Stress-Induced Hyperalgesia in Patients with Combined and Multiple Trauma
The aim of the study was to determine the effect of trauma and repeated surgical interventions on the development of hyperalgesia and intensity of postoperative pain in patients with multiple skeletal trauma. Materials and methods. 92 patients with multiple trauma were undergone an orthopedic surgery. Patients were divided into groups depending on the surgery number and replication. Pain assessment was carried out with visual analogue scale. To determine the mechanical pain threshold a set of 10-calibrated Von Frey monofilaments was used. To detect a difference between groups Mann — Whitney test and Fisher dual criterion were used. Results. Significantly more intensive pain was observed in the group of repeated surgeries. The difference in required emergency analgesia was also significant (p < 0.01). The pressure by Von Frey monofilaments, causing pain in the forearm in 1st day varied significantly between the studied groups, pain in the postoperative period was stronger in patients in acute trauma compared with patients underwent routine surgery on removing hardware. Conclusions. In patients with multiple or combined trauma after repeated surgery postoperative pain was of a higher intensity due to the development of stress-induced hyperalgesia. Adequate perioperative analgesia improves treatment outcomes in patients with associated and multiple trauma.
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Lewis J., Cannon J., Liebeskind J. Оpioid and nonopioid mechanisms of stress analgesia // Science. — 1980. — 208. — P. 623-625.
Adler G., Manfredsdottir V., Creskoff K. Neuroendocrine abnormalities in fibromyalgia // Curr. Pain Headache Rep. — 2002. — Vol. 6. — P. 289-298.
Vidal C., Jacob J. Hyperalgesia induced by non-noxious stress in the rat // Neurosci. Lett. — 1982. — Vol. 32. — P. 75-80.
Кучин Ю.Л. Послеоперационная боль высокой интенсивности у пациентов с политравмой // Український журнал екстремальної медицини ім. Г.О. Можаєва. — 2013. — Т. 14, № 2. — С. 38-42.
Donello J., Guan Y. et al. A peripheral adrenoceptor-mediated sympathetic mechanism can transform stress-induced analgesia into hyperalgesia // Anesthesiology. — 2010. — 114. — P. 1403-1416.
Khasar S., Dina O. et al. Sound stressinduced long-term enhancement of mechanical hyperalgesia in rats is maintained by sympathoadrenal catecholamines // J. Pain. — 2009. — № 10. — P. 1073-1077.
Rivat C., Becker C. et al. Chronic stress induces transient spinal neuroinflammation, triggering sensory hypersensitivity and long-lasting anxiety-induced hyperalgesia // Pain. — 2010. — 150. — P. 358-368.
Kehlet H., Jensen T., Woolf C. Persistent postsurgical pain: Risk factors and prevention // Lancet. — 2006. — 367. — P. 1618-1625.
Rivat C., Emilie Laboureyras E. et al. Non-Nociceptive Environmental Stress Induces Hyperalgesia, Not Analgesia, in Pain and Opioid-Experienced Rats // Neuropsychopharmacology. — 2007. — № 32. — P. 2217-2228.
Bair M., Robinson L. et al. Depression and pain comorbidity: A literature review // Arch. Intern. Med. — 2003. — № 163. — P. 2433-2445.
Eisenach J. Preventing chronic pain after surgery: Who, how and when? // Reg. Anesth. Pain Med. — 2006. — № 31. — P. 1-3.
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