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Updated: Aug 18, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
A 5-Item Prediction Model Incorporating Pain With Neuropathic Characteristics at 2 Weeks for Chronic Postsurgical
Wei Dou1,2, Hai-Jing Shi1,2,3, Jin-Yi Liu1,2
1Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Background:
Chronic postsurgical pain (CPSP) after video-assisted thoracoscopic surgery (VATS) is common, yet clinicians lack tools to identify high-risk patients at routine follow-up. We hypothesized that pain with neuropathic characteristics at 2 weeks, signifying central sensitization, could stratify risk and guide precision analgesia.
Methods:
This prospective cohort study enrolled 500 adults undergoing VATS lung resection. Two logistic models were developed: one using variables on postoperative day 1 (POD1), and another adding neuropathic pain features on POD14. The primary outcome was CPSP at 3 months, defined as a Numerical Rating Scale [NRS] score ≥ 1 for pain in the surgical region that was not present preoperatively and was not attributable to malignancy or infection; sensitivity analysis was conducted using NRS ≥ 3. Discrimination (area under the curve [AUC]), calibration and decision curve analysis quantified predictive performance and potential clinical applicability.
Results:
Of 483 patients analysed, 247 (51.1%) developed CPSP and 184 (38.1%) had 3-mon NRS ≥ 3. The POD14 model (sex, surgery type, chest tube duration, pain intensity, pain with neuropathic characteristics) was superior (AUC 0.904, 95% CI: 0.872-0.936) to the POD1 model (AUC 0.865, 95% CI: 0.827-0.903). Neuropathic pain at 2 weeks was the strongest predictor (odds ratio 13.98, 95% CI: 2.90-67.38). Temporal validation confirmed discrimination with good calibration. Sensitivity analysis showed an AUC of 0.786 (95% CI: 0.737-0.835) for the POD14 model; pain with neuropathic characteristics retained strong predictive value.
Conclusions:
This 5-item tool with neuropathic pain features at 2-week visit identifies patients at high risk for CPSP after VATS.
Significance Statement:
Translating central sensitization from a theoretical mechanism to an actionable bedside tool, this study demonstrates that neuropathic pain features captured at routine two-week follow-up stratify risk for CPSP after VATS. This 5-item model is a first step toward individualized CPSP risk stratification after VATS and requires external validation before clinical implementation.
