Pain assessment in women with or without endometriosis during the IVF process: a prospective study.

RESEARCH QUESTION: How does the typology and effect of pain vary between infertile patients with or without endometriosis during the different stages of the IVF process? DESIGN: A prospective, monocentric, observational cohort study was conducted at Lille University Hospital between November 2019 and June 2021. The study was proposed to all patients starting an IVF cycle. Pain assessment questionnaires using validated scales (about type of pain, without specific location), were completed by patients at key points during IVF: before starting treatment, at the end of stimulation and on the day of oocyte retrieval. RESULTS: A total of 278 patients were analysed: 73 patients with endometriosis and 205 without. At the start of the IVF process, patients with endometriosis had higher pain scores than disease-free women (mean numerical scale score 3.47 versus 1.12 [P < 0.0001]) and 17.81% of patients with endometriosis had neuropathic pain. For mental disorders before starting treatment, 22% of patients with endometriosis had suspected or confirmed depression, and 33% had anxiety compared with 8% and 20% in patients without endometriosis, respectively. During IVF, for patients without endometriosis, pain increased significantly between the baseline, the end of stimulation and on the day of retrieval (P ≤ 0.05). In patients with endometriosis, however, pain did not significantly vary during these times. CONCLUSION: Endometriosis is associated with higher pain scores, but no increase in pain was observed during IVF for these patients. It seems essential to screen and characterize pain phenotypes in all patients before starting treatment and during stimulation to improve pain management.

Trajectory of chronic and neuropathic pain, anxiety and depressive symptoms and pain catastrophizing after total knee replacement. Results of a prospective, single-center study at a mean follow-up of 7.5 years.

INTRODUCTION: A considerable number of patients are not satisfied after total knee replacement (TKR) because of persistent pain. This pain can also be neuropathic in origin. Both types of pain have a large impact on function and quality of life. Furthermore, the trajectory of anxiety and depressive symptoms and pain catastrophizing has rarely been studied after TKR surgery. The primary objective of this study was to define the trajectory of knee pain after primary TKR. The secondary objectives were to evaluate how neuropathic pain, anxiety and depressive symptoms and pain catastrophizing change over time. METHODS: This prospective, single-center study included patients who underwent primary TKR for primary osteoarthritis between July 2011 and December 2012. Personal data (age, sex, body mass index, knee history, operated side, surgical approach, type of implant, operative time, and rehabilitation course) and the responses to seven questionnaires (Numerical pain rating scale, DN4-interview for neuropathic pain, Oxford Knee Scale, Hospital and Anxiety Depression Scale, Beck Depression Inventory, Patient Catastrophizing Scale and Brief Pain Inventory) were determined preoperatively, at 6 months postoperative and at a mean follow-up of 7.5 years. RESULTS: Preoperatively, 129 patients (35 men, 94 women) filled out all the questionnaires. Subsequently, 32 patients were excluded because of incomplete responses at 6 months postoperative, 6 were excluded because they had undergone revision surgery, 11 patients were lost to follow-up and 5 patients had died. In the end, 65 patients were available for analysis (50% of the initial cohort) who were 74 years old on average at inclusion. Between the preoperative period and 6 months postoperative, pain (p<0.001), function (p<0.001), anxiety symptoms (p<0.001) and catastrophizing (p<0.001) had improved. Depressive symptoms did not change (p=0.63). Between 6 months postoperative and the latest follow-up, none of the parameters changed further (p>0.05). Of the 65 patients analyzed, 21% had chronic pain of undefined origin at 6 months postoperative and 26% had chronic pain at the end of follow-up, with 50% also having neuropathic pain. Preoperatively, 40% of the 65 patients had neuropathic pain, 30% at 6 months (p=0.27) and 18% at 7.5 years after TKR (p=0.01). CONCLUSION: The number of patients who have chronic pain after TKR is considerable, especially since knee pain stabilized at 6 months postoperative. Early detection is vital to prevent the pain from becoming chronic, which makes it more difficult to treat. Half the patients with persistent pain also had neuropathic pain, which should be detected before surgery so the patients can be referred to a specialized pain management center. The presence of anxiety and depressive symptoms and pain catastrophizing is not a contraindication to TKR, but these patients should be referred to specialists for treatment before surgery. LEVEL OF EVIDENCE: IV, prospective cohort study.

Risk factors for chronic pain after open ventral hernia repair by underlay mesh placement.

BACKGROUND: Incisional hernia is a frequent complication following abdominal surgery. Repairs that include the use of mesh have been associated with decreased recurrence. The aim of the present study was to determine the outcomes and risk factors for chronic pain after ventral hernia repair with underlay placement of a composite polypropylene mesh. METHODS: A retrospective study was conducted from September 2005 to June 2008. The study included consecutive patients who underwent elective incisional hernia repair with underlay composite mesh placement. Postoperative course, recurrence, pain, and patient satisfaction were assessed by an independent observer. Chronic pain was defined as significant pain persisting after 3 months as assessed using a 10-point numeric scale (≥ 3: chronic pain, ≥ 7: severe pain). RESULTS: After a mean follow-up period of 24.6 months, 109 of 121 patients operated on during the period were evaluated. No patients experienced small bowel obstructions, enterocutaneous fistulas, or mesh infections leading to the need for mesh removal. The recurrence rate was 6.1 % at the repair site and 10.5% at another site. Thirty-one patients (28%) had chronic pain and seven patients (6.6%) had severe pain. Affective and nociceptive components were the majority of complaints. Chronic cough was the only variable independently associated with chronic pain in univariate and multivariate analyses (OR = 4.8; p = 0.007). CONCLUSIONS: Intraperitoneal composite mesh placement after ventral hernia repair is safe with regard to intra-abdominal potential complications. Chronic pain is not uncommon, with chronic cough identified as the major independent predictor.

Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block.

BACKGROUND: Preoperative oral gabapentin has been shown to reduce postoperative pain. However, the effects of gabapentin as an adjunct to regional anesthesia is unclear and its effects on chronic pain remains unknown. In patients undergoing thyroidectomy, we investigated the effects on early and late (at 6 mo) postoperative pain of preoperative oral gabapentin as an adjunct to superficial cervical plexus block (SCPB). METHOD: Fifty consecutive consenting patients were randomized to receive either 1200 mg of gabapentin (Group G) or placebo (Group P) 2 h preoperatively. Preoperative anxiety was assessed on a numeric scale from 0 to 6. A SCPB was performed after a standardized induction of anesthesia. The primary outcome, analgesic drug consumption, was assessed during the procedure and postoperatively in the postanesthesia care unit and after discharge to the ward. Over the first 24 h, pain levels at rest and during swallowing were measured on a numeric scale from 0 to 10. If the pain level was more than 4/10 at rest, patients received 1 g/6 h of IV paracetamol and/or 50 mg/6 h of IV tramadol as a rescue analgesic treatment in the interval. The day before operation and 6 mo after thyroidectomy, included patients were asked to answer a neuropathic pain diagnostic questionnaire. RESULTS: Population characteristics, preoperative anxiety, intraoperative drug consumption, procedure duration, and postoperative care unit stay were comparable in both groups. Analgesic consumption during the first 24 postoperative hours was similar in both groups (G: 3 [0-5] doses/24 h; P: 3 [1-5] doses/24 h; P = NS), as well as pain at rest (G: 2,2 [0.2-3.7]; P: 2 [0-6.3]; P = NS), and during swallowing (G: 2.8 [0.4-8.9]; P: 3 [1.4-6.3]; P = NS]). Eight patients had a diagnostic questionnaire score more than 3, 6 mo after operation versus 2 in preoperative period (P = 0.04). Such delayed neuropathic pain complaints were reported in seven patients receiving SCPB alone and only in one patient receiving both SCPB and preoperative adjunctive oral gabapentin. (P = 0.01). CONCLUSION: Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.

Chronic post-thyroidectomy pain: Incidence, typology, and risk factors.

Chronic postoperative pain exists in varying degrees for every type of surgery. An evaluation of the incidence, the typology and predictive factors of chronic pain was carried out at 3 and 6months after thyroidectomy. A prospective observational study, having included each of the patients prior to their thyroidectomy, was carried out over 12months. The patients used an 11-point numerical rating scale (NRS), a neuropathic pain screening questionnaire (DN4), an evaluation scale for anxiety and for the need for information related to anaesthesia and surgery (APAIS), a questionnaire describing pain (QDSA) and a questionnaire evaluating neuropathic pain (NPSI) before surgery and at three and six months later. Three hundred and four patients were included. The questionnaires were completed by 251 patients (57 males and 194 females) at 3 and 6months (82%). At 3months, 31 out of 251 (12%) patients mentioned a DN4≥3; at 6months, this rate dropped to 23 out of 251 (9%). The average intensity of chronic postoperative pain remained low to moderate. Levels of anxiety and the need for information were higher in patients with postoperative pain at 3 and 6months. In contrast, the number of intraoperative procedures using a bilateral superficial cervical plexus block (BSCPB) was lower in patients with DN4≥3. Multivariate analysis demonstrated that the type of anaesthesia procedure interfered with the risk of delayed pain after thyroidectomy. The presence of a DN4≥3 was nearly three-fold greater in patients without BSCPB (OR 2.647, CI=1.198-5.848).

[Study on personality and psychiatric disorder in fibromyalgia]. / Importance des troubles de la personnalité et des comorbidités psychiatriques chez 30 patients atteints de fibromyalgie.

UNLABELLED: WORK INTEREST: To assess vulnerability factors of outpatients with fibromyalgia, by the evaluating prevalence of DSM-IV axis I disorders (mental disorders) and axis II disorders (personality disorders). METHODS: 30 outpatients with fibromyalgia were examined consecutively, and were administered the Mini International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV. RESULTS: The patients were found to have a high prevalence of DSM-IV axis I disorders (63,3% received a diagnosis of depressive and/or anxious disorder), and axis II disorders (46,7% received at least one diagnosis of personality disorder, including obsessive-compulsive personality disorder: 30%, borderline personality disorder: 16,7%, and depressive personality disorder: 16,7%). PERSPECTIVES: Our results show the importance of psychiatric comorbidities, including personality disorders from outpatients with fibromyalgia. Personality disorders have to be taken into account in the treatment by their impact on doctor-patient relation. Our results suggest the importance of liaison psychiatry in the treatment of those patients.