• Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

      Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvais; Mudrakouski, Alexander L; Hayes, Ivan D; Keohane, Catherine; Butler, Mark A; Shorten, George D; Department of Anaesthesia, Cork University Hospital, Cork City, Ireland. oonaghhickey@yahoo.co.uk (2010-08)
      One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.
    • Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

      Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvais; Mudrakouski, Alexander L; Hayes, Ivan D; Keohane, Catherine; Butler, Mark A; Shorten, George D; Department of Anaesthesia, Cork University Hospital, Cork City, Ireland., oonaghhickey@yahoo.co.uk (2012-02-03)
      BACKGROUND AND OBJECTIVE: One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus. METHODS: A prospective observational pilot study of patients (n = 39) was performed. Quantitative sensory testing, visual analogue scales for anxiety and pain, the Hospital Anxiety and Depression (HADS) Scale and the McGill Pain Questionnaire were completed, and serum nitric oxide metabolites were measured perioperatively. Excised disc tissue was examined histologically, and immunohistochemistry for phospholipase A2 was performed. RESULTS: Ten patients (26%) had an unsatisfactory outcome. Those with a satisfactory outcome had greater preoperative pain perception thresholds over the affected dermatome, which decreased by 2 months postoperatively. These patients also demonstrated a decrease in nitric oxide metabolites from preoperatively to 18 h postoperatively. Greater preoperative HADS scores, and greater pain intensity 4 h and 24 h postoperatively were associated with an unsatisfactory outcome. CONCLUSION: Patients with a satisfactory outcome demonstrate a decrease in pain perception thresholds and plasma concentration of stable nitric oxide metabolites during the perioperative period. Patients with an unsatisfactory outcome following lumbar discectomy experience greater preoperative anxiety and greater pain during the early postoperative period. These findings justify a larger prospective observational study.
    • Perioperative pregabalin improves pain and functional outcomes 3 months after lumbar discectomy.

      Burke, Siun M; Shorten, George D; Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork, Ireland. siunburke@hotmail.com (2010-04-01)
      Patient outcome after lumbar discectomy for radicular low back pain is variable and the benefit is inconsistent. Many patients continue to experience pain 3 months after surgery. Pregabalin, a membrane stabilizer, may decrease perioperative central sensitization and subsequent persistent pain.
    • Persistent pain after mastectomy with reconstruction.

      Hickey, Oonagh T; Nugent, Nora F; Burke, Siun M; Hafeez, Parvaiz; Mudrakouski, Aliaksandr L; Shorten, George D; Department of Anaesthesia, Cork University Hospital and University College, Wilton, Cork City, County Cork, Ireland. oonaghhickey@yahoo.co.uk (2011-09)
      To determine the prevalence of persistent postsurgical pain (PPSP) and its influence on functional status, and to examine associations between PPSP and single nucleotide polymorphisms of the catechol-O-methyltransferase (COMT) gene and the guanosine triphosphate cyclohydrolase 1 (GCH1) gene following mastectomy and reconstruction.
    • Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain.

      Hickey, Oonagh T; Burke, Siun M; Hafeez, Parvaiz; Mudrakouski, Aliaksandr L; Hayes, Ivan D; Shorten, George D; Department of Anaesthesia, Cork University Hospital and University College Cork, Wilton, Ireland. oonaghhickey@yahoo.co.uk (2010-09)
      Persistent postsurgical pain (PPSP) after surgery for breast cancer has a prevalence of 20% to 52%. Neuroplastic changes may play a role in the aetiology of this pain. The principal objective of this study was to examine the relationship between acute pain after surgery for breast cancer and the likelihood of subsequently developing PPSP.