Risk factors predictive of chronic postsurgical neuropathic pain: The value of the iliac crest bone harvest model

• Published in: Pain (Amsterdam) Vol. 153; no. 7; pp. 1478 - 1483
• Main Authors: Martinez, Valeria, Ben Ammar, Skander, Judet, Thierry, Bouhassira, Didier, Chauvin, Marcel, Fletcher, Dominique
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier B.V 01.07.2012; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Chronic pain; Chronic Pain - diagnosis; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Female; Fundamental and applied biological sciences. Psychology; Humans; Hyperalgesia; Hyperalgesia - physiopathology; Ilium - surgery; Illness and personality; Illness, stress and coping; Male; Medical sciences; Middle Aged; Nerve lesion; Nervous system (semeiology, syndromes); Neuralgia - diagnosis; Neurology; Neuropathic pain; Pain Measurement - methods; Pain, Postoperative - etiology; Predictive factor; Predictive Value of Tests; Prospective Studies; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Risk Factors; Surgery; Surveys and Questionnaires; Young Adult; Predictive factor; Nerve lesion; Surgery; Chronic pain; Hyperalgesia; Neuropathic pain; Human; Sensitivity disorder; Nervous system diseases; Hypoesthesia; Questionnaire; Threshold detection; Evaluation scale; Prospective; Pain; Secondary hyperalgesia; Risk factor; Detection threshold; Models; Sensitization; Sign; Neurological disorder
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2012.04.004

Acute neuropathic characteristics and secondary hyperalgesia are independent, additive factors predictive of chronic postsurgical pain after iliac crest bone harvest. Nerve lesions and secondary hyperalgesia may both be present after surgery, and their relative contributions to chronic postsurgical neuropathic pain (CPSNP) remain unclear. This prospective study explored the roles of these factors in the development of CPSNP after iliac crest bone harvest. CPSNP was defined as pain in the area of hypoesthesia, with a positive Douleur neuropathique 4 questionnaire (DN4) score 3months after iliac crest bone harvest. The location, intensity, and neuropathic characteristics of pain were evaluated in 82 patients who were followed for 6months. Neuropathic characteristics were assessed by clinical examination and DN4 questionnaire. The area of secondary hyperalgesia was evaluated 48h and 1month after surgery. The area of mechanical hypoesthesia, detection, and mechanical pain threshold were evaluated at 48h and at 1 and 3months. Nineteen patients (23%) had CPSNP at 3months. The patients who developed CPSNP had a larger area of secondary hyperalgesia at 48h (88cm2 vs 33cm2; P=.001), higher pain intensity (numerical rating scale 6.7 vs 4.7; P=.02), and higher neuropathic characteristics score on the DN4 questionnaire (4.3 vs 2.3; P=.001). However, neither the area nor the severity of hypoesthesia differed significantly between patients with and without CPSNP. Two independent, additive predictors of CPSNP were identified: area of secondary hyperalgesia (odds ratio 1.02; P=.004) and DN4 score (odds ratio 1.94; P=.001). These findings suggest that both nerve lesions and central sensitization are involved in CPSNP development and could be seen as early warning signs.