title: Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up.
abstract: To investigate the role of peripheral neuropathy in the development of neuropathic postsurgical persistent pain (N-PSPP) after surgery, this French multicentric prospective cohort study recruited 3,112 patients prior to elective cesarean, inguinal herniorrhaphy (open mesh/laparoscopic), breast cancer surgery, cholecystectomy, saphenectomy, sternotomy, thoracotomy, or knee arthroscopy. Besides perioperative data collection, postoperative postal questionnaires built to assess the existence, intensity, and neuropathic features (with the Douleur Neuropathique 4 Questions [DN4]) of pain at the site of surgery were sent at the third and sixth months after surgery. In the 2,397 patients who completed follow-up, the cumulative risk of N-PSPP within the 6 months ranged from 3.2% (laparoscopic herniorrhaphy) to 37.1% (breast cancer surgery). Pain intensity was greater if DN4 was positive and decreased with time since surgery; it depended on the type of surgery. In pain-reporting patients, the response to the DN4 changed from time to time in about 1:4 of the cases. Older age and a low anxiety score were independent protective factors of N-PSPP, whereas a recent negative event, a low preoperative quality of life, and previous history of peripheral neuropathy were risk factors. The type of anesthesia had no influence on the occurrence of N-PSPP.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT00812734.
  
  
  CONCLUSIONS
  This prospective observational study provides the incidence rate of N-PSPP occurring within the 6 months after 9 types of elective surgical procedures. It highlights the possible consequences of nerve aggression during some common surgeries. Finally, some preoperative predispositions to the development of N-PSPP have been identified.
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC 501, Clermont-Ferrand, France; Inserm, U1107 "Neuro-Dol," Clermont-Ferrand, France. Electronic address: cduale@chu-clermontferrand.fr.
authors.forename: Christian
authors.initials: C
authors.lastname: Dualé
authors.affiliation: Univ Clermont1, Clermont-Ferrand, France; CHU Clermont-Ferrand, Pôle Santé Publique, Clermont-Ferrand, France; CNRS, ISIT, UMR6284, Clermont-Ferrand, France.
authors.forename: Lemlih
authors.initials: L
authors.lastname: Ouchchane
authors.affiliation: Inserm, U1107 "Neuro-Dol," Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France; CHU Clermont-Ferrand, Pôle Anesthésie-Réanimation, Hôpital Gabriel-Montpied, Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Schoeffler
authors.affiliation: CHU Clermont-Ferrand, Centre de Pharmacologie Clinique, Clermont-Ferrand, France; Inserm, CIC 501, Clermont-Ferrand, France; Inserm, U1107 "Neuro-Dol," Clermont-Ferrand, France; Univ Clermont1, Clermont-Ferrand, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Dubray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000150:complications* / Q000453:epidemiology*; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
keywords: Chronic pain; DN4; complications; nerve lesion; postoperative