Prediction of post-operative pain by an electrical pain stimulus.
BACKGROUND
Treatment of post-operative pain is still a significant problem. Recently, interest has focused on pre-operative identification of patients who may experience severe post-operative pain in order to offer a more aggressive analgesic treatment. The nociceptive stimulation methods have included heat injury and pressure algometry. A simple method, Pain Matcher (PM), using electrical stimulation, is validated for pain assessment, but has not been evaluated as a tool for prediction of post-operative pain. Our aim was to assess the predictive value of pre-caesarean section pain threshold on intensity of post-caesarean section pain using the PM.


METHODS
Thirty-nine healthy women scheduled for elective caesarean section were studied. The anaesthetic/analgesic procedures included spinal anaesthesia, paracetamol, diclofenac, controlled-release (CR) oxycodone and morphine on request. Pre-operatively, the sensory and pain thresholds were measured using the PM. Post-operatively, a midwife, blinded for pre-caesarean pain threshold assessments, assessed the pain at rest and during mobilization every 12 h for 2 days. Consumption of analgesics was also recorded.


RESULTS
Pre-operative pain threshold correlated significantly with post-caesarean pain score (VAS) at rest and mobilization: [Spearman's rho =-0.65 (-0.30 to -0.75), P < 0.01] and [Spearman's rho =-0.52 (-0.23 to -0.72), P < 0.01], respectively. There was no significant correlation between pre-operative PM assessment of sensory threshold and post-operative pain.


CONCLUSIONS
Electrical pain threshold before caesarean section seems to predict the intensity of post-operative pain. This method may be used as a screening tool to identify patients at high risk of post-operative pain.
Nielsen
P R
PR
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. per.rotboell.nielsen@rh.regionh.dk
Nørgaard
L
L
Rasmussen
L S
LS
Kehlet
H
H
D000328:Adult; D016362:Analgesia, Obstetrical; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology*; D010149:Postoperative Pain / Q000175:diagnosis*