder postures or movement were recruited from aUniversity-based clinical research center. Measurements weretaken at baseline, immediately after intervention, and fifteen dayslater, of the pressure pain threshold (PPT) over the median, ulnar,and radial nerves, and the tibialis anterior (TA) muscle. Secondary measures included free-pain grip strength with a hydraulicdynamometer. A therapist assessed the presence of latent (notspontaneously painful, but painful upon palpation) myofascial trigger points (MTrP) over the scalene, subclavius, pectoralis minor,infraspinatus and serratus posterior superior muscles, on the mostpainful side. Deep dry needling was then performed on the latentMtrP by quickly inserting and partially removing the needle fromthe MTrP until 2 local twitch responses were provoked.Results: PPT over the nerve trunks significantly increased afterintervention (p < 0.05 for all locations). These changes remainedconstant in the second assessment, both in the treated (p < 0.001for median and ulnar nerves, and p = 0.004 for radial nerve), andthe non-treated upper limb (median nerve p < 0.001, ulnar nervep = 0.003, and radial nerve p = 0.006). No statistical significance wasfound for PPT over the TA muscle (p > 0.05) or for grip strength(p = 0.153 on the treated side, and p = 0.564 on the non-treatedupper limb).Conclusions: Dry needling on the cervicothoracic and shoulder areas may help to improve peripheral neural features overthe brachial plexus nerve trunks in subjects with recurrentneck/shoulder pain. No effect was observed for grip strength.http://dx.doi.org/10.1016/j.sjpain.2017.04.029Identification of pre-operative of risk factorsassociated with persistent post-operative painby self-reporting tools in lower limb amputeepatients – A feasibility studyM.B. Houlind a,∗ , H. Rømer b , W. Schmelling c , T.Palsson d , K.K. Petersen daOptimed, Clinical Research Center, HvidovreHospital, The Capital Region of Denmark,Copenhagen, Denmarkb Department of Ortopedic Anaesthesiology, AalborgUniversity Hospital, The North Denmark Region,Aalborg, Denmarkc Department of Orthopedic Surgery, BispebjergHospital, The Capital Region of Denmark,Copenhagen, Denmarkd SMI, Department of Health Science and Technology,Aalborg University, Aalborg, DenmarkE-mail address: morten.baltzer.houlind@regionh.dk (M.B. Houlind).Aims: The incidence of persistent post-operative pain (PPP) is30–85% in lower limb amputee (LLA) patients and identification ofpreoperative risk factors are warranted. Preoperative levels of anxiety, depression, pain catastrophizing, neuropathic pain and severepreoperative pain have previously been linked with PPP but suchscreening tools are not used in the clinical hospital setting. Theaim of this study was to assess feasibility of using questionnairesfor anxiety, depression, pain catastrophizing, neuropathic pain andpreoperative pain levels in a clinical preoperative setting.Methods: Patients scheduled for non-traumatic amputation ofthe lower leg or femur were recruited from three Danish hospitals. Exclusion criteria were surgery 4-weeks prior to LLA, sameleg re-amputation, or inability to participate. Pre-operative values of anxiety, depression and catastrophizing were assessed usingthe Hospital Anxiety (A) and Depression(D) Scale (HADS) (cutoff:8) and Pain Catastrophizing Scale (PCS) (cutoff = 32). Neuropathicpain was assessed preoperatively using Pain-Detect-Questionnaire(PD-Q) (cutoff: 19). The maximum preoperative pain intensity wasassessed using the Numeric Rating Scale (NRS; 0: no pain and 10:worst imaginable pain). Scores are presented as median values withinterquartile range (Q1–Q3).Results: Eight of 18 patients (5 females) completed this pilotstudy: median age 71 (range 56–83), 6 femur and two lower legamputees. Nine of ten excluded patients were unable to completethe questionnaires and one patient was operated acutely. Medianpre-operative HADS-D and -A scores were 7 (3–9, 50% ≥ cutoff)and 4 (1–8, 25% ≥ cutoff), pre-operative PCS score was 24 (18–28,13% ≥ cutoff), pre-operative PD-Q score was 16 (8–22, 50% ≥ cutoff)and NRS score was 9.5 (8–10).Conclusions: This study indicates that it is possible to implement preoperative questionnaires in a clinical setting. However,more than 50% of the patients are unable to complete the questionnaires.http://dx.doi.org/10.1016/j.sjpain.2017.04.030

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Scandinavian Journal of Painde Gruyter

Published: Jul 1, 2017

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