| Dissertation |
Thesis (Ph.D.) --NUI, 2012 at Department of Anaesthesia & Pain Medicine, UCC. |
| Summary |
The literature on persistent post surgical pain (PPSP) is limited to reports with insufficient pain assessment and fails to consider the multidimensional perspective that is now required if a complete clinically useful characterisation of PPSP is to be made. The key findings of the thesis include; •37.7% patients (n=53) developed PPSP following lumbar discectomy placing individuals having lumbar discectomy among those at highest risk of developing PPSP. •A relationship between the morphology of the herniated lumber disc, the degree of nerve root compromise and clinical neurophysiology indices offers a clinically useful pre-operative assessment method of identifying individuals who would benefit most from lumbar discectomy particularly in multilevel disc pathology. •A multivariate logistic regression model analysis identified independent predictor factors included age (odds ratio [OR] =1.0 per year), present pain intensity (OR = 0.6) and degree of dysfunction (OR = 1.2). Uniquely, the model focused on predicting PPSP in individuals who were known to suffer chronic pain prior to any surgical intervention. •In a randomised placebo-controlled prospective study of 32 patients (ASA I-II, 18-65 years) with radicular low back pain for > 3 months a single dose of pregabalin reduced the accumulative morphine consumption in the 24 hours following lumbar discectomy by 47% but it had no influence on long-term PPSP. This thesis advances our understanding of clinical outcome following lumbar discectomy by investigating new assessment options and including them in a multidimensional fashion to assess their role in predicting PPSP. It proposes the application of a predictive model to identify those patients who may be at a higher risk of developing PPSP and thereby supports an evidence-based clinical approach to providing better pre-operative information for both the patient and clinician with potential major implications for the understanding of other chronic pain states. |
| Subject |
Anesthesia.
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Pain.
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| Collection |
Theses Ph.D.
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Theses Anaesthesia and Intensive Care Medicine Department
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| Description |
229 p. ; 30 cm. |
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