title: Thermal quantitative sensory testing to predict postoperative pain outcomes following gynecologic surgery.
abstract: OBJECTIVE
  To evaluate the relationship of preoperative thermal quantitative sensory testing (QST) values with postoperative pain and opiate consumption in opiate-naïve patients following gynecologic surgery.
  
  
  METHODS
  Single blind observational study.
  
  
  METHODS
  Surgical center of an academic medical center.
  
  
  METHODS
  QST was performed preoperatively on 124 opioid-naïve patients. Pain outcomes were assessed on arrival to the post-anesthesia care unit and at 6 hourly intervals for 24 hours. Subjects were reclassified to three groups: Group 1 had a heat pain threshold above and a cold pain threshold below the median; Group 2 had either a heat pain threshold below or a cold pain threshold above the median; Group 3 had a heat pain threshold below and a cold pain threshold above the median. The primary outcome measure was the 24-hour morphine consumption.
  
  
  RESULTS
  One hundred twenty subjects were evaluated. Median (interquartile range) warm and cold pain thresholds were 44.8 (42.4-46.9) °C and 10.5 (3.2-19.0) °C, respectively. Heat pain thresholds demonstrated a negative (rho = -0.23, P = 0.01) and cold thresholds a positive correlation (rho = 0.21, P = 0.02) with 24-hour morphine consumption. Median morphine consumption was 19 (2-33) mg (P = 0.004) equivalents greater in subjects (N = 46) with heat pain thresholds <45 °C and cold pain thresholds >10 °C than subjects with heat pain thresholds >45 °C and cold pain thresholds <10 °C.
  
  
  CONCLUSIONS
  Reduced tolerance to both heat and cold thermal pain stimulus was associated with increased postoperative analgesic requirements. Combined responses to multiple pain modalities may be more useful than a single stimulus paradigm.
authors: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors: Shireen
authors: S
authors: Ahmad
authors: Gildasio S
authors: GS
authors: De Oliveira
authors: Jane M
authors: JM
authors: Bialek
authors: Robert J
authors: RJ
authors: McCarthy
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003080:Cold Temperature / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement / Q000379:methods*; D017288:Pain Threshold; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D016037:Single-Blind Method
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Opioids; Postoperative Pain