nach oben

Der Schmerz

Erschienen in:

01.09.2010 | CME Weiterbildung · Zertifizierte Fortbildung

Prädiktoren für chronische Schmerzen nach Operationen

Was wissen wir wirklich?

verfasst von: A. Schnabel, Prof. Dr. E. Pogatzki-Zahn

Erschienen in: Der Schmerz | Ausgabe 5/2010

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Art des operativen Eingriffs scheint wesentlich zur Schmerzchronifizierung beizutragen. Besonders gefährdet sind in der Regel Patienten, die sich einer Thorakotomie, Brust- oder Leistenhernienoperation unterziehen müssen. Bekannt ist ebenfalls die hohe Rate von Phantomschmerzen nach Amputationen. In prospektiven und retrospektiven Untersuchungen konnte neben der Art der Operation eine Reihe weiterer, insbesondere patientenbezogener prä-, intra- und postoperativer Risikofaktoren für das Auftreten chronischer postoperativer Schmerzen nach einer Operation entschlüsselt werden. Hierzu zählen z. B. chronische Schmerzen schon vor der Operation, Alter und Geschlecht, genetische Faktoren, psychosoziale Eigenschaften und Schmerzen in den ersten Tagen nach der Operation. Da eine Vielzahl dieser Faktoren schon vor der Operation identifiziert werden kann, ist ein wichtiges Ziel zukünftiger Untersuchungen deshalb die präoperative Identifizierung von Patienten mit Risikofaktoren für die Entwicklung chronischer postoperativer Schmerzen. Das individuelle Risiko (bzw. ein Spektrum bestimmter Prädiktoren) muss ermittelt werden, um schon vor der Operation die Notwendigkeit und den Therapieerfolg eines präventiven Verfahrens voraussagen zu können. Da ein derartiges Vorgehen bislang noch nicht möglich ist, spielen aktuell eine nervenschonende Operationstechnik und eine effektive postoperative Akutschmerztherapie die bedeutsamste Rolle in der Prävention chronischer Schmerzen nach Operationen.

Aasvang E, Kehlet H (2005) Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 95:69–76CrossRefPubMed

Banik RK, Brennan TJ (2004) Spontaneous discharge and increased heat sensitivity of rat C-fiber nociceptors are present in vitro after plantar incision. Pain 112:204–213CrossRefPubMed

Bennett GJ, Xie YK (1988) A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man. Pain 33(1):87–107CrossRefPubMed

Brander VA, Stulberg SD, Adams AD et al (2003) Predicting total knee replacement pain: a prospective, observational study. Clin Orthop Relat Res 416:27–36CrossRefPubMed

Brandsborg B, Nikolajsen L, Hansen CT et al (2007) Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 106:1003–1012CrossRefPubMed

Brandsborg B, Dueholm M, Nikolajsen L et al (2009) A prospective study of risk factors for pain persisting 4 months after hysterectomy. Clin J Pain 25:263–268CrossRefPubMed

Brennan TJ, Zahn PK, Pogatzki-Zahn EM (2005) Mechanisms of incisional pain. Anesthesiol Clin North America 23:1–20CrossRefPubMed

Brogly N, Wattier JM, Andrieu G et al (2008) Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block. Anesth Analg 107:1720–1725CrossRefPubMed

Burke SM, Shorten GD (2010) Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy. Anesth Analg 110:1180–1185PubMed

10.

Buvanendran A, Kroin JS, Della Valle CJ et al (2010) Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg 110:199–207CrossRefPubMed

11.

Campbell JN, Meyer RA (2006) Mechanisms of neuropathic pain. Neuron 52:77–92CrossRefPubMed

12.

Chui LB, Ng WT, Sze YS et al (2010) Prospective, randomized, controlled trial comparing lightweight versus heavyweight mesh in chronic pain incidence after TEP repair of bilateral inguinal hernia. Surg Endosc. DOI 10.1007/s00464-010-1036-8 [Epub ahead of print]

13.

Clarke H, Pereira S, Kennedy D et al (2009) Adding gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty. Acta Anaesthesiol Scand 53:1073–1083CrossRefPubMed

14.

Crombie IK, Davies HT, Macrae WA (1998) Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain 76:167–171CrossRefPubMed

15.

Daly DJ, Myles PS (2009) Update on the role of paravertebral blocks for thoracic surgery: Are they worth it? Curr Opin Anaesthesiol 22:38–43CrossRefPubMed

16.

De Kock M, Lavand’homme P, Waterloos H (2001) Balanced analgesia in the perioperative period: Is there a place for ketamine? Pain 92:373–380CrossRef

17.

Decosterd I, Woolf CJ (2000) Spared nerve injury: an animal model of persistent peripheral neuropathic pain. Pain 87:149–158CrossRefPubMed

18.

Diatchenko L, Slade GD, Nackley AG et al (2005) Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 14:135–143CrossRefPubMed

19.

Diatchenko L, Nackley AG, Slade GD et al (2006) Catechol-O-methyltransferase gene polymorphisms are associated with multiple pain-evoking stimuli. Pain 125:216–224CrossRefPubMed

20.

Dworkin RH, McDermott MP, Raja SN (2010) Preventing chronic postsurgical pain: How much of a difference makes a difference? Anesthesiology 112:516–518CrossRefPubMed

21.

Eklund A, Montgomery A, Bergkvist L et al (2010) Chronic pain 5 years after randomized comparison of laparoscopic and Lichtenstein inguinal hernia repair. Br J Surg 97:600–608CrossRefPubMed

22.

Ephraim PL, Wegener ST, MacKenzie EJ et al (2005) Phantom pain, residual limb pain and back pain in amputees: results of a national survey. Arch Phys Med Rehabil 86:1910–1919CrossRefPubMed

23.

Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q (2002) The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 95:985–991CrossRefPubMed

24.

Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C (2005) Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg 101:1427–1432CrossRefPubMed

25.

Fecho K, Miller NR, Merritt SA et al (2009) Acute and persistent postoperative pain after breast surgery. Pain Med 10:708–715CrossRefPubMed

26.

Forsythe ME, Dunbar MJ, Hennigar AW et al (2008) Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag 13:335–341PubMed

27.

Foster DC, Sazenski TM, Stodgell CJ (2004) Impact of genetic variation in interleukin-1 receptor antagonist and melanocortin-1 receptor genes on vulvar vestibulitis syndrome. J Reprod Med 49:503–509PubMed

28.

Foulkes T, Wood JN (2008) Pain genes. PLoS Genet 4:e1000086CrossRefPubMed

29.

Franneby U, Sandblom G, Nordin P et al (2006) Risk factors for long-term pain after hernia surgery. Ann Surg 244:212–219CrossRefPubMed

30.

Gartner R, Jensen MB, Nielsen J et al (2009) Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA 302:1985–1992CrossRefPubMed

31.

Gehling M, Tryba M (2003) Prophylaxis of phantom pain: Is regional analgesia ineffective? Schmerz 17:11–19CrossRefPubMed

32.

Gerbershagen HJ, Ozgur E, Dagtekin O et al (2009) Preoperative pain as a risk factor for chronic post-surgical pain – six month follow-up after radical prostatectomy. Eur J Pain 13:1054–1061CrossRefPubMed

33.

Gold MS, Weinreich D, Kim CS et al (2003) Redistribution of Na(V)1.8 in uninjured axons enables neuropathic pain. J Neurosci 23:158–166PubMed

34.

Granot M (2009) Can we predict persistent postoperative pain by testing preoperative experimental pain? Curr Opin Anaesthesiol 22:425–430CrossRefPubMed

35.

Hanley MA, Ehde DM, Jensen M et al (2009) Chronic pain associated with upper-limb loss. Am J Phys Med Rehabil 88:742–751CrossRefPubMed

36.

Herrero JF, Laird JM, Lopez-Garcia JA (2000) Wind-up of spinal cord neurones and pain sensation: Much ado about something? Prog Neurobiol 61:169–203CrossRefPubMed

37.

Iohom G, Abdalla H, O’Brien J et al (2006) The associations between severity of early postoperative pain, chronic postsurgical pain and plasma concentration of stable nitric oxide products after breast surgery. Anesth Analg 103:995–1000CrossRefPubMed

38.

Juni A, Cai M, Stankova M et al (2010) Sex-specific mediation of opioid-induced hyperalgesia by the melanocortin-1 receptor. Anesthesiology 112:181–188CrossRefPubMed

39.

Kairaluoma PM, Bachmann MS, Rosenberg PH, Pere PJ (2006) Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery. Anesth Analg 103:703–708CrossRefPubMed

40.

Kalkman CJ, Visser K, Moen J et al (2003) Preoperative prediction of severe postoperative pain. Pain 105:415–423CrossRefPubMed

41.

Katz J, Poleshuck EL, Andrus CH et al (2005) Risk factors for acute pain and its persistence following breast cancer surgery. Pain 119:16–25CrossRefPubMed

42.

Katz J, Seltzer Z (2009) Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 9:723–744CrossRefPubMed

43.

Kehlet H, Rathmell JP (2010) Persistent postsurgical pain: the path forward through better design of clinical studies. Anesthesiology 112:514–515CrossRefPubMed

44.

Khan IH, McManus KG, McCraith A, McGuigan JA (2000) Muscle sparing thoracotomy: a biomechanical analysis confirms preservation of muscle strength but no improvement in wound discomfort. Eur J Cardiothorac Surg 18:656–661CrossRefPubMed

45.

Kristensen AD, Pedersen TA, Hjortdal VE et al (2010) Chronic pain in adults after thoracotomy in childhood or youth. Br J Anaesth 104:75–79CrossRefPubMed

46.

Landau R, Kraft JC, Flint LY et al (2010) An experimental paradigm for the prediction of Post-Operative Pain (PPOP). J Vis Exp 35. DOI 10.3791/1671

47.

Landreneau RJ, Pigula F, Luketich JD et al (1996) Acute and chronic morbidity differences between muscle-sparing and standard lateral thoracotomies. J Thorac Cardiovasc Surg 112:1346–1350CrossRefPubMed

48.

Lautenbacher S, Huber C, Kunz M et al (2009) Hypervigilance as predictor of postoperative acute pain: its predictive potency compared with experimental pain sensitivity, cortisol reactivity and affective state. Clin J Pain 25:92–100CrossRefPubMed

49.

Lavand’homme P, De Kock M, Waterloos H (2005) Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 103:813–820CrossRef

50.

Lavand’homme P (2006) Perioperative pain. Curr Opin Anaesthesiol 19:556–561CrossRef

51.

Lay CL, Broner SW (2009) Migraine in women. Neurol Clin 27:503–511CrossRefPubMed

52.

Lotsch J, Klepstad P, Doehring A, Dale O (2010) A GTP cyclohydrolase 1 genetic variant delays cancer pain. Pain 148:103–106CrossRefPubMed

53.

Macrae WA, Davies HTO (1999) Chronic postsurgical pain. In: Crombie IK (Hrsg) Epidemiology of pain. IASP, Seattle, S 25–42

54.

Macrae WA (2001) Chronic pain after surgery. Br J Anaesth 87:88–98CrossRefPubMed

55.

Maihofner C, Kaltenhauser M (2009) Quality discrimination for noxious stimuli in secondary somatosensory cortex: a MEG-study. Eur J Pain 13(10):1048.e1–1048.e7PubMed

56.

Merskey HBN (1994) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms, 2. Audl. IASP, Seattle

57.

Mikkelsen T, Werner MU, Lassen B, Kehlet H (2004) Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy. Anesth Analg 99:146–151CrossRefPubMed

58.

Mogil JS, Yu L, Basbaum AI (2000) Pain genes? Natural variation and transgenic mutants. Annu Rev Neurosci 23:777–811CrossRefPubMed

59.

Mogil JS, Wilson SG, Chesler EJ et al (2003) The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans. Proc Natl Acad Sci U S A 100:4867–4872CrossRefPubMed

60.

Nikolajsen L, Finnerup NB, Kramp S et al (2006) A randomized study of the effects of gabapentin on postamputation pain. Anesthesiology 105:1008–1015CrossRefPubMed

61.

Obata H, Saito S, Fujita N et al (1999) Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain. Can J Anaesth 46:1127–1132CrossRefPubMed

62.

Ochroch EA, Gottschalk A, Augostides J et al (2002) Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology 97:1234–1244CrossRefPubMed

63.

Perttunen K, Tasmuth T, Kalso E (1999) Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand 43:563–567CrossRefPubMed

64.

Peters ML, Sommer M, Rijke JM de et al (2007) Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 245:487–494CrossRefPubMed

65.

Pogatzki EM, Gebhart GF, Brennan TJ (2002) Characterization of Adelta- and C-fibers innervating the plantar rat hindpaw one day after an incision. J Neurophysiol 87:721–731PubMed

66.

Pogatzki EM, Niemeier JS, Brennan TJ (2002) Persistent secondary hyperalgesia after gastrocnemius incision in the rat. Eur J Pain 6:295–305CrossRefPubMed

67.

Pogatzki-Zahn EM, Zahn PK, Brennan TJ (2007) Postoperative pain–clinical implications of basic research. Best Pract Res Clin Anaesthesiol 21:3–13CrossRefPubMed

68.

Pogatzki-Zahn EM, Wagner C, Meinhardt-Renner A et al (2010) Coding of incisional pain in the brain: a functional magnetic resonance imaging study in human volunteers. Anesthesiology 112:406–417CrossRefPubMed

69.

Poleshuck EL, Katz J, Andrus CH et al (2006) Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain 7:626–634CrossRefPubMed

70.

Poobalan AS, Bruce J, King PM et al (2001) Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 88:1122–1126CrossRefPubMed

71.

Richardson C, Glenn S, Nurmikko T, Horgan M (2006) Incidence of phantom phenomena including phantom limb pain 6 months after major lower limb amputation in patients with peripheral vascular disease. Clin J Pain 22:353–358CrossRefPubMed

72.

Russell IJ, Raphael KG (2008) Fibromyalgia syndrome: presentation, diagnosis, differential diagnosis and vulnerability. CNS Spectr 13:6–11PubMed

73.

Sandkuhler J (2009) Models and mechanisms of hyperalgesia and allodynia. Physiol Rev 89:707–758CrossRefPubMed

74.

Scholz J, Yaksh TL (2010) Preclinical research on persistent postsurgical pain: what we don’t know, but should start studying. Anesthesiology 112:511–513CrossRefPubMed

75.

Sen H, Sizlan A, Yanarates O et al (2009) A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg 109:1645–1650CrossRefPubMed

76.

Senturk M, Ozcan PE, Talu GK et al (2002) The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 94:11–15CrossRefPubMed

77.

Sng BL, Sia AT, Quek K et al (2009) Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia. Anaesth Intensive Care 37:748–752PubMed

78.

Staal E, Nienhuijs SW, Keemers-Gels ME et al (2008) The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia 12:153–157CrossRefPubMed

79.

Stamer UM, Musshoff F, Kobilay M et al (2007) Concentrations of tramadol and O-desmethyltramadol enantiomers in different CYP2D6 genotypes. Clin Pharmacol Ther 82:41–47CrossRefPubMed

80.

Steegers MA, Snik DM, Verhagen AF et al (2008) Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain 9:955–961CrossRefPubMed

81.

Tegeder I, Costigan M, Griffin RS et al (2006) GTP cyclohydrolase and tetrahydrobiopterin regulate pain sensitivity and persistence. Nat Med 12:1269–1277CrossRefPubMed

82.

Tegeder I, Adolph J, Schmidt H et al (2008) Reduced hyperalgesia in homozygous carriers of a GTP cyclohydrolase 1 haplotype. Eur J Pain 12:1069–1077CrossRefPubMed

83.

Weissman-Fogel I, Granovsky Y, Crispel Y et al (2009) Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase. J Pain 10:628–636CrossRefPubMed

84.

Werner MU, Duun P, Kehlet H (2004) Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation. Anesthesiology 100:115–119CrossRefPubMed

85.

Wilder-Smith OH, Tassonyi E, Crul BJ, Arendt-Nielsen L (2003) Quantitative sensory testing and human surgery: effects of analgesic management on postoperative neuroplasticity. Anesthesiology 98:1214–1222CrossRefPubMed

86.

Wildgaard K, Ravn J, Kehlet H (2009) Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothorac Surg 36:170–180CrossRefPubMed

87.

Woolf CJ, Salter MW (2000) Neuronal plasticity: increasing the gain in pain. Science 288:1765–1769CrossRefPubMed

88.

Yarnitsky D, Crispel Y, Eisenberg E et al (2008) Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk. Pain 138:22–28CrossRefPubMed

89.

Yarnitsky D, Arendt-Nielsen L, Bouhassira D et al (2010) Recommendations on terminology and practice of psychophysical DNIC testing. Eur J Pain 14:339CrossRefPubMed

90.

Zubieta JK, Heitzeg MM, Smith YR et al (2003) COMT val158met genotype affects mu-opioid neurotransmitter responses to a pain stressor. Science 299:1240–1243CrossRefPubMed

91.

Klein T, Magerl W, Treede R-D, Pogatzki-Zahn EM (2008) Physiologie und Pathophysiologie des postoperativen Schmerzes. In: Pogatzki-Zahn EM, Van Aken HK, Zahn PK (Hrsg) Postoperative Schmerztherapie: Pathophysiologie, Pharmakologie und Therapie. Thieme, Stuttgart

Titel: Prädiktoren für chronische Schmerzen nach Operationen
Was wissen wir wirklich?
verfasst von: A. Schnabel
Prof. Dr. E. Pogatzki-Zahn
Publikationsdatum: 01.09.2010
Verlag: Springer-Verlag
Erschienen in: Der Schmerz / Ausgabe 5/2010
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI: https://doi.org/10.1007/s00482-010-0932-0

Neu im Fachgebiet AINS

11.04.2024 | Rückenschmerzen | Nachrichten

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Prädiktoren für chronische Schmerzen nach Operationen

Was wissen wir wirklich?

Zusammenfassung

Neu im Fachgebiet AINS

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Neue NIV-Leitlinie mit Anleitung zur Beatmungseinstellung vorgestellt

Update AINS

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2010

Liebe Kolleginnen und Kollegen

Schmerz und Glaube

Liebe Kolleginnen und Kollegen,

Subjektive Belastung und Religiosität bei chronischen Schmerzen und Brustkrebs

Analgetische Effizienz von transkutaner elektrischer Nervenstimulation (TENS-Therapie) bei Patienten mit Gonarthrose

Laserakupunktur bei chronischen Rückenschmerzen

Neu im Fachgebiet AINS

Diclofenac-Gel versus Ibuprofen bei akuten Rückenschmerzen

Chronische Schmerzen nach Op. oft mit neuropathischer Komponente

Wie toxische Männlichkeit der Gesundheit von Männern schadet

Neue NIV-Leitlinie mit Anleitung zur Beatmungseinstellung vorgestellt

Update AINS