PDF(Pubmed)
Abstract：
Chronic postsurgical pain (CPSP) is a common complication of surgery. We report that a patient with CPSP after open reduction and internal fixation (ORIF) had pain relief with duloxetine, and that the conditioned pain modulation (CPM) efficiency may predict the efficacy of duloxetine. A 54-year-old woman with CPSP after ORIF due to proximal humeral fracture was presented to our orthopedic clinic one month after surgery. Despite several analgesics, she still had pain three months after surgery, pain during activity was 74 on the visual analogue scale (VAS), 16 on the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), 18 on the PainDETECT questionnaire, and CPM efficiency was -5.7%. The patient was treated with duloxetine, starting at 20mg/day and increasing every week. Three months after starting duloxetine, pain on the VAS was 18, ASES was 61, PainDETECT questionnaire was 6, and CPM efficiency was -39.8%. The dose of duloxetine was decreased every week and then withdrawn. Neuropathic pain may be involved even in patients with CPSP after ORIF, and duloxetine may be efficacious in such cases. CPM testing may provide useful information for clinicians in selecting appropriate drugs and in determining when to withdraw drugs.
摘要：
慢性术后疼痛（CPSP）是手术的常见并发症。我们报告，在切开复位内固定（ORIF）后，CPSP患者使用度洛西汀缓解了疼痛，并且条件性疼痛调节（CPM）效率可以预测度洛西汀的疗效。手术后一个月，一名54岁的女性因肱骨近端骨折而在ORIF后接受CPSP治疗。尽管有几种止痛药，手术后三个月她仍然疼痛，在视觉模拟评分（VAS）上，活动期间的疼痛为74，美国肩肘外科医生标准化肩关节评估表（ASES）上的16，油漆检测问卷上的18，CPM效率为-5.7%。患者接受了度洛西汀治疗,从20mg/天开始，每周增加。开始度洛西汀三个月后，VAS疼痛为18，ASES为61，PainDETECT问卷为6，CPM有效率为-39.8%。每周减少度洛西汀的剂量，然后撤回。甚至在ORIF后的CPSP患者中也可能涉及神经性疼痛，在这种情况下，度洛西汀可能是有效的。CPM测试可以为临床医生选择适当的药物和确定何时撤回药物提供有用的信息。
