Name: a quantitative sensory testing paradigm to obtain measures of pain processing in patients undergoing breast cancer surgery
Uploaded: 2018-01-18T15:00:00
Description: Watch this Scientific Journal Video about A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery at JoVE.com

Vi takker de patienter, der deltog i undersøgelsen præsenteret i afsnittet 'Repræsentative resultater'.

Denne protokol er blevet godkendt i forbindelse med en tidligere randomiseret kontrolleret forsøg8 af human forskning etiske udvalg region Arnhem-Nijmegen, Nederlandene (nr. 2004/239).
1. forberedelse til test
<ol><li>
Informeret samtykke:
	<ol>
<li>Anmeld informeret samtykkeerklæring sammen med patienten.</li>
		<li>Svar spørgsmål, patienten kan have med hensyn til undersøgelsen.</li>
		<li>Få skriftlig informeret samtykke ved at have tegnet pa...

<ol>
	<li>Macrae, W. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+post-surgical+pain:+10+years+on.">Chronic post-surgical pain: 10 years on.</a> Br J Anaesth. 101 (1), 77-86 (2008).</li><li>IASP Taxonomy Working Group. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Classification of Chronic Pain. , (2011).</li><li>Kehlet, H., Jensen, T. S., Woolf, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Persistent+postsurgical+pain:+risk+factors+and+prevention.">Persistent postsurgical pain: risk factors and prevention.</a> Lancet. 367 (9522), 1618-1625 (2006).</li><li>Steegers, M. A., Wolters, B., Evers, A. W., Strobbe, L., Wilder-Smith, O. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+axillary+lymph+node+dissection+on+prevalence+and+intensity+of+chronic+and+phantom+pain+after+breast+cancer+surgery.">Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery.</a> J Pain. 9 (9), 813-822 (2008).</li><li>Yarnitsky, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prediction+of+chronic+post-operative+pain:+pre-operative+DNIC+testing+identifies+patients+at+risk.">Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.</a> Pain. 138 (1), 22-28 (2008).</li><li>Hsu, E., Cohen, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Postamputation+pain:+epidemiology,+mechanisms,+and+treatment.">Postamputation pain: epidemiology, mechanisms, and treatment.</a> J Pain Res. 6, 121-136 (2013).</li><li>Franneby, U., Sandblom, G., Nordin, P., Nyren, O., Gunnarsson, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+for+long-term+pain+after+hernia+surgery.">Risk factors for long-term pain after hernia surgery.</a> Ann Surg. 244 (2), 212-219 (2006).</li><li>van Helmond, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperalgesia+and+Persistent+Pain+after+Breast+Cancer+Surgery:+A+Prospective+Randomized+Controlled+Trial+with+Perioperative+COX-2+Inhibition.">Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition.</a> PLoS One. 11 (12), e0166601 (2016).</li><li>Le Bars, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+whole+body+receptive+field+of+dorsal+horn+multireceptive+neurones.">The whole body receptive field of dorsal horn multireceptive neurones.</a> Brain Res Brain Res Rev. 40 (1-3), 29-44 (2002).</li><li>Yarnitsky, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Recommendations+on+practice+of+conditioned+pain+modulation+(CPM)+testing.">Recommendations on practice of conditioned pain modulation (CPM) testing.</a> Eur J Pain. 19 (6), 805-806 (2015).</li><li>Rolke, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+sensory+testing:+a+comprehensive+protocol+for+clinical+trials.">Quantitative sensory testing: a comprehensive protocol for clinical trials.</a> Eur J Pain. 10 (1), 77-88 (2006).</li><li>Wilder-Smith, O. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> A Paradigm-Shift in Pain Medicine: Implementing a Systematic Approach to Altered Pain Processing in Everyday Clinical Practice. Based on Quantitative Sensory Testing. , (2013).</li><li>Nasri-Heir, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Altered+pain+modulation+in+patients+with+persistent+postendodontic+pain.">Altered pain modulation in patients with persistent postendodontic pain.</a> Pain. 156 (10), 2032-2041 (2015).</li><li>Treede, R. D., Meyer, R. A., Raja, S. N., Campbell, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peripheral+and+central+mechanisms+of+cutaneous+hyperalgesia.">Peripheral and central mechanisms of cutaneous hyperalgesia.</a> Prog Neurobiol. 38 (4), 397-421 (1992).</li></ol>

Vores metode til kvantificering pres smertegrænser, elektriske smertegrænser, og CPM kan være anvendt med succes i en klinisk sammenhæng, da dens korte varighed (~ 20 minutter). Vi har tidligere vist, at pres smerte værdier opnået tidligt efter kirurgi kan være af værdi i at forudsige vedvarende smerter på lang sigt opfølgning i forbindelse med bryst kræft kirurgi8. Mens elektriske smertegrænser CPM ikke var prædiktiv for vedvarende smerter i vores undersøgelse, har andre vist, at di...

Kroniske smerter følgende kirurgi, vedvarende postsurgical smerter, er en vigtig forudsætning bidrager til betydelig symptom byrde og lavere livskvalitet1. Vedvarende post-operative smerter forbliver dårligt forstået, men er bredt anerkendt som smerten varer mere end 3 måneder efter operation2. Betingelsen er fælles, med skøn over dens udbredelse strækker sig fra 10% til 50% af alle postsurgical patienter3. Højrisiko procedurer omfatter bryst kirurgi4, torakotomi5, lemmer amputation6og Brok Reparation7. Vedvarende postsurgical smerter er relativt ildfaste til behandling og dermed har skabt interesse i potentielle forebyggende strategier og behandlinger. En bedre forståelse af forudsige og kendetegner vedvarende postoperative smerter vil hjælpe med at identificere delmængden af patienter, der er tilbøjelige til at kræve yderligere behandling for at optimere deres peri-operative smertebehandling.
For nylig blev det vist, at unormale ændringer i smertegrænser svar til kirurgi kan være prædiktiv værdi for udvikling på lang sigt vedvarende smerter i forbindelse med operation for brystkræft kræft8. Andre har understreget betydningen af konditioneret smerte graduering (CPM) effekt til at forudsige vedvarende postoperative smerter, for eksempel med hensyn til vedvarende smerter efter torakotomi5. CPM er den adfærdsmæssige korrelat af diffuse skadelige hæmmende kontrol, et fysiologisk fænomen, hvor input fra perifere c-fibre resultater i diffus hæmning fra hjernestammen af alle indkommende stimuli medieret af c-fiber fra heterotopisk felter9 . CPM-effekt måles ved at sammenligne tærskler til en skadelige stimulus, som måles før og efter anvendelsen af en anden forskellige stimulus, som er benævnt konditionering stimulus10.
Nuværende standardiseret kvantitative sensory testing (QST) protokoller, som tysk forskningsnetværk på neuropatiske smerter protokol11 er ganske omfattende og kan ikke være egnet til at udføre kirurgiske patienter. Formålet med den aktuelle publikation er at detaljer en kort og standardiseret protokol til at opnå både smertegrænser og en CPM-effektmåling i kirurgi brystkræftpatienter. Denne protokol er afledt fra en sammenlignende protokol mellem vores Universitet og Aalborg Universitet, Danmark12.

<table>
	<tbody>
		<tr>
			<td>Bed</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of hospital bed or medical exam table</td>
		</tr>
		<tr>
			<td>Desk</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available desk</td>
		</tr>
		<tr>
			<td>Office chair</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available office chair</td>
		</tr>
		<tr>
			<td>Force FPX 50 Pressure algometer</td>
			<td>Wagner Instruments, Greenwich, CT, USA</td>
			<td>N/A</td>
			<td>Pressure algometer with a 1.0 cm2 circular tip to deliver pressure to perform pressure pain threshold measurements</td>
		</tr>
		<tr>
			<td>Desktop computer</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available Windows computer to run QST-IV Stimulus Manager software on to control the QST-IV stimulator</td>
		</tr>
		<tr>
			<td>QST-IV Stimulus Manager</td>
			<td>Embedded Control BV, Ruurlo, the Netherlands</td>
			<td>N/A</td>
			<td>Software to control the settings of QST-IV electrical stimulator</td>
		</tr>
		<tr>
			<td>QST-IV Electrical Stimulator</td>
			<td>Embedded Control BV, Ruurlo, the Netherlands</td>
			<td>N/A</td>
			<td>Electrical quantitative sensory testing device with a patient operated switch. Device used to deliver electrical current to perform the electrical threshold measurements</td>
		</tr>
		<tr>
			<td>VAS Slider</td>
			<td>Embedded Control BV, Ruurlo, the Netherlands</td>
			<td>N/A</td>
			<td>The VAS slider consists of a box with a mobile lever on a horizontal bar that represents the VAS and is connected to the QST-IV.</td>
		</tr>
		<tr>
			<td>Kendall H34SG 50 x 45 mm</td>
			<td>Covidien, Mansfield, USA</td>
			<td>N/A</td>
			<td>Self-adhesive skin electrodes to apply to the measurement points on the skin to deliver electrical stimualtion</td>
		</tr>
		<tr>
			<td>Crushed Ice</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Ice generated by ice machine to cool water sufficiently for the cold pressor test</td>
		</tr>
		<tr>
			<td>Bucket</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available 10 L bucket</td>
		</tr>
		<tr>
			<td>Surgical skin marker</td>
			<td>Covidien, Mansfield, USA</td>
			<td>N/A</td>
			<td>Any type of commercially available surgical skin marker</td>
		</tr>
		<tr>
			<td>Stopwatch</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available stopwatch</td>
		</tr>
		<tr>
			<td>Measurement form</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Score form provided in the manuscript</td>
		</tr>
		<tr>
			<td>Pencil</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available pencil</td>
		</tr>
		<tr>
			<td>Thermometer</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Thermometer to measure water temperature of ice water</td>
		</tr>
		<tr>
			<td>Ruler</td>
			<td>N/A</td>
			<td>N/A</td>
			<td>Any type of commercially available ruler</td>
		</tr>
	</tbody>
</table>

a quantitative sensory testing paradigm to obtain measures of pain processing in patients undergoing breast cancer surgery

Kroniske smerter følgende kirurgi, vedvarende postsurgical smerter, er en vigtig meget udbredt tilstand bidrager til betydelig symptom byrde og lavere livskvalitet. Vedvarende postsurgical smerter er relativt ildfaste til behandling dermed generere et højt behov for forebyggende strategier og behandlinger. Identifikation af patienter med risiko for at udvikle vedvarende smerter er derfor et område med aktivt igangværende forskning. For nylig blev det påvist at peri-operative forstyrrelser i centrale smerter behandling muligvis kan forudsige vedvarende postsurgical smerter på lang sigt opfølgning i brystkræftpatienter. Formålet med den foreliggende betænkning er at præsentere en kort protokol for at opnå smertegrænser på forskellige stimuli på flere steder og en foranstaltning af endogene analgesi i brystkræftpatienter. Vi har brugt denne metode med held i klinisk sammenhæng og detaljeret nogle repræsentative resultater fra en klinisk undersøgelse.

I tidligere udgivne kliniske forsøg med kvinder (N = 94) gennemgår operation for brystkræft, vi målte elektriske og pres smertegrænser samt CPM-ved hjælp af den protokol, der er beskrevet i denne rapport8. Vi udførte test paradigme før indgrebet og på forskellige tidspunkter i løbet af året efter kirurgi. Vi fandt, at kvinder, der udvikles vedvarende postsurgical smerter 12 måneder efter brystkræft kirurgi, defineret som en VAS af > 30 mm, udv...

Watch this Scientific Journal Video about A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery at JoVE.com

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

Vedvarende postsurgical smerter kan være relateret til ændringer i smerte behandling. Ved vurdering af smerte som svar på standardiseret stimuli, kan ændringer i smerte behandling blive belyst. Vi præsenterer metoder for at opnå smertegrænser til forskellige stimuli og en foranstaltning af endogene analgesi i patienter, der gennemgår bryst kræft kirurgi.

En kvantitativ sensoriske test paradigme at få foranstaltninger af smerte behandling i patienter, der gennemgår bryst kræft kirurgi

Chronic pain following surgery, persistent postsurgical pain, is an important highly prevalent condition contributing to significant symptom burden and ...

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