Advancement of Psychophysics of Pain Modulation From Lab to Clinic: Constructing Susceptibility Profile for Appearance of Postoperative Neuropathic Pain

Recent advances in the field of pain psychophysics that have enhanced the understanding of pain processing by the nervous system seem to characterize the individual pattern of pain processing, thereby enabling the prediction of a person's susceptibility to develop chronic pain consequent to surgery.

In this project, the researchers propose to apply a wide array of advanced testing methods in order to prospectively assess the pain modulation pattern of pain free patients about to undergo an elective thoracotomy. Since about half of post-thoracotomy patients suffer from chronic neuropathic postoperative pain, the researchers expect to identify which tests predict a risk for this pain and the relative power of the relevant tests in this prediction, and to construct a short and applicable tool, the 'pain susceptibility profile', that will reliably predict the risk for the development of pain. The expected results of this project will serve the field of pain prevention by identifying patients at risk and tailoring interventions to reduce the risk of chronic pain.

Study Overview

• Status: Completed
• Conditions: Pain, Postoperative

Detailed Description

The common prevalence of painful syndromes following surgical interventions and injuries calls for a preventive therapeutic approach that can only be based on better insight into the pain modulation mechanisms in these patients. Recent advances in the field of pain psychophysics that have enhanced our understanding of pain processing by the nervous system seem to characterize the individual pattern of pain processing, thereby enabling the prediction of a person's susceptibility to develop chronic pain consequent to surgery.

In this project, we propose to apply a wide array of advanced testing methods in order to prospectively assess the pain modulation pattern of pain free patients about to undergo an elective thoracotomy. Tests will include:

1. psychophysical tests: pain thresholds and suprathreshold magnitude estimation, temporal summation, endogenous analgesia - diffuse noxious inhibitory control (DNIC);
2. tests for the interaction between pain and the autonomic nervous system including the inhibitory effect of vagal activation on pain perception, and the response pattern of the sympatho-parasympathetic balance to noxious stimulation; and
3. evaluation of personality components known to be associated with chronic pain including anxiety, catastrophization and somatization.

Since about half of post-thoracotomy patients suffer from chronic neuropathic postoperative pain, we expect to identify which tests predict a risk for this pain and the relative power of the relevant tests in this prediction, and to construct a short and applicable tool, the 'pain susceptibility profile', that will reliably predict the risk for the development of pain. The contribution of the above tests to the severity of acute postoperative pain, and of the latter on the development of the chronic postoperative pain will also be evaluated.

The expected results of this project will serve pain prevention by identifying patients at risk and tailoring interventions to reduce the risk of chronic pain. Also, in the wider pain research context, this understanding will allow better design and analysis of studies on pain mechanisms and therapies by considering the pain susceptibility of participating patients.

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• Israel
  • Haifa, Israel, 31096
    • Rambam Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Inclusion Criteria:

• Pain free patients to undergo major thoracic operation with both malignant and non-malignant diseases.

Exclusion Criteria:

• Psychiatric or cognitive dysfunction precluding use of psychophysics
• Existing thoracic pain
• Patients who cannot communicate in Hebrew

Description

Inclusion Criteria:

• Pain free patients to undergo major thoracic operation with both malignant and non-malignant diseases.

Exclusion Criteria:

• Psychiatric or cognitive dysfunction precluding use of psychophysics
• Existing thoracic pain
• Patients who cannot communicate in Hebrew

Study Plan

How is the study designed?

Collaborators and Investigators

• Sponsor: Rambam Health Care Campus
• Collaborators: Israel Scientific Foundation
• Investigators: Principal Investigator: David Yarnitsky, Professor, Neurology Department Chairman, Rambam Medical Center, Haifa, Israel

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2005
• Primary Completion (Actual): January 1, 2010
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: March 19, 2006
• First Submitted That Met QC Criteria: March 19, 2006
• First Posted (Estimate): March 21, 2006

Study Record Updates

• Last Update Posted (Actual): October 11, 2017
• Last Update Submitted That Met QC Criteria: October 10, 2017
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Keywords: chronic pain; prediction; thoracotomy; central sensitization; post-operative pain; temporal summation; endogenous analgesia; Patients Who Should Undergo Thoracotomy
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Postoperative Complications; Pain; Neurologic Manifestations; Neuromuscular Diseases; Peripheral Nervous System Diseases; Pain, Postoperative; Neuralgia
• Other Study ID Numbers: Thoracotomy02CTIL; ISF