Quantitative testing of a patient's basal pain perception before surgery has the potential to be of clinical value if it can accurately predict the magnitude of pain and requirement of analgesics after surgery. This review includes 14 studies that have investigated the correlation between preoperative responses to experimental pain stimuli and clinical postoperative pain and demonstrates that the preoperative pain tests may predict 4-54% of the variance in postoperative pain experience depending on the stimulation methods and the test paradigm used. The predictive strength is much higher than previously reported for single factor analyses of demographics and psychologic factors. In addition, some of these studies indicate that an increase in preoperative pain sensitivity is associated with a high probability of development of sustained postsurgical pain.

RECENT surveys indicate that postoperative pain still remains inadequately treated.1–4In addition, it has been estimated that up to 5% of individuals undergoing surgery will develop severe persisting pain leading to chronic physical disability and psychosocial distress.5,6In a number of studies, preexisting pain and high-intensity postoperative pain have been the predictors of development of persisting pain after surgery.7–12 

The research in postoperative pain management has for more than two decades centered on delivery methods, pharmacotherapy with new drugs or combination of older drugs, and organizational aspects.13,14Despite extensive resources used on patient-controlled analgesia, spinal drug delivery methods, coanalgesics, multimodal analgesia, guidelines for acute pain management, and implementation of acute pain services, the results, in terms of an improved outcome after major surgery, seem unexpectedly modest.15,16 

Therefore, the postoperative pain research has recently focused on investigating pharmacologic and psychophysiologic explanations for the insufficient pain relief, that is, an inadequate response to analgesics17or an increased response to pain.18Implementation of relevant preoperative screening methods may facilitate more aggressive pain therapies specifically targeted at individuals at a high risk of experiencing severe postoperative pain, which may translate to an improvement in postoperative rehabilitation and a reduction in short- and long-term morbidity.

This article is a review of studies investigating the correlation between responses to preoperatively applied experimental pain stimuli and clinical postoperative pain.19–32 

Literature Search


Ten of the studies included in this review were known to the authors before the start of the review. Reference lists in the included articles were reviewed for related articles. To cross-track studies, a citation search for each of these articles was made (ISI Web of KnowledgeSM). The original articles were as of July 1, 2009 cited a total of 220 times (median 6 [interquartile range, 3–21]), and these references were examined manually. Finally a PubMed, EMBASE, CINHAL, and Cochrane database search was performed between the years 1966 and 2009 using the MeSH terms postoperative pain, predictive value of tests, and pain measurement.

Quality Assessment.

Nineteen quality domains33reflecting study population, study attrition, prognostic factor measurement, outcome measurement, confounding factors, and analysis were analyzed ( appendix). Each domain was evaluated using a dichotomized quality score of 0 or 1. A global quality assessment score was obtained by simple summation of the scores, thus the global assessment score for each study was between 0 and 19 points. Initial assessments of all studies were made independently by the authors. In case of a difference in assessors' scores of more than or equal to 3 points, a reevaluation was made and a consensus was reached.

Literature Search

Fifteen studies with preoperative pain testing were identified.19–32,34One study correlated preoperative data with intraoperative pain assessments during transrectal biopsy of the prostate and did not fill the inclusion criteria, and therefore, it was excluded.34 

Quality Assessment

The median (interquartile range) of the global quality assessment scores (0–19) of the studies was 16 (14–17).

Physical Status

In five of the studies,19,21,23,24,26patients were classified according to the American Society of Anesthesiologists classification system as status I–III. The demographical data are presented in table 1.

Table 1.  Surgical Procedures, Demographics, and Preoperative Tests

Table 1.  Surgical Procedures, Demographics, and Preoperative Tests
Table 1.  Surgical Procedures, Demographics, and Preoperative Tests

Preoperative Pain Evaluation

In six of the studies,19,22,24,27,28,30the presence of preoperative pain was reported. In one study,28the patients were asked to indicate the presence of preoperative pain, but in the remaining studies, only pain localized to the area of surgery was investigated. In the knee surgery studies, the duration of pain27,30and the skin temperature and knee circumferences27were reported. In two thoracotomy studies, individuals with pain29or with thoracic pain,32respectively, were excluded.

Preoperative Pain Stimulation Methods

Quantitative sensory testing (QST),35defined as quantifiable mechanical (pressure, punctuate, vibratory, and light touch), thermal (cold pain, cool, warm, and heat pain) or electrical stimuli, was used in nearly all the studies. (In neurologic literature, QST usually refers only to testing with light touch, vibratory, and thermal stimulation.36,37) The experimental stimulation methods were the cold-pressor test,19heat immersion test,29brief phasic20,24,27,28,32or tonic heat stimulation,25cutaneous electrical stimulation,21,26,30,31pressure algometry,23punctate mechanical stimulation,27,32and induction of an inflammatory injury (table 1).22Contact thermodes were used in eight studies,20,22,24,25,27–29,32hand immersion in cold or hot water in two studies,19,29electrical stimulation with surface electrodes in four studies,21,26,30,31pressure algometry with digital pinching in one study,23and punctuate stimulation with monofilaments in two studies.27,32 

Pain intensity during the preoperative stimulation procedure was assessed with a Visual Analog Scale (VAS) or Numerical Rating Scales (Verbal Rating Scale and Numerical Pain Scale [table 1]). The additional pain assessments were with the short-form McGill Pain Questionnaire19,28or nonvalidated questionnaires.22,24 

Preoperative Psychometric Evaluations

In six studies,19,23–25,28,32,the assessments of psychologic vulnerability,19,28anxiety and depression (State Trait Anxiety Inventory and Hospital Anxiety Depression Scale),23,28,32and pain catastrophizing (Pain Catastrophizing Scale)25,32supplemented the experimental pain testing (table 1).

Surgical Procedure, Anesthesia, and Postoperative Analgesia

Data concerning the surgical procedure, and anesthesia and postoperative analgesia are outlined in tables 1 and 2, respectively. Epidural analgesia with bupivacaine and fentanyl was used in two studies.29,32Systemic analgesia was with paracetamol, nonsteroidal antiinflammatory drugs, nefopam (centrally acting inhibitor of serotonin, dopamine, and norepinephrine reuptake), and opioids. In most of the studies, a combination therapy was used except for one study that used opioid monotherapy.23In all studies except two,23,27nonsteroidal antiinflammatory drugs were used. In four studies,19,21,22,26postoperative around-the-clock analgesia with fixed doses was prescribed, with a duration of medication from 1 to 7 days. In the remaining studies, analgesics were prescribed as a rescue medication.20,23–25,27–29,31,32 

Table 2.  Anesthesia, Postoperative Analgesia, and Pain Assessment

Table 2.  Anesthesia, Postoperative Analgesia, and Pain Assessment
Table 2.  Anesthesia, Postoperative Analgesia, and Pain Assessment

Postoperative Pain Assessments

In all studies except one,31resting pain scores were reported, and in 10 studies, dynamic pain scores were also reported20–22,24,26–29,31,32(table 2). Pain localization was specified in eight studies.19–21,24–27,30In two studies, patients were asked either to indicate incisional, deep, evoked, referred, and/or overall pain,19or to indicate pain localizations on an anatomic chart daily for 10 days after surgery.28Two studies investigated sustained pain in the surgical area at 29 weeks and 18 months, respectively, after surgery.29,30 

Statistical Methods

In all studies except one,30univariate analyses19–29,31,32were used to investigate the association between dependent variables, postoperative pain, or analgesic requirement and independent preoperative predictor variables (table 3). Univariate parametric analyses (Pearson's r ) were used in six studies,20,23,25,28,29,32and nonparametric analyses (Spearman's rho [ρ]) were used in six studies.19,22,24,26,27,31In two studies, data distribution was evaluated for normality by the Kolmogorov-Smirnov test.22,23In eight studies,19,23–25,28–30,32the predictor variables were tested in a multiple linear regression analyses stepwise method, calculating the multiple regression coefficient (R ), or in a logistic regression model calculating odds ratio in six studies19,23–25,28,32and two studies29,30(table 3).

Table 3.  Outcome Variables, Predictors, Nonpredictors, and Correlation

Table 3.  Outcome Variables, Predictors, Nonpredictors, and Correlation
Table 3.  Outcome Variables, Predictors, Nonpredictors, and Correlation

Prediction of Postoperative Pain Intensity

The predictive variables for acute and chronic postoperative pain were investigated in 13 studies19–29,31,32and three studies,27,29,30respectively. The significant predictors for acute postoperative pain were found in 11 studies19–28,32and for chronic postoperative pain in two studies.29,30The psychologic factors significantly predicted postoperative pain intensity in five studies using univariate analyses19,23–25,28or using multiple regression models.23–25,28 

Prediction of Postoperative Requirement of Analgesics

Four studies evaluated the predictive power of QST and psychometrics on requirement of analgesics.23,24,27,28In a pressure algometry study,23the preoperative pain tolerance after the intravenous administration of fentanyl (2 μg/kg) predicted 23% of variance in postoperative morphine requirement the first 24 h postoperatively. In the cesarean section studies, preoperative anxiety assessments (State Trait Anxiety Inventory) predicted 22% of the variance in total analgesic requirement (assessed intraoperatively, at the postanesthesia care unit and 6 h postoperatively),24whereas preoperative pain catastrophizing (Pain Catastrophizing Scale),25response to phasic heat pain test,25and electrical pain thresholds26did not correlate with postoperative need of supplemental analgesics. In one of the knee studies, preoperative heat hyperalgesia at the inflammatory changed surgical area predicted 44% of the variance in postoperative morphine consumption by patient-controlled analgesia during the first 24 h.27 

The present review demonstrates that the preoperative pain tests may predict 4–54% of the variance in postoperative pain experience depending on the testing method and testing paradigm used (table 3). The predictive strength of these tests is much higher than previously reported for single factor analyses of demographics (age,38,39gender40,41) and psychologic factors (depression,42–46anxiety,8,47–49and vulnerability18). Indeed, the authors in the first experimental pain studies19,20,22indicated that the incentive to use a psychophysical testing paradigm was based on the previous unsuccessful attempts at getting adequate predictive power from psychometrically based tests. This was indirectly corroborated in the current study, because by adding psychologic variables (vulnerability,19,28anxiety,23,28,32depression,28and catastrophizing25,32) to the sensory variables in the multivariate regression analysis, the increase in predictive power of the model generally was modest or even absent. However, the variables may be dependent, and therefore, it is noteworthy that only one of the studies tested for interdependency of the variables.28 

Quality Assessment

More than 2,500 new systematic reviews are indexed annually in PubMed.50Although elaborate reporting guidance exists for randomized controlled trials, the Consolidated Standards of Reporting Trials statements,51and for reporting of meta-analysis of randomized controlled trials,52the Quality of Reporting of Meta-analyses statement, a standard quality assessment method for systematic reviews of nonrandomized controlled trails has not until recently been available.33,50Therefore, quality appraisal is incomplete in most reviews of prediction studies.33We selected a number of relevant domains, used a simple quality score, and for each study, calculated a global quality assessment score to facilitate a quantitative comparison of the studies. The studies of this review achieved a high median score, but a high score does not necessarily per se  imply a greater scientific value because most of the studies included in this review are small-scale studies of exploratory nature.

Preoperative Pain

Only four studies19,27,28,30reported the prevalence of preoperative pain, which has been considered a significant predictor of severe postoperative pain5,48,53,54and for development of chronic postsurgery pain.5,7The prevalence of chronic pain in Europe is 19%, which underscores the significance of the problem in the surgical population.55However, not all studies have observed a relationship between preoperative pain and development of chronic pain; in a recently published study, high-intensity postoperative pain, but not preoperative pain, was associated with the development of chronic pain and functional impairment 6 months after surgery.11Nevertheless, it has been hypothesized that severe preoperative pain is associated with a sustained nociceptive input that may lead to neuroplasticity changes in the central nervous system.5,56This sensitization, which may be enhanced by opioid treatment,57plays an important role in the exaggerated postoperative pain response seen in chronic pain patients.29,57–60 

Preoperative Pain Stimulation Methods

In two knee studies, the QST assessments were made either in an experimentally induced burn injury contralateral to the surgery site22,61or in the inflammatory changed tissues at the surgery site.27This distinction could be important because surgery is associated with profound changes in the inflammatory and nociceptive system leading to pain and hyperalgesia, where abnormal persistence of the nervous system sensitization may lead to the development of chronic postsurgery pain.62It could be speculated that the preoperative QST assessments in the inflammatory changed tissues more accurately reflect and predict the postoperative state of the nociceptive system. In support of this is the fairly good predictive power, observed in these two studies,22,27explaining 36–43% of the variance in postoperative pain experience (table 3).

It is believed that suprathreshold noxious stimulation has a better predictive performance than pain thresholds in regard to experience of clinical pain and requirement of analgesics.63,64The current data corroborate this statement because in five20,22,24,25,28of six thermal QST studies (table 3), a better predictive power of suprathreshold stimulation was observed. Furthermore, in 11 of 12 studies, suprathreshold pain stimulation, either in a phasic20,24,25,27,28,32or tonic19,21–23,25,29stimulation mode, was used.

However, a number of interesting observations were made in the three of four studies that used transcutaneous electrical stimulation.21,26,30First, a highly significant correlation between electrical pain thresholds and postoperative pain ratings was observed (table 3). Second, in one of the studies, a high predictive power (ρ2= 0.27–0.42) was found.26Third, in a recent total knee replacement study, preoperative low electrical pain thresholds were associated with an increased risk of chronic pain 18 months after surgery.30These findings suggest that important differences may exist between stimulation modalities, that is, the electrical pain thresholds seem to have a much greater predictive potential than the mechanical or thermal pain thresholds. However, it should be noted that in the fourth of the electrical stimulation studies, in male groin hernia repair patients,31no significant predictive role for electrical pain thresholds and tolerance thresholds was observed, which probably can be explained by gender-related differences.

In the electrical stimulation studies,21,26,30,31the gender distribution (females/males) was 50% (194/196), and for studies with positive predictive value, the gender distribution (females/males) was 85% (194/36). Females generally demonstrate lower electrical detection thresholds, electrical pain thresholds, and electrical tolerance levels than males.65–67This may indicate that perception of electrical stimulation is associated with higher levels of anxiety and greater level of discomfort in females compared with males.66 

From a methodologic standpoint, it is remarkable that 67% (645/964) of the study population in the 14 studies in the current review was female and that 58% (559/964) of the study populations were included in single-gender studies (table 1). Although the heterogeneity of the studies in this review does not allow any gender-related comparisons, there are data that indicate a higher correlation between responses to experimental pain stimuli, and clinical pain and pain-treatment outcomes in females compared with males.63,68 

Five studies included cesarean section patients corresponding to 31% (298/964) of the study population.20,21,24–26A majority of the parturients (53%) was investigated with electrical stimulation. The prevailing opinion has been that pregnancy is associated with an increased antinociception.20In a recent study,69however, the responses to mechanical and electrical noxious stimuli were tested immediately before and 4 days after elective cesarean section in 30 women and compared with a control group of nonpregnant women. No intragroup or between-group differences were observed, indicating that late pregnancy does not seem associated with an increased antinociception.

Preoperative Psychometric Evaluations and Age

As previously stated, psychologic factors do not seem as efficient predictors of intensity of postoperative pain as QST variables (table 3). This is interesting because a number of recent studies have reported that in particular preoperative anxiety,47,70but also depression,44neuroticism71,72and catastrophizing behavior49seem associated with the development of high-intensity postoperative pain18and may have a negative effect on surgical outcome.73 

A significant inverse correlation between age and postoperative pain intensity was seen in the two largest studies,19,31including patients from 20 to 85 yr, a finding that is consistent with the previous studies.43,74 

Surgical Procedures

The previous research has demonstrated that the surgical procedure and technique may influence the intensity and the duration of postoperative pain.5,74Therefore, an important limitation of this systematic review is that although 5 of 14 studies were on cesarean section, in the remaining studies, seven different surgical procedures were performed (table 1), indicating an important heterogeneity of data. It is not known whether the pain mechanisms or pain trajectory may differ between inflammatory, neuropathic, or visceral types of postoperative pain. The results from the elective cesarean section studies20,21,24–26suggest rather consistently that pain after this procedure can, in part, be predicted (table 3).

In the current review, two relatively minor surgical procedures were included, that is, laparoscopic tubal ligation28and open groin hernia repair.31Both studies indicate that even after minor tissue injury, a considerable number of patients experience movement-related acute pain of moderate to severe intensity. Unfortunately, because of the large interstudy variability in the assessments of postoperative pain and in the postoperative analgesia regimen, it is not possible to seek out differences in pain ratings between various procedures. Even in the cesarean section studies20,21,24–26with a standardized tissue injury, a major variability in pain ratings was evident.

In the large thoracotomy study,29focused on the development of chronic postsurgical pain, the patients were not fully characterized in terms of their concomitant oncological disease. The adjuvant treatments and the presence of metastases are confounding factors that may lead to an increased pain. Even short-term treatment with morphine has been demonstrated to be associated with diffuse noxious inhibitory control (DNIC)-interference75and development of tolerance and hyperalgesia, which may influence postoperative pain management.76,77 

Prediction of Postoperative Pain Intensity and Development of Chronic Postsurgical Pain

The initial mean or median pain ratings (VAS, Verbal Rating Scale and Numerical Pain Scale [0–100]) were more than 45 in four studies during rest19,23,25,27and in seven studies during movement,20,22,24,26,27,29,32representing 29 and 26%, respectively, of the total study population. An association between intensity of acute postoperative pain and subsequent development of chronic pain has been demonstrated.5,11,12In a 1 yr, questionnaire-based follow-up12of the patients included in the large laparoscopic cholecystectomy study,19the sum of postoperative VAS during days 1–7 was a better predictor than maximum reported VAS, which may indicate that also the duration of postoperative pain may influence the development of chronic pain.12 

In a number of predictive studies, the focus has recently shifted from acute postoperative pain and requirement of analgesics to development of chronic postsurgical pain.11,12,29,30In the 1-yr follow-up12of the laparoscopic cholecystectomy study,1911% of the patients fulfilled criteria of chronic pain. The first preoperative QST study on development of chronic postoperative pain30included 69 patients with osteoarthritis undergoing total knee replacement surgery. The relationship between preoperative variables and postoperative assessments of pain at rest and during movement, 18 months after the surgical procedure, was studied by logistic regression analysis (n = 63). A VAS score (0–10) of 1 was used as the lower boundary for persistent postoperative pain at rest or during movement (!). Two preoperative variables, pain at rest and electrical pain sensitivity, contributed significantly to the prediction of persistent pain with odds ratios of 6.48 (95% CI, 1.32–31.96) and 9.19 (1.69–50.07), respectively. The study did not report data on acute postoperative pain or give details on postoperative pain management.

The second QST study29investigated 62 patients undergoing anterolateral thoracotomy during a follow-up period of 29 weeks. This study used preoperative activation of the DNIC system induced by hand immersion in hot water (46.5°C) for 1 min as the “conditioning stimulus.” Noxious test stimuli were 30 s heat stimuli calibrated individually for each patient (45°–47°C)78corresponding to a perceived pain intensity of 60 of 100 on a Numerical Pain Scale. These test stimuli were given before and after the DNIC-challenge, and the difference in Numerical Pain Scale values of the assessments represented “DNIC efficiency.” Higher levels of DNIC efficiency was associated with an odds ratio of 0.52 (95% CI, 0.33–0.77), that is, predicting a nearly halved risk of developing chronic pain, whereas severe postoperative pain was associated with an odds ratio of 1.80 (1.28–2.77), predicting a nearly doubled risk of chronic pain development. Interestingly, DNIC efficiency per se  did not correlate with the magnitude of acute postoperative pain. These results are in the vanguard of predictive postoperative research and seem applicable in a clinical setting, in particular if the high noxious intensity of the conditioning stimulus can be reduced.79 

Prediction of Postoperative Requirement of Analgesics

These data indicate that during specific procedures (cesarean section, hysterectomy, knee surgery, and myomectomy), preoperative QST and State Trait Anxiety Inventory assessments may predict 22–44% of the postoperative analgesic requirement.23–27However, a composite calculation score based on rescue analgesic consumption and pain ratings (both before and after rescue) during a defined time period is probably much more appropriate to use, but unfortunately it is used rarely in clinical pain research.80,81 

Clinical Implications

Although some authors in the current review stated a necessity for a multifactorial model combining psychosocial and psychophysical aspects of pain,24,28others pointed to the need for a simple and reliable prognostic assessment method of postoperative pain.23,26The application of sensory tests and psychometric questionnaires are in most cases a time consuming process,82and not clinically feasible at this time, although a simple electrical device was used in two of the studies.26,31Kalkman et al .48presented a multivariate model that included seven clinically relevant variables, all easily obtained during the preoperative evaluation, to predict the probability of severe pain at the first postoperative hour. The specificity and sensitivity of the model in predicting severe postoperative pain (Numerical Rating Scale ≥8 of 10) was 61 and 74%. The authors recently revised the model and improved its content and construct validity.70,74Unfortunately, this method has not been compared with preoperative QST assessments.

This review demonstrates that QST assessments may predict up to 54% of the variance in postoperative pain experience, particularly after cesarean section, and in development of persistent postsurgical pain. The predictive strength of the tests is much higher than previously reported for single factor analyses of demographics and psychologic factors.

The predictive ability of thermal methods requires stimuli of suprathreshold intensity, whereas for electrical methods, only stimuli at pain threshold intensity are needed. The data corroborate that there is a better correlation between electrical pain threshold and clinical pain, in females compared with males. The psychometric assessments do not seem to contribute to an increase in predictive power.

Future predictive studies will benefit from improved methodology, in regard to selection of surgical procedures, standardization of assessments, and increased clinical applicability of methods, and use of dynamic QST-assessments, such as DNIC efficiency29and temporal summation.32 

The authors thank Dorte M. Saltoft, B.A. (Speech and Language Therapist, Department of Stroke 122, Hvidovre University Hospital, Copenhagen, Denmark), for help during completion of the manuscript.

Appendix: Quality Assessment: Grading System33 

Selected domains:

  1. Study population described

  2. Completeness of follow-up described

  3. Completeness of follow-up adequate

  4. Prognostic factors defined

  5. Prognostic factors measured appropriately

  6. Outcome defined

  7. Outcome measured appropriately

  8. Confounders defined and measured

  9. Confounding accounted for

  10. Analysis described

  11. Analysis appropriate

  12. Analysis provides sufficient presentation of data

  13. Follow-up length appropriate

  14. Follow-up length described

  15. General appropriateness of outcome

  16. Research question definition

  17. Sample size adequate

  18. Study design adequate

  19. Evidence supporting conclusions

Grading is dichotomized yes (1) or no (0), and a simple summation of grades (0–19) gives global assessment score.

Gramke HF, de Rijke JM, van KM, Raps F, Kessels AG, Peters ML, Sommer M, Marcus MA: The prevalence of postoperative pain in a cross-sectional group of patients after day-case surgery in a university hospital. Clin J Pain 2007; 23:543–8
Fletcher D, Fermanian C, Mardaye A, Aegerter P: A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 2008; 137:441–51
Benhamou D, Berti M, Brodner G, De AJ, Draisci G, Moreno-Azcoita M, Neugebauer EA, Schwenk W, Torres LM, Viel E: Postoperative analgesic therapy observational survey (PATHOS): A practice pattern study in 7 Central/Southern European countries. Pain 2008; 136:134–41
Sommer M, de Rijke JM, van KM, Kessels AG, Peters ML, Geurts JW, Gramke HF, Marcus MA: The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol 2008; 25:267–74
Kehlet H, Jensen TS, Woolf CJ: Persistent postsurgical pain: Risk factors and prevention. Lancet 2006; 367:1618–25
Poleshuck EL, Green CR: Socioeconomic disadvantage and pain. Pain 2008; 136:235–8
Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH: Risk factors for chronic pain following breast cancer surgery: A prospective study. J Pain 2006; 7:626–34
Katz J, Poleshuck EL, Andrus CH, Hogan LA, Jung BF, Kulick DI, Dworkin RH: Risk factors for acute pain and its persistence following breast cancer surgery. Pain 2005; 119:16–25
Pluijms WA, Steegers MA, Verhagen AF, Scheffer GJ, Wilder-Smith OH: Chronic post-thoracotomy pain: A retrospective study. Acta Anaesthesiol Scand 2006; 50:804–8
Steegers MA, van de LA, Noyez L, Scheffer GJ, Wilder-Smith OH: The role of angina pectoris in chronic pain after coronary artery bypass graft surgery. J Pain 2007; 8:667–73
Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, Marcus MA, Vlaeyen JW, van KM: Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007; 245:487–94
Bisgaard T, Rosenberg J, Kehlet H: From acute to chronic pain after laparoscopic cholecystectomy: A prospective follow-up analysis. Scand J Gastroenterol 2005; 40:1358–64
Rawal N: Organization, function, and implementation of acute pain service. Anesthesiol Clin North Am 2005; 23:211–25
Werner MU, Rotboll-Nielsen P: The acute pain service—roles and challenges. Curr Anaesth Crit Care 2007; 18:135–9
Liu SS, Wu CL: Effect of postoperative analgesia on major postoperative complications: A systematic update of the evidence. Anesth Analg 2007; 104:689–702
White PF, Kehlet H: Postoperative pain management and patient outcome: Time to return to work! Anesth Analg 2007; 104:487–9
Stamer UM, Stuber F: The pharmacogenetics of analgesia. Expert Opin Pharmacother 2007; 8:2235–45
Rotboll-Nielsen P, Rudin A, Werner MU: Prediction of postoperative pain. Curr Anaesth Crit Care 2007; 18:157–65
Bisgaard T, Klarskov B, Rosenberg J, Kehlet H: Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain 2001; 90:261–9
Granot M, Lowenstein L, Yarnitsky D, Tamir A, Zimmer EZ: Postcesarean section pain prediction by preoperative experimental pain assessment. Anesthesiology 2003; 98:1422–6
Wilder-Smith CH, Hill L, Dyer RA, Torr G, Coetzee E: Postoperative sensitization and pain after cesarean delivery and the effects of single im doses of tramadol and diclofenac alone and in combination. Anesth Analg 2003; 97:526–33
Werner MU, Duun P, Kehlet H: Prediction of postoperative pain by preoperative nociceptive responses to heat stimulation. Anesthesiology 2004; 100:115–9
Hsu YW, Somma J, Hung YC, Tsai PS, Yang CH, Chen CC: Predicting postoperative pain by preoperative pressure pain assessment. Anesthesiology 2005; 103:613–8
Pan PH, Coghill R, Houle TT, Seid MH, Lindel WM, Parker RL, Washburn SA, Harris L, Eisenach JC: Multifactorial preoperative predictors for postcesarean section pain and analgesic requirement. Anesthesiology 2006; 104:417–25
Strulov L, Zimmer EZ, Granot M, Tamir A, Jakobi P, Lowenstein L: Pain catastrophizing, response to experimental heat stimuli, and post-cesarean section pain. J Pain 2006; 8:273–9
Nielsen PR, Norgaard L, Rasmussen LS, Kehlet H: Prediction of post-operative pain by an electrical pain stimulus. Acta Anaesthesiol Scand 2007; 51:582–6
Martinez V, Fletcher D, Bouhassira D, Sessler DI, Chauvin M: The evolution of primary hyperalgesia in orthopedic surgery: Quantitative sensory testing and clinical evaluation before and after total knee arthroplasty. Anesth Analg 2007; 105:815–21
Rudin A, Wolner-Hanssen P, Hellbom M, Werner MU: Prediction of post-operative pain after a laparoscopic tubal ligation procedure. Acta Anaesthesiol Scand 2008; 52:938–45
Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, Ben-Nun B, Best LA, Granot M: Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk. Pain 2008; 138:22–8
Lundblad H, Kreicbergs A, Jansson KA: Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg Br 2008; 90:166–71
Aasvang EK, Hansen JB, Kehlet H: Can preoperative electrical nociceptive stimulation predict acute pain after groin herniotomy? Eur J Pain 2009; 13:1018–22
Weissman-Fogel I, Granovsky Y, Crispel Y, Ben-Nun A, Best LA, Yarnitsky D, Granot M: Enhanced presurgical pain temporal summation response predicts post-thoracotomy pain intensity during the acute postoperative phase. J Pain 2009; 10:628–36
Hayden JA, Cote P, Bombardier C: Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med 2006; 144:427–37
Soyupek S, Bozlu M, Armagan A, Ozorak A, Perk H: Does experimental pain assessment before biopsy predict for pain during transrectal ultrasound-guided prostate biopsy? Urology 2007; 70:681–4
Arendt-Nielsen L, Yarnitsky D: Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. J Pain 2009; 10:556–72
Chong PS, Cros DP: Technology literature review: Quantitative sensory testing. Muscle Nerve 2004; 29:734–47
Shy ME, Frohman EM, So YT, Arezzo JC, Cornblath DR, Giuliani MJ, Kincaid JC, Ochoa JL, Parry GJ, Weimer LH: Quantitative sensory testing: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2003; 60:898–904
Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, Jackson K, Parmelee PA, Rudy TE, Lynn BB, Chibnall JT, Craig KD, Ferrell B, Ferrell B, Fillingim RB, Gagliese L, Gallagher R, Gibson SJ, Harrison EL, Katz B, Keefe FJ, Lieber SJ, Lussier D, Schmader KE, Tait RC, Weiner DK, Williams J: An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 2007; 23:S1–43
Gibson SJ: IASP global year against pain in older persons: Highlighting the current status and future perspectives in geriatric pain. Expert Rev Neurother 2007; 7:627–35
Keogh E, Herdenfeldt M: Gender, coping and the perception of pain. Pain 2002; 97:195–201
Holdcroft A, Berkley KJ: Sex and gender differences in pain and its relief, Wall and Melzack's Textbook of Pain., 5th edition. Edited by McMahon SB, Koltzenburg M. Philadelphia, Elsevier Churchill Livingstone, 2006, pp 1181–97McMahon SB, Koltzenburg M
Elsevier Churchill Livingstone
Kain ZN, Sevarino FB, Rinder C, Pincus S, Alexander GM, Ivy M, Heninger G: Preoperative anxiolysis and postoperative recovery in women undergoing abdominal hysterectomy. Anesthesiology 2001; 94:415–22
Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, Bandeira D, Ferreira MB: Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 2002; 46:1265–71
Ozalp G, Sarioglu R, Tuncel G, Aslan K, Kadiogullari N: Preoperative emotional states in patients with breast cancer and postoperative pain. Acta Anaesthesiol Scand 2003; 47:26–9
Kudoh A, Takahira Y, Katagai H, Takazawa T: Small-dose ketamine improves the postoperative state of depressed patients. Anesth Analg 2002; 95:114–8
Brander VA, Stulberg SD, Adams AD, Harden RN, Bruehl S, Stanos SP, Houle T: Predicting total knee replacement pain: A prospective, observational study. Clin Orthop Relat Res 2003:27–36
Munafo MR, Stevenson J: Anxiety and surgical recovery. Reinterpreting the literature. J Psychosom Res 2001; 51:589–96
Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG: Preoperative prediction of severe postoperative pain. Pain 2003; 105:415–23
Granot M, Ferber SG: The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. Clin J Pain 2005; 21:439–45
Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG: Epidemiology and reporting characteristics of systematic reviews. PLoS Med 2007; 4:e78
Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, Gotzsche PC, Lang T: The revised CONSORT statement for reporting randomized trials: Explanation and elaboration. Ann Intern Med 2001; 134:663–94.
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF: Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. QUOROM Group Br J Surg 2000; 87:1448–54
Perkins FM, Kehlet H: Chronic pain as an outcome of surgery: A review of predictive factors. Anesthesiology 2000; 93:1123–33
Poobalan AS, Bruce J, King PM, Chambers WA, Krukowski ZH, Smith WC: Chronic pain and quality of life following open inguinal hernia repair. Br J Surg 2001; 88:1122–6
Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D: Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10:287–333
Woolf CJ, Salter MW: Plasticity and pain: Role of the dorsal horn, Wall and Melzacks Textbook of Pain, 5th edition. Edited by McMahon SB, Koltzenburg M. Philadelphia, Elsevier Churchill Livingstone, 2006, pp 91–106McMahon SB, Koltzenburg M
Elsevier Churchill Livingstone
Angst MS, Clark JD: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology 2006; 104:570–87
Wilder-Smith OH, Tassonyi E, Arendt-Nielsen L: Preoperative back pain is associated with diverse manifestations of central neuroplasticity. Pain 2002; 97:189–94
Fischer HB, Simanski CJ: A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement. Anaesthesia 2005; 60:1189–202
Koppert W: Opioid-induced hyperalgesia—pathophysiology and clinical relevance. Acute Pain 2007; 9:21–34
Werner MU, Duun P, Kraemer O, Lassen B, Kehlet H: Arthroscopic knee surgery does not modify hyperalgesic responses to heat injury. Anesthesiology 2003; 99:1152–7
Wilder-Smith OH, Arendt-Nielsen L: Postoperative hyperalgesia: Its clinical importance and relevance. Anesthesiology 2006; 104:601–7
Edwards RR, Sarlani E, Wesselmann U, Fillingim RB: Quantitative assessment of experimental pain perception: Multiple domains of clinical relevance. Pain 2005; 114:315–9
Gracely RH: Studies of pain in human subjects, Wall and Melzack's textbook of Pain, 5th edition. Edited by McMahon SB, Koltzenburg M. Philadelphia, Elsevier Churchill Livingstone, 2006, pp 267–89McMahon SB, Koltzenburg M
Elsevier Churchill Livingstone
Walker JS, Carmody JJ: Experimental pain in healthy human subjects: Gender differences in nociception and in response to ibuprofen. Anesth Analg 1998; 86:1257–62
Rollman GB, Lautenbacher S, Jones KS: Sex and gender differences in responses to experimentally induced pain in humans, Sex, Gender, and Pain. Edited by Fillingim RB. Seattle, IASP Press, 2000, pp 165–90Fillingim RB
IASP Press
Lund I, Lundeberg T, Kowalski J, Svensson E: Gender differences in electrical pain threshold responses to transcutaneous electrical nerve stimulation (TENS). Neurosci Lett 2005; 375:75–80
Edwards RR, Doleys DM, Lowery D, Fillingim RB: Pain tolerance as a predictor of outcome following multidisciplinary treatment for chronic pain: Differential effects as a function of sex. Pain 2003; 106:419–26
Staikou C, Siafaka I, Petropoulos G, Katafigioti A, Fassoulaki A: Responses to mechanical and electrical stimuli are not attenuated by late pregnancy. Acta Anaesthesiol Belg 2006; 57:277–81
Janssen KJ, Moons KG, Kalkman CJ, Grobbee DE, Vergouwe Y: Updating methods improved the performance of a clinical prediction model in new patients. J Clin Epidemiol 2008; 61:76–86
Borly L, Andersen IB, Christensen E, Sehested A, Kehlet H, Matzen P, Rehfeld JF, Stage P, Toftdahl DB, Gernow A, Højgaard L: Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Scand J Gastroenterol 1999; 34:1144–52
Cohen L, Fouladi RT, Katz J: Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery. J Psychosom Res 2005; 58:201–9
Rosenberger PH, Jokl P, Ickovics J: Psychosocial factors and surgical outcomes: An evidence-based literature review. J Am Acad Orthop Surg 2006; 14:397–405
Janssen KJ, Kalkman CJ, Grobbee DE, Bonsel GJ, Moons KG, Vergouwe Y: The risk of severe postoperative pain: Modification and validation of a clinical prediction rule. Anesth Analg 2008; 107:1330–9
Ram KC, Eisenberg E, Haddad M, Pud D: Oral opioid use alters DNIC but not cold pain perception in patients with chronic pain—new perspective of opioid-induced hyperalgesia. Pain 2008; 139:431–8
Chu LF, Clark DJ, Angst MS: Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: A preliminary prospective study. J Pain 2006; 7:43–8
Koppert W, Schmelz M: The impact of opioid-induced hyperalgesia for postoperative pain. Best Pract Res Clin Anaesthesiol 2007; 21:65–83
Granot M, Weissman-Fogel I, Crispel Y, Pud D, Granovsky Y, Sprecher E, Yarnitsky D: Determinants of endogenous analgesia magnitude in a diffuse noxious inhibitory control (DNIC) paradigm: Do conditioning stimulus painfulness, gender and personality variables matter? Pain 2008; 136:142–9
Lautenbacher S, Roscher S, Strian F: Inhibitory effects do not depend on the subjective experience of pain during heterotopic noxious conditioning stimulation (HNCS): A contribution to the psychophysics of pain inhibition. Eur J Pain 2002; 6:365–74
Silverman DG, O'Connor TZ, Brull SJ: Integrated assessment of pain scores and rescue morphine use during studies of analgesic efficacy. Anesth Analg 1993; 77:168–70
Kongsgaard UE, Werner MU: Clinical trials: Cancer pain, In: Clinical Pain Management—Cancer Pain, 2nd edition. Edited by Sykes N, Fallon MT, Patt RB. London, United Kingdom, Arnold Hodder Headline Group, 2007, pp 538–51Clinical trials: Cancer pain,Sykes N, Fallon MT, Patt RB
London, United Kingdom
Arnold Hodder Headline Group
Edwards RR, Fillingim RB: Self-reported pain sensitivity: Lack of correlation with pain threshold and tolerance. Eur J Pain 2007; 11:594–8