title: Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model.
abstract: Nerve lesions and secondary hyperalgesia may both be present after surgery, and their relative contributions to chronic postsurgical neuropathic pain (CPSNP) remain unclear. This prospective study explored the roles of these factors in the development of CPSNP after iliac crest bone harvest. CPSNP was defined as pain in the area of hypoesthesia, with a positive Douleur neuropathique 4 questionnaire (DN4) score 3 months after iliac crest bone harvest. The location, intensity, and neuropathic characteristics of pain were evaluated in 82 patients who were followed for 6 months. Neuropathic characteristics were assessed by clinical examination and DN4 questionnaire. The area of secondary hyperalgesia was evaluated 48 h and 1 month after surgery. The area of mechanical hypoesthesia, detection, and mechanical pain threshold were evaluated at 48 h and at 1 and 3 months. Nineteen patients (23%) had CPSNP at 3 months. The patients who developed CPSNP had a larger area of secondary hyperalgesia at 48 h (88 cm(2) vs 33 cm(2); P=.001), higher pain intensity (numerical rating scale 6.7 vs 4.7; P=.02), and higher neuropathic characteristics score on the DN4 questionnaire (4.3 vs 2.3; P=.001). However, neither the area nor the severity of hypoesthesia differed significantly between patients with and without CPSNP. Two independent, additive predictors of CPSNP were identified: area of secondary hyperalgesia (odds ratio 1.02; P=.004) and DN4 score (odds ratio 1.94; P=.001). These findings suggest that both nerve lesions and central sensitization are involved in CPSNP development and could be seen as early warning signs.
authors.affiliation: Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, F-92380 Garches, France INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Boulogne Billancourt F-92100, France Service de chirurgie orthopédique et traumatologique, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 Boulevard Raymond Poincaré, F-92380 Garches, France Université Versailles Saint-Quentin, 55 Avenue de Paris, Versailles F-78035, France.
authors.forename: Valeria
authors.initials: V
authors.lastname: Martinez
authors.forename: Skander Ben
authors.initials: SB
authors.lastname: Ammar
authors.forename: Thierry
authors.initials: T
authors.lastname: Judet
authors.forename: Didier
authors.initials: D
authors.lastname: Bouhassira
authors.forename: Marcel
authors.initials: M
authors.lastname: Chauvin
authors.forename: Dominique
authors.initials: D
authors.lastname: Fletcher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D007085:Ilium / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult