Global Prevalence Post-Sternotomy Pain Syndrome (PSPS) after Cardiac Surgery: Systematic Reviews and Meta-Analyse
Abstract
Background: One of the important types of pain is post sternotomy pain syndrome (PSPS). PSPS is defined as pain that persists for 2 months after sternotomy-open cardiac surgery without a specific cause.
Methods: In this meta-analysis study, patients undergoing cardiac surgery in which the prevalence of PSPS has been reported were included in the study. Search keywords included pain, heart surgery, prevalence, heart problems, sternotomy and post-sternotomy pain syndrome. The search was conducted by two researchers based on PICO criteria. The time range of the surge was from the beginning of the publication of articles on the outbreak of PSPS until the beginning of August 2024. Data extraction was done using the researcher's checklist and CMA software was used for data analysis.
Results: In the search that was done with the primary keywords, 108 articles were extracted, after checking the inclusion and exclusion criteria, 8 articles with a sample size of 3423 patients were included in the meta-analysis stage. The analyzed articles were between the years 2001 and 2024, and their methodology was done in different ways, including retrospective, interview, case-control and original. The age range of patients varied from 13 months to 63 years and the sample size of patients varied from 48 patients to 1395 patients. the overall prevalence of PSPS in the 8 analyzed patient articles was 33.4% (with 95% confidence interval: 22.7-46.1).
Conclusions: The prevalence of PSPS in patients worldwide was reported, and drug and non-drug measures are suggested to reduce pain after surgery.
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[11] Cogan J. Pain management after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2010; 14(3):201-4.
[12] Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, Rajesh K. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018; 21(3):323-7.
[13] Sudin A, Chong C, Hassan R. Incidence and Factors Associated With Post-Sternotomy Pain Syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2024; 38(2):466-74.
[14] van Gulik L, Janssen LI, Ahlers SJ, Bruins P, Driessen AH, van Boven WJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011; 40(6):1309-13.
[15] Bordoni B, Marelli F, Morabito B, Sacconi B, Severino P. Post-sternotomy pain syndrome following cardiac surgery: case report. J Pain Res. 2017: 1163-9.
[16] Mohammadi HR, Erfani A, Jamshidbeigi Y, Rahmatian A, Otaghi M. Effect of using rituximab on disability in patients with multiple sclerosis. J Med Pharm Chem Res. 2024; 6(12):1854-60.
[17] Hatefi M, Komlakh K. Investigating the effect of methylprednisolone pulse on treatment of back pain. Eur Chem Commun. 2022; 4(5):366-371.
[18] Shaker MR, Momennasab M, Dehghanrad F, Dokoohaki R, Dakhesh R, Jaberi A. The effect of using augmentative and alternative communication strategies on the quality of nurses’ communication with patients with endotracheal intubation in the cardiac surgery intensive care unit. J Hayat. 2022; 28(1):102-16.
[19] El Nasr MMA, Taha A. Persistent post sternotomy chest pain: Does sternal wire removal have a role? J Egypt Soc Cardio-Thorac Surg. 2017; 25(2):142-6.
[20] Sudin A, Chong C, Hassan R. Incidence and factors associated with post-sternotomy pain syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2024; 38(2):466-74.
[21] Meyerson J, Thelin S, Gordh T, Karlsten R. The incidence of chronic post‐sternotomy pain after cardiac surgery–a prospective study. Acta Anaesthesiol Scand. 2001; 45(8):940-4.
[22] Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006; 105(4):794-800.
[23] Kalso E, Mennander S, Tasmuth T, Nilsson E. Chronic post-sternotomy pain. Acta Anaesthesiol Scand. 2001; 45(8):935-9.
[24] Kalliomäki ML, Puolakka P, Huhtala H, Sisto T, Järvelä K. Bedside diagnosis of persistent post-sternotomy pain. Acta Anaesthesiol Scand. 2016; 60(7):969-76.
[25] Rashidi S, Elenbaas TW, Hamad MAS, van Suijlekom HJ, van Straten AH. Does removal of steel wires relieve post-sternotomy pain after cardiac surgery?. Asian Cardiovasc Thorac Ann. 2013; 21(4):409-13.
[26] Costa MACd, Trentini CA, Schafranski MD, Pipino O, Gomes RZ, Reis ESdS. Factors associated with the development of chronic post-sternotomy pain: a case-control study. Rev Bras Cir Cardiovasc. 2015; 30(5):552-6.
[27] Erfani A, Aghamiri SH, Karimi R. Investigating the Role of Hyper Density Signal Length in the Middle Cerebral Artery on the Degree of Disability of Arterial Ischemic Stroke Patients. Arch Neurosci. 2024; 11(4):e150888.
[28] Rahmatian A, Bastani E, Shokri F, Karbasfrushan A. Prevalence of Hemiplegic Shoulder Pain in Iran: A Systematic Review and Meta-analysis. Anesth Pain Med. 2023; 13(3):e136423.
[29] Bastani E, Rizehbandi M, Shokri F. Prevalence of Pain and Factors Affecting it in Patients with Lung Cancer in Ilam. Int J Cancer Manag. 2024; 17(1):e136637.
[30] Hatefi M, KomLakh K. Investigation of the effect of Duloxetine on pain status of patients with spinal cord injuries: A systematic review of drug therapy. Eur Chem Commun. 2022; 4(3):256-62.
[31] Karimiyarandi H, Karbasfrushan A. Effect of duloxetine on pain relief in patients undergoing arthroplasty surgery: a systematic review. Gomal J Med Sci. 2022; 20(4):213-20.
[32] Mohammadi HR, Asadoola Y, Erfani A, Amin NG, Karimiyarandi H, Sadeghi S, Abiri M. Effectiveness of Pulse Intravenous Infusion of Methylprednisolone on Pain in Patients with Lumbar Disc Herniation: A Randomized Controlled Trial. Anesth Pain Med. 2024; 14(4): e149442.
[33] Mandrekar S, Venkatesan P, Nagaraja R. Prevalence of musculoskeletal chest pain in the emergency department: a systematic review and meta-analysis. Scand J Pain. 2021; 21(3):434-44.
[34] Sposito NPB, Rossato LM, Bueno M, Kimura AF, Costa T, Guedes DMB. Assessment and management of pain in newborns hospitalized in a Neonatal Intensive Care Unit: a cross-sectional study. Rev Latino-Am Enfermagem. 2017; 25:e2931.
[35] Fayaz A, Croft P, Langford R, Donaldson L, Jones G. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open. 2016; 6(6):e010364.
[36] French HP, Smart KM, Doyle F, editors. Prevalence of neuropathic pain in knee or hip osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017; 47(1): 1-8.
[37] Sá KN, Moreira L, Baptista AF, Yeng LT, Teixeira MJ, Galhardoni R, et al. Prevalence of chronic pain in developing countries: systematic review and meta-analysis. Pain reports. 2019; 4(6):e779.
[38] Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016; 157(1):55-64.
[39] Ezzati K, Ravarian B, Saberi A, Salari A, Reyhanian Z, Khakpour M. Prevalence of cervical myofascial pain syndrome and its correlation with the severity of pain and disability in patients with chronic non-specific neck pain. Arch Bone Joint Surg. 2021; 9(2):230.
[40] Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011; 186(2):540-4.
[41] Alvarez-Nemegyei J, Pelaez-Ballestas I, Rodriguez-Amado J, Sanin LH, Garcia-Garcia C, Garza-Elizondo MA, et al. Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria. J Rheumatol Suppl. 2011; 86:15-20.
[2] Borji M, Mousavimoghadam SR, Salimi E, Otaghi M, Azizi Y. The Impact of Spiritual Care Education on Anxiety in Family Caregivers of Patients with Heart Failure. J Relig Health. 2019; 58(6):1961-9.
[3] Khoshkesht S, Ghiyasvandian S, Esmaeili M, Rahimzadeh M, Rahmanian M, Zakerimoghadam M. The Effect of Designed Transitional Care Program on Anxiety and General Comfort of the Patients Undergoing Coronary Artery Bypass Graft during Transfer from Open Heart Surgery Intensive Care Unit to General Ward: A Clinical Trial. Scientific JKUMS. 2023; 28(5):108-21.
[4] Janjani P, Salehabadi Y, Motevaseli S, Heidari Moghadam R, Siabani S, Salehi N. Comparison of Risk Factors, Prevalence, Type of Treatment, and Mortality Rate for Myocardial Infarction in Diabetic and Non-diabetic Older Adults: A Cohort Study. Iranian J Ageing. 2023; 18(2):268-83.
[5] Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020; 76(25):2982-3021.
[6] Shin D, Singh M, Shlofmitz E, Scheller B, Latib A, Kandzari DE, et al. Paclitaxel-coated versus sirolimus-coated balloon angioplasty for coronary artery disease: A systematic review and meta-analysis. Catheter Cardiovasc Interv. 2024.
[7] Bradić J, Andjić M, Novaković J, Jeremić N, Jakovljević V. Cardioplegia in Open Heart Surgery: Age Matters. J Clin Med. 2023; 12(4).
[8] Costa MA, Trentini CA, Schafranski MD, Pipino O, Gomes RZ, Reis ES. Factors Associated With the Development of Chronic Post-Sternotomy Pain: a Case-Control Study. Braz J Cardiovasc Surg. 2015; 30(5):552-6.
[9] Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013; 118(4):934-44.
[10] Bjørnnes AK, Rustøen T, Lie I, Watt-Watson J, Leegaard M. Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs. 2016; 15(1):47-54.
[11] Cogan J. Pain management after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2010; 14(3):201-4.
[12] Nagaraja PS, Ragavendran S, Singh NG, Asai O, Bhavya G, Manjunath N, Rajesh K. Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery. Ann Card Anaesth. 2018; 21(3):323-7.
[13] Sudin A, Chong C, Hassan R. Incidence and Factors Associated With Post-Sternotomy Pain Syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2024; 38(2):466-74.
[14] van Gulik L, Janssen LI, Ahlers SJ, Bruins P, Driessen AH, van Boven WJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011; 40(6):1309-13.
[15] Bordoni B, Marelli F, Morabito B, Sacconi B, Severino P. Post-sternotomy pain syndrome following cardiac surgery: case report. J Pain Res. 2017: 1163-9.
[16] Mohammadi HR, Erfani A, Jamshidbeigi Y, Rahmatian A, Otaghi M. Effect of using rituximab on disability in patients with multiple sclerosis. J Med Pharm Chem Res. 2024; 6(12):1854-60.
[17] Hatefi M, Komlakh K. Investigating the effect of methylprednisolone pulse on treatment of back pain. Eur Chem Commun. 2022; 4(5):366-371.
[18] Shaker MR, Momennasab M, Dehghanrad F, Dokoohaki R, Dakhesh R, Jaberi A. The effect of using augmentative and alternative communication strategies on the quality of nurses’ communication with patients with endotracheal intubation in the cardiac surgery intensive care unit. J Hayat. 2022; 28(1):102-16.
[19] El Nasr MMA, Taha A. Persistent post sternotomy chest pain: Does sternal wire removal have a role? J Egypt Soc Cardio-Thorac Surg. 2017; 25(2):142-6.
[20] Sudin A, Chong C, Hassan R. Incidence and factors associated with post-sternotomy pain syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth. 2024; 38(2):466-74.
[21] Meyerson J, Thelin S, Gordh T, Karlsten R. The incidence of chronic post‐sternotomy pain after cardiac surgery–a prospective study. Acta Anaesthesiol Scand. 2001; 45(8):940-4.
[22] Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006; 105(4):794-800.
[23] Kalso E, Mennander S, Tasmuth T, Nilsson E. Chronic post-sternotomy pain. Acta Anaesthesiol Scand. 2001; 45(8):935-9.
[24] Kalliomäki ML, Puolakka P, Huhtala H, Sisto T, Järvelä K. Bedside diagnosis of persistent post-sternotomy pain. Acta Anaesthesiol Scand. 2016; 60(7):969-76.
[25] Rashidi S, Elenbaas TW, Hamad MAS, van Suijlekom HJ, van Straten AH. Does removal of steel wires relieve post-sternotomy pain after cardiac surgery?. Asian Cardiovasc Thorac Ann. 2013; 21(4):409-13.
[26] Costa MACd, Trentini CA, Schafranski MD, Pipino O, Gomes RZ, Reis ESdS. Factors associated with the development of chronic post-sternotomy pain: a case-control study. Rev Bras Cir Cardiovasc. 2015; 30(5):552-6.
[27] Erfani A, Aghamiri SH, Karimi R. Investigating the Role of Hyper Density Signal Length in the Middle Cerebral Artery on the Degree of Disability of Arterial Ischemic Stroke Patients. Arch Neurosci. 2024; 11(4):e150888.
[28] Rahmatian A, Bastani E, Shokri F, Karbasfrushan A. Prevalence of Hemiplegic Shoulder Pain in Iran: A Systematic Review and Meta-analysis. Anesth Pain Med. 2023; 13(3):e136423.
[29] Bastani E, Rizehbandi M, Shokri F. Prevalence of Pain and Factors Affecting it in Patients with Lung Cancer in Ilam. Int J Cancer Manag. 2024; 17(1):e136637.
[30] Hatefi M, KomLakh K. Investigation of the effect of Duloxetine on pain status of patients with spinal cord injuries: A systematic review of drug therapy. Eur Chem Commun. 2022; 4(3):256-62.
[31] Karimiyarandi H, Karbasfrushan A. Effect of duloxetine on pain relief in patients undergoing arthroplasty surgery: a systematic review. Gomal J Med Sci. 2022; 20(4):213-20.
[32] Mohammadi HR, Asadoola Y, Erfani A, Amin NG, Karimiyarandi H, Sadeghi S, Abiri M. Effectiveness of Pulse Intravenous Infusion of Methylprednisolone on Pain in Patients with Lumbar Disc Herniation: A Randomized Controlled Trial. Anesth Pain Med. 2024; 14(4): e149442.
[33] Mandrekar S, Venkatesan P, Nagaraja R. Prevalence of musculoskeletal chest pain in the emergency department: a systematic review and meta-analysis. Scand J Pain. 2021; 21(3):434-44.
[34] Sposito NPB, Rossato LM, Bueno M, Kimura AF, Costa T, Guedes DMB. Assessment and management of pain in newborns hospitalized in a Neonatal Intensive Care Unit: a cross-sectional study. Rev Latino-Am Enfermagem. 2017; 25:e2931.
[35] Fayaz A, Croft P, Langford R, Donaldson L, Jones G. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open. 2016; 6(6):e010364.
[36] French HP, Smart KM, Doyle F, editors. Prevalence of neuropathic pain in knee or hip osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2017; 47(1): 1-8.
[37] Sá KN, Moreira L, Baptista AF, Yeng LT, Teixeira MJ, Galhardoni R, et al. Prevalence of chronic pain in developing countries: systematic review and meta-analysis. Pain reports. 2019; 4(6):e779.
[38] Mansfield KE, Sim J, Jordan JL, Jordan KP. A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population. Pain. 2016; 157(1):55-64.
[39] Ezzati K, Ravarian B, Saberi A, Salari A, Reyhanian Z, Khakpour M. Prevalence of cervical myofascial pain syndrome and its correlation with the severity of pain and disability in patients with chronic non-specific neck pain. Arch Bone Joint Surg. 2021; 9(2):230.
[40] Berry SH, Elliott MN, Suttorp M, Bogart LM, Stoto MA, Eggers P, et al. Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the United States. J Urol. 2011; 186(2):540-4.
[41] Alvarez-Nemegyei J, Pelaez-Ballestas I, Rodriguez-Amado J, Sanin LH, Garcia-Garcia C, Garza-Elizondo MA, et al. Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria. J Rheumatol Suppl. 2011; 86:15-20.
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How to Cite
1.
Ali Roozegar M, Erfani A, Vasigh A. Global Prevalence Post-Sternotomy Pain Syndrome (PSPS) after Cardiac Surgery: Systematic Reviews and Meta-Analyse. Arch Anesth & Crit Care. 2024;.
