Background: Postoperative neuropathic pain (PNP) is associated with a significant decline in quality of life, characterized by sleep disturbances, persistent functional limitations, and psychological distress, including anxiety and depression. The objective of this study was to determine the prevalence and associated factors of PNP. Methods: We conducted an analytical cross-sectional study in the general surgery and gynecology departments of first-category hospitals in the city of Douala. Sociodemographic, clinical, surgical, and therapeutic data, as well as the DN4 score, were collected from 211 operated and hospitalized postoperative patients. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Multivariate logistic regression was used to identify factors associated with the occurrence of PNP by estimating odds ratios (ORs) and their 95% confidence intervals (95% CIs). Results: The mean age of patients was 45.41 ± 14.75 years. The most represented age group was 41 to 55 years, with 96 patients (45.5%). The majority of patients were male (n = 122, 57.8%), unemployed (n = 86, 40.8%), and originated from the West region of Cameroon (n = 99; 46.9%). The prevalence of PNP was 28%. Neuropathic pain was mainly of moderate intensity (62.7%; n = 37), described as burning (54.2%; n = 32), associated with tingling sensations (55.9%; n = 33), and triggered by brushing (89.8%; n = 53). Gynecological surgery (aOR = 1.53; 95% CI: 1.19 - 2.80; p = 0.002), anxiety disorders (aOR = 1.72; 95% CI: 1.48 - 3.18; p = 0.001), amputation (aOR = 1.96; 95% CI: 1.13 - 3.40; p = 0.025), mastectomy (aOR = 1.71; 95% CI: 1.09 - 2.90; p = 0.012), and thoracotomy (aOR = 1.36; 95% CI: 1.26 - 4.61; p = 0.009) were significantly associated with postoperative neuropathic pain. Conclusion: The prevalence of PNP is high among postoperative patients and is most commonly characterized by burning sensations, tingling, and brush-induced allodynia. Its occurrence is independently associated with preoperative anxiety, amputations, mastectomies, as well as gynecological and thoracic surgeries.
References
[1]
Treede, R.D., Jensen, T.S., Campbell, J.N., Cruccu, G., et al. (2008) Neuropathic Pain: Redefinition and a Grading System for Clinical and Research Purposes. Neurology, 70, 1630-1635.
[2]
Finnerup, N.B., Haroutounian, S., Kamerman, P., Baron, R., Bennett, D.L.H., Bouhassira, D., et al. (2016) Neuropathic Pain: An Updated Grading System for Research and Clinical Practice. Pain, 157, 1599-1606. https://doi.org/10.1097/j.pain.0000000000000492
[3]
Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J., et al. (2005) Comparison of Pain Syndromes Associated with Nervous or Somatic Lesions and Development of a New Neuropathic Pain Diagnostic Questionnaire (DN4). Pain, 114, 29-36. https://doi.org/10.1016/j.pain.2004.12.010
[4]
Haroutiunian, S., Nikolajsen, L., Finnerup, N.B. and Jensen, T.S. (2013) The Neuropathic Component in Persistent Postsurgical Pain: A Systematic Literature Review. Pain, 154, 95-102. https://doi.org/10.1016/j.pain.2012.09.010
[5]
Nikolajsen, L. (2012) Postamputation Pain: Studies on Mechanisms. Danish Medical Journal, 59, B4527.
[6]
Hofer, D.M., Lehmann, T., Zaslansky, R., Harnik, M., Meissner, W., Stüber, F., et al. (2022) Rethinking the Definition of Chronic Postsurgical Pain: Composites of Patient-Reported Pain-Related Outcomes vs Pain Intensities Alone. Pain, 163, 2457-2465. https://doi.org/10.1097/j.pain.0000000000002653
[7]
Kehlet, H., Jensen, T.S. and Woolf, C.J. (2006) Persistent Postsurgical Pain: Risk Factors and Prevention. The Lancet, 367, 1618-1625. https://doi.org/10.1016/s0140-6736(06)68700-x
[8]
Ip, H.Y.V., Abrishami, A., Peng, P.W.H., Wong, J. and Chung, F. (2009) Predictors of Postoperative Pain and Analgesic Consumption: A Qualitative Systematic Review. Anesthesiology, 111, 657-677. https://doi.org/10.1097/aln.0b013e3181aae87a
[9]
Schug, S.A. and Bruce, J. (2017) Risk Stratification for the Development of Chronic Postsurgical Pain. PAIN Reports, 2, e627. https://doi.org/10.1097/pr9.0000000000000627
[10]
Hinrichs-Rocker, A., Schulz, K., Järvinen, I., Lefering, R., Simanski, C. and Neugebauer, E.A.M. (2009) Psychosocial Predictors and Correlates for Chronic Post-Surgical Pain (CPSP)—A Systematic Review. European Journal of Pain, 13, 719-730. https://doi.org/10.1016/j.ejpain.2008.07.015
[11]
Beloeil, H., Sion, B., Rousseau, C., Albaladejo, P., Raux, M., Aubrun, F., et al. (2017) Early Postoperative Neuropathic Pain Assessed by the DN4 Score Predicts an Increased Risk of Persistent Postsurgical Neuropathic Pain. European Journal of Anaesthesiology, 34, 652-657. https://doi.org/10.1097/eja.0000000000000634
[12]
Doth, A.H., Hansson, P.T., Jensen, M.P. and Taylor, R.S. (2010) The Burden of Neuropathic Pain: A Systematic Review and Meta-Analysis of Health Utilities. Pain, 149, 338-344. https://doi.org/10.1016/j.pain.2010.02.034
[13]
Smith, B.H. and Torrance, N. (2012) Epidemiology of Neuropathic Pain and Its Impact on Quality of Life. Current Pain and Headache Reports, 16, 191-198. https://doi.org/10.1007/s11916-012-0256-0
[14]
Brummett, C.M., Waljee, J.F., Goesling, J., Moser, S., Lin, P., Englesbe, M.J., et al. (2017) New Persistent Opioid Use after Minor and Major Surgical Procedures in US Adults. JAMA Surgery, 152, e170504. https://doi.org/10.1001/jamasurg.2017.0504
[15]
Finnerup, N.B., Attal, N., Haroutounian, S., McNicol, E., Baron, R., Dworkin, R.H., et al. (2015) Pharmacotherapy for Neuropathic Pain in Adults: A Systematic Review and Meta-Analysis. The Lancet Neurology, 14, 162-173. https://doi.org/10.1016/s1474-4422(14)70251-0
[16]
Gao, L., Mu, H., Lin, Y., Wen, Q. and Gao, P. (2023) Review of the Current Situation of Postoperative Pain and Causes of Inadequate Pain Management in Africa. Journal of Pain Research, 16, 1767-1778. https://doi.org/10.2147/jpr.s405574
[17]
Agoons, B.B., Tchapmi, D., Boli, A.O. and Katte, J. (2020) Clinical Utility of the DN4 Questionnaire in the Assessment of Neuropathic Pain in Patients with Type 2 Diabetes: Experience from a Newly-Created Diabetes Clinic in Cameroon. PAMJ Clinical Medicine, 3, Article 165. https://doi.org/10.11604/pamj-cm.2020.3.165.23789
[18]
Rauf, W.N., Meyer, H.P., Marcus, T.S. and Becker, P.J. (2014) The Impact of Chronic Pain on the Quality of Life of Patients Attending Primary Healthcare Clinics: Original Research. Southern African Journal of Anaesthesia and Analgesia, 20, 122-126.
[19]
van Hecke, O., Austin, S.K., Khan, R.A., Smith, B.H. and Torrance, N. (2014) Neuropathic Pain in the General Population: A Systematic Review of Epidemiological Studies. Pain, 155, 654-662. https://doi.org/10.1016/j.pain.2013.11.013
[20]
Pourhoseingholi, M.A., Vahedi, M. and Rahimzadeh, M. (2013) Sample Size Calculation in Medical Studies. The Gastroenterology and Hepatology from Bed to Bench, 6, 14-17.
[21]
Keita, O. (2011) Etude de la douleur chronique post opératoire au service de gynécologie-obstétrique du CHU Gabriel Touré. Ph.D. Thesis, Université de Bamako. https://bibliosante.ml/handle/123456789/1173
[22]
Freynhagen, R., Baron, R., Gockel, U. and Tölle, T.R. (2006) Paindetect: A New Screening Questionnaire to Identify Neuropathic Components in Patients with Back Pain. Current Medical Research and Opinion, 22, 1911-1920. https://doi.org/10.1185/030079906x132488
[23]
Celik, F. and Edipoglu, I.S. (2018) Evaluation of Preoperative Anxiety and Fear of Anesthesia Using APAIS Score. European Journal of Medical Research, 23, Article No. 41. https://doi.org/10.1186/s40001-018-0339-4
[24]
Boonstra, A.M., Stewart, R.E., Köke, A.J.A., Oosterwijk, R.F.A., Swaan, J.L., Schreurs, K.M.G., et al. (2016) Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing. Frontiers in Psychology, 7, Article 1466. https://doi.org/10.3389/fpsyg.2016.01466
[25]
Katz, J. and Seltzer, Z. (2009) Transition from Acute to Chronic Postsurgical Pain: Risk Factors and Protective Factors. Expert Review of Neurotherapeutics, 9, 723-744. https://doi.org/10.1586/ern.09.20
[26]
Peng, Z., Li, H., Zhang, C., Qian, X., Feng, Z. and Zhu, S. (2014) A Retrospective Study of Chronic Post-Surgical Pain Following Thoracic Surgery: Prevalence, Risk Factors, Incidence of Neuropathic Component, and Impact on Qualify of Life. PLOS ONE, 9, e90014. https://doi.org/10.1371/journal.pone.0090014
[27]
Wildgaard, K., Ravn, J. and Kehlet, H. (2009) Chronic Post-Thoracotomy Pain: A Critical Review of Pathogenic Mechanisms and Strategies for Prevention. European Journal of Cardio-Thoracic Surgery, 36, 170-180. https://doi.org/10.1016/j.ejcts.2009.02.005
[28]
Dualé, C., Ouchchane, L., Schoeffler, P., Soule-Sonneville, S., Decoene, C., Baylot, D., et al. (2014) Neuropathic Aspects of Persistent Postsurgical Pain: A French Multicenter Survey with a 6-Month Prospective Follow-Up. The Journal of Pain, 15, 24.e1-24.e20. https://doi.org/10.1016/j.jpain.2013.08.014
[29]
Perez, C., Galvez, R., Huelbes, S., Insausti, J., Bouhassira, D., Diaz, S., et al. (2007) Validity and Reliability of the Spanish Version of the DN4 (Douleur Neuropathique 4 Questions) Questionnaire for Differential Diagnosis of Pain Syndromes Associated to a Neuropathic or Somatic Component. Health and Quality of Life Outcomes, 5, Article No. 66. https://doi.org/10.1186/1477-7525-5-66
[30]
Ilhan, E., Chee, E., Hush, J. and Moloney, N. (2017) The Prevalence of Neuropathic Pain Is High after Treatment for Breast Cancer: A Systematic Review. Pain, 158, 2082-2091. https://doi.org/10.1097/j.pain.0000000000001004
[31]
Limakatso, K., Bedwell, G.J., Madden, V.J. and Parker, R. (2020) The Prevalence and Risk Factors for Phantom Limb Pain in People with Amputations: A Systematic Review and Meta-Analysis. PLOS ONE, 15, e0240431. https://doi.org/10.1371/journal.pone.0240431
[32]
Brandsborg, B., Nikolajsen, L., Hansen, C.T., Kehlet, H. and Jensen, T.S. (2007) Risk Factors for Chronic Pain after Hysterectomy: A Nationwide Questionnaire and Database Study. Anesthesiology, 106, 1003-1012.
[33]
Beyaz, S.G., Özocak, H., Ergönenç, T., Palabıyık, O., Tuna, A.T., Kaya, B., et al. (2016) Chronic Postsurgical Pain and Neuropathic Symptoms after Abdominal Hysterectomy: A Silent Epidemic. Medicine, 95, e4484. https://doi.org/10.1097/md.0000000000004484
[34]
Montes, A., Roca, G., Sabate, S., Lao, J.I., Navarro, A., Cantillo, J., et al. (2015) Genetic and Clinical Factors Associated with Chronic Postsurgical Pain after Hernia Repair, Hysterectomy, and Thoracotomy: A Two-Year Multicenter Cohort Study. Anesthesiology, 122, 1123-1141. https://doi.org/10.1097/aln.0000000000000611
[35]
Theunissen, M., Peters, M.L., Bruce, J., Gramke, H.F. and Marcus, M.A. (2012) Preoperative Anxiety and Catastrophizing: A Systematic Review and Meta-Analysis of the Association with Chronic Postsurgical Pain. The Clinical Journal of Pain, 28, 819-841.
[36]
Giusti, E.M., Lacerenza, M., Manzoni, G.M. and Castelnuovo, G. (2021) Psychological and Psychosocial Predictors of Chronic Postsurgical Pain: A Systematic Review and Meta-Analysis. Pain, 162, 10-30. https://doi.org/10.1097/j.pain.0000000000001999
[37]
Rosenberger, D.C. and Pogatzki-Zahn, E.M. (2022) Chronic Post-Surgical Pain—Update on Incidence, Risk Factors and Preventive Treatment Options. BJA Education, 22, 190-196. https://doi.org/10.1016/j.bjae.2021.11.008
[38]
Weinrib, A.Z., Azam, M.A., Birnie, K.A., Burns, L.C., Clarke, H. and Katz, J. (2017) The Psychology of Chronic Post-Surgical Pain: New Frontiers in Risk Factor Identification, Prevention and Management. British Journal of Pain, 11, 169-177. https://doi.org/10.1177/2049463717720636
[39]
Masselin-Dubois, A., Attal, N., Fletcher, D., Jayr, C., Albi, A., Fermanian, J., et al. (2013) Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer. The Journal of Pain, 14, 854-864. https://doi.org/10.1016/j.jpain.2013.02.013
