Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability
IntroductionThe pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on post...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-08-01
|
| Series: | Frontiers in Pain Research |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpain.2023.1180969/full |
| _version_ | 1827867316635828224 |
|---|---|
| author | Jeko M. Madjarov Jeko M. Madjarov Michael G. Katz Michael G. Katz Yoav Hadas Sofia Jisoo Kim Lina Freage-Kahn Svetozar Madzharov Adam Vincek Sophia J. Madjarova Piers Seidman Nataly Shtraizent Nataly Shtraizent Steven A. Robicsek Efrat Eliyahu Efrat Eliyahu |
| author_facet | Jeko M. Madjarov Jeko M. Madjarov Michael G. Katz Michael G. Katz Yoav Hadas Sofia Jisoo Kim Lina Freage-Kahn Svetozar Madzharov Adam Vincek Sophia J. Madjarova Piers Seidman Nataly Shtraizent Nataly Shtraizent Steven A. Robicsek Efrat Eliyahu Efrat Eliyahu |
| author_sort | Jeko M. Madjarov |
| collection | DOAJ |
| description | IntroductionThe pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on postoperative pain, risk factors for chronic pain after cardiac surgery and to explore how chest reconstruction was associated with the intensity of pain.MethodsThe authors performed a study of acute and chronic thoracic pain after cardiac surgery in patients with and without sternal infection and compared different techniques for chest reconstruction. 42 high-risk patients for the development of mediastinitis were included. Patients with mediastinitis received chest reconstruction (group 1). Their demographics and risk factors were matched with no-infection patients with chest reconstruction (group 2) and subjects who underwent conventional sternal closure (group 3). Chronic pain was assessed by the numeric rating scale after surgery.ResultsThe assessment of the incidence and intensity of chest pain at 3 months post-surgery demonstrated that 14 out of 42 patients across all groups still experienced chronic pain. Specifically, in group 1 with sternal infection five patients had mild pain, while one patient experienced mild pain in group 2, and eight patients in group 3. Also, follow-up results indicated that the highest pain score was in group 3. While baseline levels of cytokines were increased among patients with sternal infection, at discharge only the level of interleukin 6 remained high compared to no infection groups. Compared to conventional closure, after chest reconstruction, we found better healing scores at 3-month follow-up and a higher percentage of patients with the complete sternal union.ConclusionsOverall, 14 out of 42 patients have chronic pain after cardiac surgery. The intensity of the pain in mediastinitis patients significantly decreased at 3 months follow-up after chest reconstruction. Thus, post-surgery mediastinitis is not a determining factor for development the chronic chest pain. There is no correlation between cytokines levels and pain score except interleukin 6 which remains elevated for a long time after treatment. Correlation between sternal healing score and chronic chest pain was demonstrated. |
| first_indexed | 2024-03-12T15:16:15Z |
| format | Article |
| id | doaj.art-b000e712612f414d9dcdf9079646b853 |
| institution | Directory Open Access Journal |
| issn | 2673-561X |
| language | English |
| last_indexed | 2024-03-12T15:16:15Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pain Research |
| spelling | doaj.art-b000e712612f414d9dcdf9079646b8532023-08-11T12:28:44ZengFrontiers Media S.A.Frontiers in Pain Research2673-561X2023-08-01410.3389/fpain.2023.11809691180969Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stabilityJeko M. Madjarov0Jeko M. Madjarov1Michael G. Katz2Michael G. Katz3Yoav Hadas4Sofia Jisoo Kim5Lina Freage-Kahn6Svetozar Madzharov7Adam Vincek8Sophia J. Madjarova9Piers Seidman10Nataly Shtraizent11Nataly Shtraizent12Steven A. Robicsek13Efrat Eliyahu14Efrat Eliyahu15Department of Cardiovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC, United StatesDepartment of Cardiovascular Surgery, Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC, United StatesDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Biology and Environmental Studies, New York University, New York, NY, United StatesFrezent Biological Solutions, New York, NY, United StatesDepartment of Cardiovascular Surgery, Atrium Health Sanger Heart and Vascular Institute, Charlotte, NC, United StatesDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Biology, Columbia University, New York, NY, United StatesBaruch College, City University of New York, New York, NY, United StatesFrezent Biological Solutions, New York, NY, United StatesSenex, New York, NY, United States0Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, United StatesDepartment of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States1Icahn School of Medicine at Mount Sinai, Icahn Genomics Institute, New York, NY, United StatesIntroductionThe pathogenesis of chronic chest pain after cardiac surgery has not been determinate. If left untreated, postoperative sternal pain reduces the quality of life and patient satisfaction with cardiac surgery. The purpose of the study was to examine the effect of chest inflammation on postoperative pain, risk factors for chronic pain after cardiac surgery and to explore how chest reconstruction was associated with the intensity of pain.MethodsThe authors performed a study of acute and chronic thoracic pain after cardiac surgery in patients with and without sternal infection and compared different techniques for chest reconstruction. 42 high-risk patients for the development of mediastinitis were included. Patients with mediastinitis received chest reconstruction (group 1). Their demographics and risk factors were matched with no-infection patients with chest reconstruction (group 2) and subjects who underwent conventional sternal closure (group 3). Chronic pain was assessed by the numeric rating scale after surgery.ResultsThe assessment of the incidence and intensity of chest pain at 3 months post-surgery demonstrated that 14 out of 42 patients across all groups still experienced chronic pain. Specifically, in group 1 with sternal infection five patients had mild pain, while one patient experienced mild pain in group 2, and eight patients in group 3. Also, follow-up results indicated that the highest pain score was in group 3. While baseline levels of cytokines were increased among patients with sternal infection, at discharge only the level of interleukin 6 remained high compared to no infection groups. Compared to conventional closure, after chest reconstruction, we found better healing scores at 3-month follow-up and a higher percentage of patients with the complete sternal union.ConclusionsOverall, 14 out of 42 patients have chronic pain after cardiac surgery. The intensity of the pain in mediastinitis patients significantly decreased at 3 months follow-up after chest reconstruction. Thus, post-surgery mediastinitis is not a determining factor for development the chronic chest pain. There is no correlation between cytokines levels and pain score except interleukin 6 which remains elevated for a long time after treatment. Correlation between sternal healing score and chronic chest pain was demonstrated.https://www.frontiersin.org/articles/10.3389/fpain.2023.1180969/fullcardiac surgerychronic chest painmediastinitiscytokineschest reconstructionsternal healing |
| spellingShingle | Jeko M. Madjarov Jeko M. Madjarov Michael G. Katz Michael G. Katz Yoav Hadas Sofia Jisoo Kim Lina Freage-Kahn Svetozar Madzharov Adam Vincek Sophia J. Madjarova Piers Seidman Nataly Shtraizent Nataly Shtraizent Steven A. Robicsek Efrat Eliyahu Efrat Eliyahu Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability Frontiers in Pain Research cardiac surgery chronic chest pain mediastinitis cytokines chest reconstruction sternal healing |
| title | Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability |
| title_full | Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability |
| title_fullStr | Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability |
| title_full_unstemmed | Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability |
| title_short | Chronic thoracic pain after cardiac surgery: role of inflammation and biomechanical sternal stability |
| title_sort | chronic thoracic pain after cardiac surgery role of inflammation and biomechanical sternal stability |
| topic | cardiac surgery chronic chest pain mediastinitis cytokines chest reconstruction sternal healing |
| url | https://www.frontiersin.org/articles/10.3389/fpain.2023.1180969/full |
| work_keys_str_mv | AT jekommadjarov chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT jekommadjarov chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT michaelgkatz chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT michaelgkatz chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT yoavhadas chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT sofiajisookim chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT linafreagekahn chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT svetozarmadzharov chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT adamvincek chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT sophiajmadjarova chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT piersseidman chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT natalyshtraizent chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT natalyshtraizent chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT stevenarobicsek chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT efrateliyahu chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability AT efrateliyahu chronicthoracicpainaftercardiacsurgeryroleofinflammationandbiomechanicalsternalstability |