The long-term incidence of chronic post-surgical pain after coronary artery bypass surgery - A prospective observational study.

BACKGROUND: Chronic post-surgical pain (CPSP) represents a significant issue for many patients following surgery; however, the long-term incidence and impact have not been well described following cardiac surgery. Our aim was to characterize CPSP at least 5 years following coronary artery bypass grafting (CABG) surgery. METHODS: This prospective observational study investigated a cohort of patients from a larger trial investigating cognitive outcomes following CABG surgery, with 89 of 148 eligible patients (60.1%) assessed for CPSP at a mean (standard deviation [SD]) of 6.8 [1.2] years. Questionnaires interrogated pain presence, intensity, location, neuropathic characteristics, Geriatric Depression Scale scores (GDS) and instrumental activities of daily living (IADL). RESULTS: CPSP was described in 21/89 (23.6%), with 10 rating it as moderate to severe. Six of the CPSP patients (29%) met criteria for neuropathic pain (6.7% overall). The highest rate of CPSP was associated with the leg surgical site (chest 12/89 [13.5%], arm 8/68 [11.8%] and leg (saphenous vein graft-SVG) 11/37 [29.7%]; χ2 = 6.523, p = 0.038). IADL scores were significantly lower for patients with CPSP (mean [SD]: 36.7 [1.6] vs. no CPSP 40.6 [0.6]; p = 0.006). Patients had GDS scores consistent with moderate depression (GDS >8) in 3/21 (14.3%) with CPSP, versus 3/68 (4.4%) non-CPSP patients (χ2 = 3.20, p = 0.073). CONCLUSIONS: This study identified a CPSP incidence of 23.6% at a mean of 6.8 years after CABG surgery, with the highest pain proportion at SVG harvest sites. CPSP was associated with neuropathic pain symptoms and had a significant impact on IADLs. This emphasizes the need for long-term follow-up of CABG patients. SIGNIFICANCE: This study highlights the impact of CPSP 7 years following cardiac surgery and highlights the effect of surgical site, neuropathic pain and the importance of including pain assessment and management in the long-term follow-up of cardiac surgical patients. Strategies to address and prevent chronic pain following cardiac surgery should be further explored.

Abnormalities in the Visual Processing of Viewing Complex Visual Stimuli Amongst Individuals With Body Image Concern.

Individuals with body dysmorphic disorder (BDD) and clinically concerning body-image concern (BIC) appear to possess abnormalities in the way they perceive visual information in the form of a bias towards local visual processing. As inversion interrupts normal global processing, forcing individuals to process locally, an upright-inverted stimulus discrimination task was used to investigate this phenomenon. We examined whether individuals with nonclinical, yet high levels of BIC would show signs of this bias, in the form of reduced inversion effects (i.e., increased local processing). Furthermore, we assessed whether this bias appeared for general visual stimuli or specifically for appearance-related stimuli, such as faces and bodies. Participants with high-BIC (n = 25) and low-BIC (n = 30) performed a stimulus discrimination task with upright and inverted faces, scenes, objects, and bodies. Unexpectedly, the high-BIC group showed an increased inversion effect compared to the low-BIC group, indicating perceptual abnormalities may not be present as local processing biases, as originally thought. There was no significant difference in performance across stimulus types, signifying that any visual processing abnormalities may be general rather than appearance-based. This has important implications for whether visual processing abnormalities are predisposing factors for BDD or develop throughout the disorder.

Portable, inexpensive instruments to quantify stratum corneum hydration and skin erythema: applications to clothing science.

The level of stratum corneum hydration is assessed by measurement of the changes in skin resistance and is referred to as the galvanic skin response or electrical skin resistance. Skin erythema may be assessed by measurement of skin blood flow, tristimulus colorimetry or narrow-band reflectance spectroscopy. Currently available measuring devices are relatively expensive. Presented here are two inexpensive, hand-held, portable instruments which conveniently measure stratum corneum hydration and skin erythema.

Expired air temperature during prolonged exercise in cool- and hot-humid environments.

The purpose of this investigation was to measure expired air temperature under cool- and hot-humid environmental conditions at rest and during prolonged exercise to: (1) establish if significant increases in body core temperature affected expired air temperature, and (2) to determine if the temperature setting for heating the pneumotachometer in an open-circuit system requires adjustment during prolonged exercise tests to account for changes in expired air temperature. Six male distance runners completed two tests in cool-humid [dry bulb temperature (Tdb) 15.5 (SD 1.3) degrees C, wet bulb temperature (TWb) 12.1 (SD 1.4) degrees C] and hot-humid [Tdb 31.6 (SD 0.6) degrees C, TWb 24.9 (SD 0.6) degrees C, black globe temperature (Tg) 34.3 (SD 0.3) degrees C] environments, running at a velocity corresponding to 65% [67.1 (SD 2.82)%] of their maximal oxygen uptake. Rectal temperature and expired air temperatures were compared at rest, and after 30 min and 60 min of exercise for each environment. The main finding of this investigation was a significant (P < 0.05) but small increase in expired air temperature between the 30-min and 60-min measures in the hot-humid environment. No significant differences in expired air temperature were found between the 30-min and 60-min measures in the cool-humid environment. These findings suggest that: (1) expired air temperature is influenced by elevations in body core temperature during prolonged exercise in hot-humid conditions, and (2) that the temperature setting for heating the head of the pneumotachometer (after determining the appropriate temperature through measuring expired air temperature for the set environmental condition) may require adjustment during prolonged exercise trials in hot-humid environmental conditions.