To examine the relationships between preoperative hypersensitivity to pain and central sensitization, and postoperative ureteral stent pain after ureteroscopy for urinary stones.
Adults enrolled in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to ureteroscopy and stent placement. Hypersensitivity to mechanical pain was assessed using a pressure algometer. Participants rated their pain intensity to pressure applied to the ipsilateral flank area and lower abdominal quadrant on the side of planned stent placement, and the contralateral forearm (control). Pressure pain thresholds were also assessed. Central sensitization was assessed by applying a pointed stimulator (pinprick) and calculating the temporal summation. Postoperative stent pain intensity and interference was assessed using PROMIS questionnaires. Data were analyzed using repeated-measures mixed-effects linear models.
Among the 412 participants, the median age was 54.0 years, and 46% were female. Higher preoperative pain ratings to 2 kg and 4 kg mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher postoperative stent pain intensity with the stent in situ. Greater degree of central sensitization preoperatively, manifesting as higher temporal summation, was associated with higher postoperative pain intensity. Factors associated with preoperative hypersensitivity on QST included female sex, presence of chronic pain conditions, widespread pain, and depression.
Hypersensitivity to pain and central sensitization preoperatively was associated with postoperative ureteral stent pain, suggesting a physiologic basis for stent symptom variation. QST may identify patients more likely to develop stent pain after ureteroscopy and could inform selection for preventive and interventional strategies.
Urology. 2023 Dec 07 [Epub ahead of print]
H Henry Lai, Hongqui Yang, Gregory E Tasian, Jonathan D Harper, Alana C Desai, Rebecca D McCune, Ziya Kirkali, Hussein R Al-Khalidi, Charles D Scales, Michele Curatolo, NIDDK Urinary Stone Disease Research Network (USDRN)
Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA. Electronic address: ., Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Division of Urology and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA., Department of Urology, University of Washington, Seattle, WA, USA., Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA., Division of Urology and Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA., Departments of Surgery (Urology) and Population Health Science, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA, USA; Harborview Injury Preventions and Research Center, University of Washington, Seattle WA, USA; Center for Sensory-Motor Interaction, University of Aalborg, Denmark.