Sex moderates the association between quantitative sensory testing and acute and chronic pain after total knee/hip arthroplasty.

OBJECTIVES: Acute postsurgical pain (APSP) may persist over time and become chronic. Research on predictors for APSP and chronic postsurgical pain (CPSP) has produced inconsistent results. This observational study aimed to analyze psychological and psychophysical variables associated with APSP and CPSP after total knee or hip arthroplasty, and to explore the role of sex. METHODS: Assessments were conducted before surgery, 48 h, and 3 months postsurgery, including questionnaires (sociodemographic, pain related, and psychological) and quantitative sensory testing (QST). Hierarchical linear regression models analyzed potential predictors of APSP and CPSP, and moderation analyses evaluated the role of sex. RESULTS: The study included 63 participants undergoing total knee (34, 54%) or hip (29, 46%) arthroplasty. Thirty-one (49.2%) were female and 32 (50.8%) were male. APSP (48 h) was associated with impaired conditioned pain modulation (CPM) (ß = 0.301, p = 0.019). CPSP (3 months) was associated with being female (ß = 0.282, p = 0.029), longer presurgical pain duration (ß = 0.353, p = 0.006), knee arthroplasty (ß = -0.312, p = 0.015), higher APSP intensity (ß = 373, p = 0.004), and impaired CPM (ß = 0.126, p = 0.004). In multivariate analysis, these clinical variables were significant predictors of CPSP, unlike sex, and CPM (adj. R 2 = 0.349). Moderation analyses showed that wind-up ratio (WUR) was a significant predictor of APSP in men (WUR × sex: b = -1.373, p = 0.046) and CPM was a significant predictor of CPSP in women (CPM × sex: b = 1.625, p = 0.016). CONCLUSIONS: Specific QST parameters could identify patients at risk for high-intensity APSP and CPSP, with sex as a moderator. This has important clinical implications for patient care, paving the way for developing tailored preventive pain management strategies.

Critérios mínimos para credenciamento de centros formadoresde especialistas em Alergia e Imunologia Clínica: propostaelaborada pelas oficinas de discussão realizadas nos CongressosBrasileiros de Alergia e Imunopatologia de 2010 e 2011 / Minimum criteria for accreditation of specialty training centers in Allergyand Clinical Immunology: proposal prepared by discussion workshopsheld in 2010 and 2011 Brazilian Congresses of Allergy and Immunopathology

Em resposta às necessidades da Comissão de Títulode Especialista, a Diretoria de Ensino e Credenciamentode Serviços realizou pesquisa sobre os serviços brasileirosenvolvidos na capacitação e treinamento de especialistasem Alergologia e Imunologia Clínica no ano de 2010 cujosresultados foram publicados recentemente1. Este estudo tevecomo base outros realizados pela World Allergy Organization(WAO) ao estabelecer os critérios mínimos para a formaçãode um especialista em Alergologia e Imunologia2-4 e tevepor objetivo a busca sobre o perfil do serviço que reunisseas condições mínimas para ser credenciado como apto paraoferecer tal capacitação na especialidade, tomando-se comobase os requisitos mínimos para admissão dos especializandos,os critérios de seleção, o tipo de treinamento, o tempo idealde treinamento, bem como o seu modo de certificação.