Abstract
Background/aims
The mechanisms behind chronic postsurgical pain remains unsettled. Quantitative sensory testing and questioning sensory function may help understand mechanisms behind the transition from acute to chronic pain. The aim of this study was to assess these aspects in postsurgical patients with and without chronic postsurgical pain.
Methods
116 women, who answered a questionnaire in a four years follow-up study of pain, sensory changes and quality of life after cosmetic breast augmentation surgery [1], were invited to participate in a psychophysical study. Twenty women answered the request and filled in a questionnaire, and 12 of these women finally met for examination.
Results
Six of the 12 women had pain in the area of surgery, three were pain-free, but reported sensory changes and three reported no pain or sensory disturbances. We performed a detailed quantitative sensory examination, with a protocol adapted from Rollke et al. [2] While only 3/6 patients in the pain-free group reported hypoesthesia, an area of hypoesthesia to tactile-, heat- and cold stimuli was identified in all subjects when examined (Table 1).
Number in each group (subjects with pain vs. subjects without pain) showing presence of sensory characteristics.
| Pain (N = 6) | No pain (N = 6) | |
|---|---|---|
| Questionnaire | ||
| Hypoesthesia | 5 | 3 |
| Hyperesthesia | 6 | 3 |
| Examination | ||
| Hypoesthesia (tactile, heat, cold) | 6 | 6 |
| Hypersensitivity detected | 4 | 1 |
| Hyperpathia to heat | 5 | 5 |
| Paradoxical heat sensation during cold stimulation | 4 | 0 |
| Allodynia, cotton | 0 | 0 |
| Allodynia, brush | 0 | 1 |
| Cold allodynia | 5 | 1 |
| Abnormal temporal summation | 5 | 1 |
| Deep pain after algometry | 4 | 0 |
The most striking difference between the group reporting pain and the one not reporting pain was the presence of paradoxical heat sensation, cold allodynia, abnormal temporal summation, and the presence of deep pain during/after pressure pain threshold testing with the algometer in the group with pain.
Conclusion
Self-reported sensory changes under-estimated sensory changes. Sensory testing revealed signs of peripheral nerve injury changes in all subjects, while signs of central nervous changes were found predominantly in patients with persistent pain.
References
[1] Kaasa T, Romundstad L, Roald H, Skolleborg K, Stubhaug A. Hyperesthesia one year after breast augmentation surgery increases the odds for persisting pain at four years. A prospective four year follow-up. Scandinavian Journal of Pain 2010;1:24.Search in Google Scholar
[2] Rollke R, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. European Journal of Pain 2006;10:77–88.10.1016/j.ejpain.2005.02.003Search in Google Scholar PubMed
© 2012 Scandinavian Association for the Study of Pain
