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A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

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Heterogeneous sensory processing in persistent postherniotomy pain.

Eske Kvanner Aasvang¹, Birgitte Brandsborg, Troels Staehelin Jensen

¹Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Denmark Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.

|April 21, 2010

Summary

This summary is machine-generated.

Persistent postherniotomy pain (PPP) involves diverse sensory changes, including hypoesthesia and hyperalgesia. Quantitative sensory testing (QST) identifies patient subgroups for targeted pain management strategies.

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Area of Science:

Pain research
Neurology
Surgical outcomes

Background:

Previous studies on persistent postherniotomy pain (PPP) had limited patient numbers, hindering subgroup identification.
Existing research primarily identified differences in pressure pain thresholds, despite reported cutaneous pain and wind-up phenomena.

Purpose of the Study:

To comprehensively evaluate sensory functions in PPP patients using a standardized quantitative sensory testing (QST) protocol.
To enable individual sensory characterization of pain patients through calculated Z-values.
To identify potential patient subgroups for targeted treatment allocation.

Main Methods:

A standardized QST protocol was applied to 70 PPP patients with pain-related daily activity impairment.
Sensory function data were compared with normative data from 40 pain-free postherniotomy patients operated on over a year prior.
Z-values were calculated for individual sensory characterization.

Main Results:

A wide spectrum of sensory disturbances was observed, from hypoesthesia (e.g., cold detection) to hyperalgesia (e.g., pressure).
Hyperalgesia for various stimuli was present in 80% of patients, including pressure (65%) and cutaneous (35%).
Paradoxical tactile hypoesthesia and hyperalgesia occurred in 25% of patients; 51% reported increased pain from repetitive stimulation, suggesting altered central nociceptive function.
Contralateral pressure hyperalgesia (26%) correlated significantly with ipsilateral hyperalgesia, indicating central mechanisms in PPP.

Conclusions:

Standardized surgical trauma leads to heterogeneous combinations of sensory hypoesthesia and hyperalgesia in PPP.
Z-score evaluation of sensory function effectively identifies distinct subpopulations within PPP.
These identified subpopulations can inform the selection of appropriate surgical and/or pharmacological treatment strategies for persistent postherniotomy pain.