Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk

Yarnitsky, David; Crispel, Yonathan; Eisenberg, Elon; Granovsky, Yelena; Ben-Nun, Alon; Sprecher, Elliot; Best, Lael-Anson; Granot, Michal

doi:10.1016/j.pain.2007.10.033

« Previous Next »PAIN
Volume 138, Issue 1 , Pages 22-28, 15 August 2008

Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk

David Yarnitsky
- Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Israel
- Corresponding author. Address: Department of Neurology, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. Tel.: +972 4 8542605; fax: +972 4 8542944.
Yonathan Crispel
- Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Israel
Elon Eisenberg
- Pain Relief Unit, Rambam Health Care Campus, and Faculty of Medicine, Technion, Israel
Yelena Granovsky
- Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Israel
Alon Ben-Nun
- Department of Thoracic Surgery, Rambam Health Care Campus, and Faculty of Medicine, Technion, Israel
Elliot Sprecher
- Department of Neurology, Rambam Health Care Campus, and Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Israel
Lael-Anson Best
- Department of Thoracic Surgery, Rambam Health Care Campus, and Faculty of Medicine, Technion, Israel
Michal Granot
- Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel

Received 6 August 2007; received in revised form 18 October 2007; accepted 31 October 2007. published online 13 December 2007.

Abstract

Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are ‘at risk’ to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0±16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33–0.77 95% CI, p=0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28–2.77, p=0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual’s ability to tackle noxious events, identifying patients ‘at risk’ to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering.