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The effect of post‐surgical neuroplasticity on the stability of systemic pain perception: A psychophysical study
Author(s) -
Granot M.,
WeissmanFogel I.
Publication year - 2012
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2011.07.003
Subject(s) - perioperative , medicine , allodynia , anesthesia , hyperalgesia , nociception , referred pain , neuroplasticity , surgery , physical therapy , psychiatry , receptor
Background Surgery‐induced neuroplasticity at spinal and supra‐spinal levels is assumed to evoke a clinical acute post‐operative pain ( cAPOP ) experience, which is expressed by allodynia and/or hyperalgesia. It remains unclear whether the systemic pain perception measured outside the incision area remains unchanged and whether it is affected by the presence of cAPOP . Aims This study explored whether the systemic perception of experimental pain would be altered towards hypersensitivity following elective gynecological surgery unmasked by opioids. Methods A perioperative psychophysical evaluation of heat pain thresholds ( HPT ) and pain estimations were obtained in a remote bodily area before and after surgery among 35 women. Results The ratings for both pain dimensions of intensity and unpleasantness remained stable following surgery. However, there was a reduction found in HPT the day after surgery (43.6 ± 2.2 ° C to 42.2 ± 3.1 ° C , p = 0.002). This reduction was associated with lower HPT measured before surgery ( r = .56, p < 0.000) and with higher cAPOP intensity obtained at rest ( r = −.44, p = 0.008). Conclusions This post‐surgical allodynia, as reflected by the systemic enhancement of pain perception, may represent plasticity in the central pain pathways at the supra‐spinal level. Pre‐surgical assessment of a patient's pain perception profile may predict certain pain dimensions of post‐surgical pain plasticity. The evaluation of individual pain profiles may contribute to a mechanism‐based approach aimed to attenuate the cAPOP .