Pain assessment and post-operative pain management in orthopedic patients

Pain assessment and post-operative pain management in orthopedic patients Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188at activity and the individual expectations should be furtherfocused.http://dx.doi.org/10.1016/j.sjpain.2017.04.046Paradoxical differences in pain ratings of thesame stimulus intensityM.E. McPhee a,∗ , K.K. Petersen a , M.S. Hoegh b , T.Graven-Nielsen baSMI, Department of Health Science and Technology,Aalborg University, Denmarkb Center for Neuroplasticity and Pain (CNAP), SMI,Department of Health Science and Technology,Aalborg University, DenmarkE-mail address: mmp@hst.aau.dk (M.E. McPhee).Aims: Stimulus intensity used for assessing temporal summation of pain (TSP) is commonly set at the participants’ paintolerance. Yet pain ratings during TSP rarely reach that initial paintolerance pain rating. This study aimed to explore the differencesbetween baseline pain tolerance assessed by cuff algometry andsubsequent pain ratings of the same stimulus intensity, and thereliability of these ratings over 2 sessions.Methods: In two sessions, separated by one week, 24 healthy,pain-free males had their pressure pain detection (PDT) and tolerance threshold (PTT) recorded using a staircase inflation paradigm(5 kPa increments, 1sec-ON:4sec-OFF) with a cuff algometry system. The pain intensity was assessed during cuff stimulation usingan electronic visual analogue scale (VAS, 0–10 cm). Three different inflation paradigms were then performed, using the PTT levelas stimulation intensity, and a 1-s duration for each stimulus:PEAKS: 3 inflations at 0.17 Hz, SLOW: 10 inflations at 0.01 Hz, FAST:10 inflations at 0.5 Hz). Approximately 5-min was kept betweenthe staircase assessment and the first stimulation paradigm, andbetween each of the 3 inflation paradigms. The PTT and first inflation VAS rating from each paradigm was extracted.Results: The VAS rating of PTT pressure was higher in thestaircase (VAS: 8.5 ± 2.1 cm) than the first PPT stimulus in anyother paradigm (PEAKS: 5.4 ± 2.0; SLOW: 4.6 ± 2.1; FAST: 4.0 ± 2.3,P < 0.05). VAS ratings were also lower in each subsequent paradigm(i.e. PEAKS > SLOW > FAST, P < 0.05). Intra-class coefficients demonstrated excellent reliability for each paradigm (all ICC > 0.79)between sessions.Conclusions: PTT, as assessed with the staircase inflationparadigm, was rated more painful during baseline assessment thanwhen the identical stimulus profile (PPT intensity for 1-s) wasapplied afterwards and this finding is considered reliable.http://dx.doi.org/10.1016/j.sjpain.2017.04.047Pain assessment and post-operative painmanagement in orthopedic patientsW. Schmelling a,∗ , J.N. Poulsen b , L. Christrup c , P.Gazerani baBispebjerg Hospital, Region Hovedstaden,Copenhagen, Denmarkb Department of Health science and Technology,Aalborg University, Aalborg, Denmarkc Department of Pharmacology andPharmaco-therapy, Faculty of PharmaceuticalSciences, University of Copenhagen, Copenhagen,DenmarkE-mail address: Winnie.Schmelling@regionh.dk (W. Schmelling).181Aims: A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficientpostoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficientpostoperative pain management is however a widespread problem.Lack of knowledge about pain and pain treatment among healthcare professionals and general community has been considered asa major potential contributor in insufficient pain management. Ithas been suggested that severe postoperative pain might imply apotential risk of developing chronic pain. The purpose of this studywas to examine this problem in acute and elective surgical patientsin department of orthopedic surgery at Bispebjerg Hospital in orderto identify obstacles and possibilities for future improvement.Methods: Questionnaires were developed and distributed topatients consisted of 10 acute admitted and 10 elective orthopedic patients. The patients’ pain scores were recorded with a 0–10NRS scale. The scores were obtained for current pain in rest, currentpain in activity, and the highest and lowest pain intensity for thelast 24 hours. Data were handled using descriptive statistics.Results: The goal for sufficient pain treatment was patients withpain score at ≤3 NRS at rest and ≤5 in activity. For pain at rest 45%of the patients were within the goal range and 55% for the currentpain in activity. For the mildest pain experienced in the last 24 h,75% and for the worst pain experienced 30% of the patients reachedthe goal.Conclusions: Corresponding to similar studies, half of thepatients received a sufficient pain treatment at the time of examination. The consequences for insufficient pain management would bereduced effect of the physiotherapy, reduced ability to handle everyday activity, sleep disturbances, and potential risk of developingchronic pain.http://dx.doi.org/10.1016/j.sjpain.2017.04.048Combined electric and pressure cuff painstimuli for assessing conditioning painmodulation (CPM)M. Tsukamoto a,b , K.K. Petersen a,∗ , C.D. Mørch a , L.Arendt-Nielsen aaAalborg University, Center for Sensory-MotorInteraction, Aalborg, Denmarkb Asahi Kasei Pharma Corporation, ClinicalDevelopment Center, Tokyo, JapanE-mail address: kkp@hst.aau.dk (K.K. Petersen).Aims: Traditionally, conditioning pain modulation (CPM) canbe assessed by applying a test stimulus (TS) before and after application of a conditioning stimulus (CS), which is normally appliedextra-segmental. Currently, no studies have attempted to apply theTS and CS to the same site using different stimuli modalities. Theaim of this study was to evaluate electrical TS and cuff pressure CSapplied to the same experimental site for studying CPM.Methods: 20 male volunteers participated in this study, whichconsisted of stimulations applied by a cuff-algometer (NociTechand Aalborg University, Denmark) and current stimulator (Dig®itimer DS5, UK), through two Ag/AgCl electrodes (Ambu Neuroline700, Denmark). The cuff was wrapped around the lower leg andstimulation electrodes were placed under the cuff and to the samelocation on the contralateral leg. Electrical TS were applied to thenon-dominant leg with or without cuff pressure CS on the dominant (CS1) or the same (non-dominant) leg (CS2, electrode undercuff). The subjects were instructed to rate the electrical evoked painintensity on a 10-cm continuous visual analog scale (VAS, “0” represented “no pain”, and “10” represented “maximal pain”). The paindetection threshold (PDT) was defined as “1” on the VAS scale. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Pain assessment and post-operative pain management in orthopedic patients

Free
1 page

Loading next page...
1 Page
 
/lp/degruyter/pain-assessment-and-post-operative-pain-management-in-orthopedic-V1GETzcsFJ
Publisher
De Gruyter
Copyright
© 2017 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2017.04.048
Publisher site
See Article on Publisher Site

Abstract

Scientific presentations at the 2017 Annual Meeting / Scandinavian Journal of Pain 16 (2017) 165–188at activity and the individual expectations should be furtherfocused.http://dx.doi.org/10.1016/j.sjpain.2017.04.046Paradoxical differences in pain ratings of thesame stimulus intensityM.E. McPhee a,∗ , K.K. Petersen a , M.S. Hoegh b , T.Graven-Nielsen baSMI, Department of Health Science and Technology,Aalborg University, Denmarkb Center for Neuroplasticity and Pain (CNAP), SMI,Department of Health Science and Technology,Aalborg University, DenmarkE-mail address: mmp@hst.aau.dk (M.E. McPhee).Aims: Stimulus intensity used for assessing temporal summation of pain (TSP) is commonly set at the participants’ paintolerance. Yet pain ratings during TSP rarely reach that initial paintolerance pain rating. This study aimed to explore the differencesbetween baseline pain tolerance assessed by cuff algometry andsubsequent pain ratings of the same stimulus intensity, and thereliability of these ratings over 2 sessions.Methods: In two sessions, separated by one week, 24 healthy,pain-free males had their pressure pain detection (PDT) and tolerance threshold (PTT) recorded using a staircase inflation paradigm(5 kPa increments, 1sec-ON:4sec-OFF) with a cuff algometry system. The pain intensity was assessed during cuff stimulation usingan electronic visual analogue scale (VAS, 0–10 cm). Three different inflation paradigms were then performed, using the PTT levelas stimulation intensity, and a 1-s duration for each stimulus:PEAKS: 3 inflations at 0.17 Hz, SLOW: 10 inflations at 0.01 Hz, FAST:10 inflations at 0.5 Hz). Approximately 5-min was kept betweenthe staircase assessment and the first stimulation paradigm, andbetween each of the 3 inflation paradigms. The PTT and first inflation VAS rating from each paradigm was extracted.Results: The VAS rating of PTT pressure was higher in thestaircase (VAS: 8.5 ± 2.1 cm) than the first PPT stimulus in anyother paradigm (PEAKS: 5.4 ± 2.0; SLOW: 4.6 ± 2.1; FAST: 4.0 ± 2.3,P < 0.05). VAS ratings were also lower in each subsequent paradigm(i.e. PEAKS > SLOW > FAST, P < 0.05). Intra-class coefficients demonstrated excellent reliability for each paradigm (all ICC > 0.79)between sessions.Conclusions: PTT, as assessed with the staircase inflationparadigm, was rated more painful during baseline assessment thanwhen the identical stimulus profile (PPT intensity for 1-s) wasapplied afterwards and this finding is considered reliable.http://dx.doi.org/10.1016/j.sjpain.2017.04.047Pain assessment and post-operative painmanagement in orthopedic patientsW. Schmelling a,∗ , J.N. Poulsen b , L. Christrup c , P.Gazerani baBispebjerg Hospital, Region Hovedstaden,Copenhagen, Denmarkb Department of Health science and Technology,Aalborg University, Aalborg, Denmarkc Department of Pharmacology andPharmaco-therapy, Faculty of PharmaceuticalSciences, University of Copenhagen, Copenhagen,DenmarkE-mail address: Winnie.Schmelling@regionh.dk (W. Schmelling).181Aims: A fast-track based surgical treatment reduces morbidity and hospital stay by providing early mobilization. Sufficientpostoperative pain management is mandatory for early mobilization and optimal utilization of rehabilitation measures. Insufficientpostoperative pain management is however a widespread problem.Lack of knowledge about pain and pain treatment among healthcare professionals and general community has been considered asa major potential contributor in insufficient pain management. Ithas been suggested that severe postoperative pain might imply apotential risk of developing chronic pain. The purpose of this studywas to examine this problem in acute and elective surgical patientsin department of orthopedic surgery at Bispebjerg Hospital in orderto identify obstacles and possibilities for future improvement.Methods: Questionnaires were developed and distributed topatients consisted of 10 acute admitted and 10 elective orthopedic patients. The patients’ pain scores were recorded with a 0–10NRS scale. The scores were obtained for current pain in rest, currentpain in activity, and the highest and lowest pain intensity for thelast 24 hours. Data were handled using descriptive statistics.Results: The goal for sufficient pain treatment was patients withpain score at ≤3 NRS at rest and ≤5 in activity. For pain at rest 45%of the patients were within the goal range and 55% for the currentpain in activity. For the mildest pain experienced in the last 24 h,75% and for the worst pain experienced 30% of the patients reachedthe goal.Conclusions: Corresponding to similar studies, half of thepatients received a sufficient pain treatment at the time of examination. The consequences for insufficient pain management would bereduced effect of the physiotherapy, reduced ability to handle everyday activity, sleep disturbances, and potential risk of developingchronic pain.http://dx.doi.org/10.1016/j.sjpain.2017.04.048Combined electric and pressure cuff painstimuli for assessing conditioning painmodulation (CPM)M. Tsukamoto a,b , K.K. Petersen a,∗ , C.D. Mørch a , L.Arendt-Nielsen aaAalborg University, Center for Sensory-MotorInteraction, Aalborg, Denmarkb Asahi Kasei Pharma Corporation, ClinicalDevelopment Center, Tokyo, JapanE-mail address: kkp@hst.aau.dk (K.K. Petersen).Aims: Traditionally, conditioning pain modulation (CPM) canbe assessed by applying a test stimulus (TS) before and after application of a conditioning stimulus (CS), which is normally appliedextra-segmental. Currently, no studies have attempted to apply theTS and CS to the same site using different stimuli modalities. Theaim of this study was to evaluate electrical TS and cuff pressure CSapplied to the same experimental site for studying CPM.Methods: 20 male volunteers participated in this study, whichconsisted of stimulations applied by a cuff-algometer (NociTechand Aalborg University, Denmark) and current stimulator (Dig®itimer DS5, UK), through two Ag/AgCl electrodes (Ambu Neuroline700, Denmark). The cuff was wrapped around the lower leg andstimulation electrodes were placed under the cuff and to the samelocation on the contralateral leg. Electrical TS were applied to thenon-dominant leg with or without cuff pressure CS on the dominant (CS1) or the same (non-dominant) leg (CS2, electrode undercuff). The subjects were instructed to rate the electrical evoked painintensity on a 10-cm continuous visual analog scale (VAS, “0” represented “no pain”, and “10” represented “maximal pain”). The paindetection threshold (PDT) was defined as “1” on the VAS scale.

Journal

Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve Freelancer

DeepDyve Pro

Price
FREE
$49/month

$360/year
Save searches from
Google Scholar,
PubMed
Create lists to
organize your research
Export lists, citations
Read DeepDyve articles
Abstract access only
Unlimited access to over
18 million full-text articles
Print
20 pages/month
PDF Discount
20% off