José W. Geurts

The prevalence of postoperative pain in a sample of 1490 surgical inpatients

Background and objective: To measure the prevalence of postoperative pain, an assessment was made of 1490 surgical inpatients who were receiving postoperative pain treatment according to an acute pain protocol. Methods: Measurements of pain (scores from 0 to 100 on a visual analogue scale) were obtained three times a day on the day before surgery and on days 0‐4 postoperatively; mean pain intensity scores were calculated. Patients were classified as having no pain (score 0‐5), mild pain (score 6‐40), moderate pain (score 41‐74) or severe pain (score 75‐100). Results: Moderate or severe pain was reported by 41% of the patients on day 0, 30% on days 1 and 19%, 16% and 14% on days 2, 3 and 4. The prevalence of moderate or severe pain in the abdominal surgery group was high on postoperative days 0‐1 (30‐55%). A high prevalence of moderate or severe pain was found during the whole of days 1‐4 in the extremity surgery group (20‐71%) and in the back/spinal surgery group (30‐64%). Conclusion: We conclude that despite an acute pain protocol, postoperative pain treatment was unsatisfactory, especially after intermediate and major surgical procedures on an extremity or on the spine.

Clinical course of non-specific low back pain: A systematic review of prospective cohort studies set in primary care

Non‐specific low back pain is a relatively common and recurrent condition for which at present there is no effective cure. In current guidelines, the prognosis of acute non‐specific back pain is assumed to be favourable, but this assumption is mainly based on return to function. This systematic review investigates the clinical course of pain in patients with non‐specific acute low back pain who seek treatment in primary care.

Predictors of Acute Postoperative Pain After Elective Surgery

ObjectivesObjectives:Despite efforts to improve acute postoperative pain management, a substantial number of patients still experience moderate to severe pain during the immediate postoperative days. The purpose of the present study was to identify predictors of moderate to severe acute postoperative pain. MethodsMethods: A total of 1490 patients undergoing heterogeneous surgical procedures recorded their pain 3 times a day on a 100-mm visual analog scale from the day before the operation until 5 days postoperation. For each postoperative day, pain intensity was classified as moderate when the mean pain score was 41 to 74mm and as “severe when the mean pain score was 75 to 100 mm. Using logistic regression analyses, we examined the predictive value of a comprehensive set of preoperative and perioperative variables for moderate to severe pain. ResultsResults: The most important predictors seemed to be; preoperative pain, expected pain, surgical fear, and pain catastrophizing. DiscussionDiscussion: Several predictive factors of postoperative pain were identified in this study. These factors could be taken into account in postoperative pain management.

Prevalence and Predictors of Postoperative Pain After Ear, Nose, and Throat Surgery

OBJECTIVE To determine postoperative pain in different types of ear, nose, and throat (ENT) surgery and their psychological preoperative predictors. DESIGN Prospective cohort study. SETTING Academic hospital. PATIENTS A total of 217 patients undergoing ENT surgery. INTERVENTIONS All ENT, neck, and salivary gland surgery. MAIN OUTCOME MEASURES Postoperative pain and predictors for postoperative pain. RESULTS Fifty percent of the patients undergoing surgery on the oral, pharyngeal, and laryngeal region and on the neck and salivary gland region had a visual analog scale score higher than 40 mm on day 1. In the patients who underwent oropharyngeal region operations the VAS score remained high on all 4 days. A VAS pain score higher than 40 mm was found in less than 30% of patients after endoscopic procedures and less than 20% after ear and nose surgery. After bivariate analysis, 6 variables--age, sex, preoperative pain, expected pain, short-term fear, and pain catastrophizing--had a predictive value. Multivariate analysis showed only preoperative pain, pain catastrophizing, and anatomical site of operation as independent predictors. CONCLUSIONS Differences exist in the prevalence of unacceptable postoperative pain between ENT operations performed on different anatomical sites. A limited set of variables can be used to predict the occurrence of unacceptable postoperative pain after ENT surgery.

1. Trigeminal neuralgia.

Trigeminal neuralgia is a common cause of facial pain. It has a significant impact on the quality of life and the socioeconomic functioning of the patient. The aim of this review is to provide recommendations for medical management of trigeminal neuralgia based on current evidence. Based upon the analyses of the literature combined with experience in pain management, symptoms, assessment, differential diagnosis, and treatment possibilities of trigeminal neuralgia are described and discussed. Recommendations for pain management are given and are displayed in a clinical practice algorithm. Treatment should be multidisciplinary. Various treatment options and their risks should be discussed with the patient. The first treatment of choice is carbamazepine or oxcarbazepine. In younger patients, the first choice of invasive treatment is probably microvascular decompression. For elderly patients, radiofrequency treatment of Gasserian ganglion is recommended and the technique is described in detail.

Spinal Cord Stimulation for Complex Regional Pain Syndrome Type I: A Prospective Cohort Study With Long‐Term Follow‐Up

Spinal cord stimulation (SCS) is an effective treatment for intractable complex regional pain syndrome type I pain. Long‐term data are scarce on effectiveness, degree of pain relief, predictors, and complications.

Brush-evoked allodynia predicts outcome of spinal cord stimulation in complex regional pain syndrome type 1.

Background: Spinal cord stimulation (SCS) has proven to be an effective however an invasive and relatively expensive treatment of chronic Complex Regional Pain Syndrome type 1(CRPS‐1). Furthermore, in one third of CRPS‐1 patients, SCS treatment fails to give significant pain relief and 32–38% of treated patients experience complications. The aim of the current study was to develop effective prognostic factors for prediction of successful outcome of SCS.

Treatment of Patients With Complex Regional Pain Syndrome Type I With Mannitol: A Prospective, Randomized, Placebo-Controlled, Double-Blinded Study

UNLABELLED To assess the effects of intravenous administration of the free radical scavenger mannitol 10% on complaints associated with complex regional pain syndrome Type I (CRPS I), a randomized, placebo-controlled, double-blinded trial was performed. Forty-one CRPS I patients according to the Bruehl et al diagnostic criteria, were included in 2 outpatient pain clinics of 2 university medical centers and randomly assigned to receive either 10% mannitol iv in 1 L 0.9% NaCL in 4 hours for 5 consecutive days or equal volumes of 0.9% NaCL (placebo). Patients in both groups received physical therapy according to protocol and rescue pain medication if required. Complaints on impairment and disability level and quality of life were assessed up to 9 weeks after baseline, with primary measurement points at 2, 6, and 9 weeks. Monitoring of pain using the visual analogue scale took place continuously during the course of the trial. Except for a significant improvement on a subscale of the Jebsen-Taylor hand function test, no significant differences were found between mannitol and placebo treatment. Changes in both groups in the course of the trial were small and clinically irrelevant on all measurement indices. We conclude that intravenous administration of 10% mannitol is not more effective than placebo in reducing complaints for CRPS I patients and provides no addition to already-established interventions for CRPS I. Whether 10% mannitol can provide beneficial effects for subgroups of CRPS I patients with a pathophysiological profile more closely fitting the presumed mode of action for this intervention remains to be established. PERSPECTIVE This article addresses the efficacy of the intravenous administration of the free radical scavenger mannitol for treatment of CRPS type 1. This intervention is not more effective than placebo in reducing complaints for CRPS I patients and provides no addition to already-established interventions for CRPS I.

Predictors of Pain Relieving Response to Sympathetic Blockade in Complex Regional Pain Syndrome Type 1

Background: Sympathetic blockade with local anesthetics is used frequently in the management of complex regional pain syndrome type 1(CRPS-1), with variable degrees of success in pain relief. The current study investigated which signs or symptoms of CRPS-1 could be predictive of outcome. The incidence of side effects and complications of sympathetic blockade also were determined prospectively. Methods: A prospective observational study was done of 49 patients with CRPS-1 in one extremity only and for less than 1-yr duration who had severe pain and persistent functional impairment with no response to standard treatment with medication and physical therapy. Results: Fifteen (31%) patients had good or moderate response. The response rate was not different in patient groups with cold or warm type CRPS-1 or in those with more or less than 1.5°C differential increase in skin temperature after sympathetic blockade. Allodynia and hypoesthesia were negative predictors for treatment success in CRPS-1. There were no symptoms or signs of CRPS-1 that positively predicted treatment success. A majority of patients (84%) experienced transient side effects such as headache, dysphagia, increased pain, backache, nausea, blurred vision, groin pain, hoarseness, and hematoma at the puncture site. No major complications were reported. Conclusions: The presence of allodynia and hypoesthesia are negative predictors for treatment success. The selection of sympathetic blockade as treatment for CRPS-1 should be balanced carefully between potential success and side effect ratio. The procedure is as likely to cause a transient increase in pain as a decrease in pain. Patients should be informed accordingly.

Spinal Cord Stimulation in Complex Regional Pain Syndrome Type I of Less Than 12-Month Duration

Introduction:  Complex regional pain syndrome type 1 (CRPS‐1) has a 31% probability of becoming chronic. The early use of spinal cord stimulation (SCS) has been recommended as a strategy to prevent chronicity and functional impairment.