Acute and persistent post-operative pain following mastectomy: a descriptive study in a tertiary hospital cohort.

AIMS: Post mastectomy pain syndrome (PMPS) can have significant negative effects on patients' quality of life after mastectomy. The estimated prevalence of PMPS varies widely and there is little data from a New Zealand population. This limits clinicians' ability to meaningfully describe and discuss pain-related complications of mastectomy peri-operatively. METHOD: We designed a single-centre, retrospective study to describe acute post-operative analgesic requirements after mastectomy, to describe the prevalence of PMPS at least 1 year after surgery, and to identify associated risk factors for this complication. RESULTS: One hundred and thirty mastectomy patients met inclusion criteria and 59 were willing and able to participate in 12-month follow-up. Acute post-operative pain was generally well managed with modest doses of oral analgesics. Sixty-six percent (n=39) of women reported some form of persistent pain symptoms post-mastectomy; this was associated with younger age, axillary surgery and chemotherapy. Only 5% of patients (n=3) met consensus criteria for PMPS, which limited identification of risk factors for this more severe complication. CONCLUSION: Despite PMPS occurring infrequently, post-operative pain of a less severe nature after mastectomy occurs commonly. Clinicians should remain vigilant to possible risk factors for this post-operative complication and counsel patients appropriately.

Prospective cohort study investigating frequency and risk factors for acute pain 1 day after refractive surgery.

BACKGROUND/AIMS: To examine demographic and clinical factors associated with ocular pain 1 day after refractive surgery. METHODS: Prospective study of individuals undergoing refractive surgery. Participants rated their ocular pain on a 0-10 numerical rating scale (NRS) presurgery and 1 day after surgery. Presurgery, participants completed questionnaires on demographics, comorbidities, medications and dry eye and ocular pain symptoms; and an anaesthetised Schirmer test was performed. Acute ocular pain 1 day after surgery was defined as an NRS score of worst pain since surgery ≥3 and this group was compared with individuals with NRS scores<3. RESULTS: 251 individuals underwent refractive surgery (89% laser-assisted in situ keratomileusis, n=222; 11% PRK, n=29). Mean age was 35±8 years (range 19 to 60); 60% (n=150) self-identified as female, 80% (n=203) as White, and 36% (n=89) as Hispanic. Thirteen (5%) individuals reported ocular pain (NRS ≥3) prior to surgery and 67% (n=168) reported ocular pain 1 day after surgery (nine individuals had pain at both time points). Factors that were associated with pain 1 day after surgery included Hispanic ethnicity (adjusted relative risk (aRR) 1.42, 95% CI 1.21 to 1.68, p<0.001) and the presence of eye pain presurgery (aRR 1.10, 95% CI 1.02 to 1.18, p=0.02). CONCLUSION: A majority of individuals report moderate or greater pain within 24 hours of refractive surgery. Hispanic ethnicity and eye pain prior to surgery were associated with self-reported acute postsurgical pain.

Effect of use of NSAIDs or steroids during the acute phase of pain on the incidence of chronic pain: a systematic review and meta-analysis of randomised trials.

BACKGROUND: This study is the first to summarize the evidence on how the use of anti-inflammatory drugs during acute pain has an impact on the development of chronic pain. METHODS: Randomized controlled trials retrieved from nine databases included anti-inflammatory drugs (NSAIDs or steroids) versus non-anti-inflammatory drugs in patients with acute pain and reported the incidence of chronic pain. No specified date, age, sex, or language restrictions. Subgroup analyses were performed according to pain classification, follow-up time, and medication. The GRADE method was used to evaluate quality of evidence. RESULTS: A total of 29 trials (5220 patients) were included. Steroids or NSAIDs did not reduce the incidence of chronic nociceptive pain. Steroid use in acute phase significantly reduced the incidence of chronic neuropathic pain. In subgroup analysis, benefits were observed for methylprednisolone and dexamethasone, with some adverse effects. Steroids or NSAIDs were statistically significant in reducing pain intensity over 1 year, but the effect size was too small, and whether the long-term effect is clinically relevant needs to be further studied. CONCLUSION: Quality of the evidence was low to moderate. No drug can be recommended to prevent chronic nociceptive pain. Injections of steroids (methylprednisolone or dexamethasone) during the acute phase reduce the incidence of chronic neuropathic pain, but most included studies also used local anesthetics. The results are indirect and need to be interpreted with caution. The pooled data effect sizes for pain intensity were small, so the clinical relevance was unclear. Study registration PROSPERO (CRD42022367030).

Acute and chronic back pain in adults and elderly in southern Brazil: a population-based study / Dor aguda e crônica nas costas em adultos e idosos no sul do Brasil: um estudo de base populacional

Aims: to determine the prevalence of acute and chronic back pain and associated factors and identify the consequences of this pain in adults and the elderly in southern Brazil. Methods: cross-sectional study conducted in 2019, in Criciúma, Santa Catarina, in individuals aged 18 and over. Acute back pain was pain in the cervical, thoracic, or lumbar regions not exceeding 3 months and chronic pain as pain for 3 months or more. Bivariate analyzes and multinomial logistic regression were performed. Results: among the 820 participants, the prevalence of back pain was 67.0%, acute pain 39.3% (95% CI: 35.5% to 43.3%) and chronic pain 27.4% (95% CI: 24.5% to 30.4%). Acute back pain was associated with women, overweight, obesity, and with WMSD/RSI, while chronic pain chronic pain was found mostly in women, being related to leisure inactivity ...were female, leisure inactivity, falls, Work-related musculoskeletal disorder/repetitive strain injury, and arthritis/rheumatism. Conclusions: acute pain was greater among overweight/obese and chronic pain contribute to absenteeism and demand for health services.

Objetivos: determinar a prevalência de dores aguda e crônica nas costas e fatores associados e identificar as consequências dessas dores em adultos e idosos no Sul do Brasil. Métodos: estudo transversal realizado em 2019, em Criciúma, Santa Catarina, em indivíduos com 18 anos ou mais. Dor aguda foi a dor nas regiões cervical, torácica ou lombar não superior a três meses e dor crônica como dor por três meses ou mais. Foram realizadas análises bivariadas e regressão logística multinomial. Resultados: entre os 820 participantes, a prevalência de dor nas costas foi de 67,0%, dor aguda 39,3% (IC 95%: 35,5% a 43,3%) e dor crônica 27,4% (IC 95%: 24,5% a 30,4%). A dor aguda nas costas foi associada a mulheres, sobrepeso, obesidade e a distúrbio musculoesquelético relacionado ao trabalho/lesão por esforço repetitivo, enquanto a dor crônica, foi constatada majoritariamente em mulheres, tendo relação com sedentarismo, quedas, distúrbio musculoesquelético relacionado ao trabalho/lesão por esforço repetitivo e artrite/reumatismo. Conclusões: a dor aguda mais associada a excesso de peso/obesidade e a dor crônica contribuiu para o absenteísmo e procura pelos serviços de saúde.

Associação da catastrofização da dor com a incidência e a intensidade da dor perineal aguda e persistente após parto normal: estudo longitudinal tipo coorte / Association of pain catastrophizing with the incidence and severity of acute and persistent perineal pain after natural childbirth: longitudinal cohort study / Asociación de la catastrofización del dolor con la incidencia y la intensidad del dolor perineal agudo y persistente posteriormente al parto normal: estudio longitudinal tipo cohorte

JUSTIFICATIVA E OBJETIVOS: O parto vaginal pode resultar em dor perineal aguda e persistente pósparto. Este estudo avaliou a associação da catastrofização, fenômeno de má adaptação psicológica à dor que leva o indivíduo a magnificar a experiência dolorosa, tornando-a mais intensa, com a incidência e a intensidade da dor perineal e sua relação com o trauma perineal. MÉTODO: Estudo coorte. Realizado com gestantes em trabalho de parto. Foi aplicada a escala de pensamentos catastróficos sobre a dor durante o internamento e foram avaliados o grau da lesão perineal e a intensidade da dor perineal nas primeiras 24 horas e após oito semanas do parto por meio da escala numérica de dor. RESULTADOS: Avaliadas 55 mulheres. Sentiram dor aguda 69,1% das pacientes. Dessas, 36,3% queixaram-se de dor de moderada/forte intensidade e 14,5% de dor persistente. O escore médio de catastrofização foi de 2,15 ± 1,24. As pacientes catastrofizadoras apresentaram um risco 2,90 vezes maior (95% IC: 1,08-7,75) de apresentar dor perineal aguda e 1,31 vezes maior (95% IC: 1,05-1,64) de desenvolver dor perineal persistente. Também apresentaram um risco 2,2 vezes maior de desenvolver dor perineal aguda de maior intensidade (95% IC: 1,11-4,33). CONCLUSÕES: A incidência de dor perineal aguda e persistente após parto vaginal é alta. Gestantes catastrofizadoras apresentam maior risco de desenvolver dor perineal aguda e persistente, como também dor de maior intensidade. O trauma perineal aumentou o risco de ocorrência de dor perineal persistente.

BACKGROUND AND OBJECTIVES: Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. METHOD: Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the first 24 hours and after 8 weeks of delivery using a numerical pain scale. RESULTS: We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 ± 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). CONCLUSIONS: The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain.

JUSTIFICATIVA Y OBJETIVOS: El parto vaginal puede traer dolor perineal agudo y persistente postparto. Este estudio evaluó la asociación de la catastrofización, fenómeno de mala adaptación psicológica al dolor, que hace con que el individuo exagere la experiencia dolorosa, convirtiéndola en algo más intenso, con la incidencia y la intensidad del dolor perineal y su relación con el trauma perineal. MÉTODO: Estudio de cohorte realizado con gestantes en trabajo de parto. Se aplicó la escala de pensamientos catastróficos sobre el dolor durante el ingreso, y se evaluaron el grado de la lesión perineal y la intensidad del dolor perineal en las primeras 24 horas y después de ocho semanas del parto, por medio de la escala numérica del dolor. RESULTADOS: Fueron evaluadas 55 mujeres. Sintieron dolor agudo 69,1% de las pacientes. De ellas, un 36,3% se quejaron de dolor de moderado/fuerte intensidad y 14,5% de dolor persistente. La puntuación promedio de catastrofización fue de 2,15 ± 1,24. Las pacientes catastrofizadoras tuvieron un riesgo 2,90 veces mayor (95% IC: 1,08-7,75) de presentar dolor perineal agudo y 1,31 veces mayor (95% IC: 1,05-1,64) de desarrollar dolor perineal persistente. También tuvieron un riesgo 2,2 veces mayor de desarrollar dolor perineal agudo de mayor intensidad (95% IC: 1,11-4,33). CONCLUSIONES: La incidencia de dolor perineal agudo y persistente posteriormente al parto vaginal es elevada. Las gestantes catastrofizadoras tienen un mayor riesgo de desarrollar dolor perineal agudo y persistente, como también dolor de mayor intensidad. El trauma perineal aumentó el riesgo de prevalencia de dolor perineal persistente.