Association Between Experimental Pain Thresholds and Trajectories of Postoperative Recovery Measures After Benign Hysterectomy

Abstract

Peter Lukas,1 Björn Gerdle,2 Lena Nilsson,3 Ninnie Borendal Wodlin,1 Mats Fredrikson,4,5 Lars Arendt-Nielsen,6,7 Preben Kjølhede1 1Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden; 2Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden; 3Department of Anesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden; 4Forum Östergötland, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; 5Occupational and Environmental Medicine, Department of Experimental and Clinical Medicine, Faculty of Medicine Health Sciences, Linköping University, Linköping, Sweden; 6Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; 7Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, DenmarkCorrespondence: Preben Kjølhede, Department of Obstetrics and Gynecology, University Hospital, Linköping, 581 85, Sweden, Tel [phone], Email [email protected]: Quantitative sensory testing (QST) can be applied to quantify the sensitivity to different painful stimuli. This study aims to evaluate the association between preoperative pressure and thermal pain thresholds and trajectories of measurements of postoperative recovery (patient-reported daily maximum and average pain intensity, sum score of symptoms, and analgesic consumption) after benign hysterectomy.Patients and Methods: A prospective, longitudinal single-blinded, observational multicenter study was conducted in five hospitals in the southeast of Sweden between 2011 and 2017. A total of 406 women scheduled for abdominal or vaginal hysterectomy for benign conditions were enrolled in the study. QST measuring pressure (PPT), heat (HPT), and cold pain thresholds (CPT) were performed preoperatively. The cut-off levels for dichotomizing the pain thresholds (low/high) were set at the 25-percentile for PPT and HPT and the 75-percentile for CPT. The Swedish Postoperative Symptom Questionnaire was used to measure postoperative pain and other symptoms of discomfort (symptom sum score) on 13 occasions for six weeks postoperatively. Daily analgesic consumption of opioids and non-opioids was registered.Results: A CPT above the 75-percentile was associated with high postoperative maximum pain intensity (p = 0.04), high symptom sum score (p = 0.03) and greater consumption of non-opioids (p = 0.03). A HPT below the 25-percentile was only associated with greater consumption of non-opioids (p = 0.02). PPT was not associated with any of the outcome measures.Conclusion: CPT seemed to be predictive for postoperative pain and symptoms of discomfort after benign hysterectomy. Preoperative QST may be used to individualize the management of postoperative recovery for low pain threshold individuals.Keywords: hysterectomy, quantitative sensory testing, postoperative symptoms, postoperative recovery, pressure and thermal pain thresholds

Keywords

• hysterectomy
• quantitative sensory testing
• postoperative symptoms
• postoperative recovery
• pressure and thermal pain thresholds.