Tag: postoperative pain

Categories : CancerTags :

Low Vitamin D Levels Linked to More Pain After Breast Cancer Surgery

On By ModernMedia

Patients with vitamin D deficiency may benefit from supplements before operations

Photo by Tima Miroshnichenko on Pexels

Vitamin D deficiency is associated with more moderate to severe pain following breast cancer surgery and an increased consumption of opioid drugs, finds research published online in the journal Regional Anesthesia & Pain Medicine. Breast cancer patients with low levels of vitamin D (below 30nmol/L) may benefit from taking supplements before undergoing a radical mastectomy, suggest researchers.

There is emerging evidence suggesting that vitamin D helps control how pain is felt and processed by the body. This is likely due to its anti-inflammatory effects and action on the immune system. Vitamin D deficiency is also commonly reported among patients with breast cancer. A team of researchers set out to examine the relationship between vitamin D deficiency and postoperative pain in patients undergoing breast cancer surgery.

Their prospective observational study, carried out at Fayoum University Hospital in Egypt between September 2024 and April 2025, included 184 breast cancer patients who were scheduled to undergo surgical removal of one entire breast.

Half of the patients were classified as vitamin D deficient (below 30 nmol/L) and half were classified as vitamin D sufficient (above 30nmol/L). Both groups had similar characteristics with an average age of 44 in the vitamin D deficient group and 42 in the vitamin D sufficient group.

Patients were managed according to the hospital’s routine protocol both during and after surgery. Clinical staff involved in their care were unaware of the patients’ vitamin D levels.

The opioid fentanyl was administered during the operation to manage acute pain. Following surgery, all patients were given paracetamol through a drip every 8 hours. In addition, patients could control how much tramadol (another opioid analgesic) they were given by directly pressing a button.

Patients reported their pain levels at zero, 6 hours, 12 hours, 18 hours and 24 hours after surgery. Nausea and vomiting, sedation score and days in hospital following surgery were also recorded.

Patients with vitamin D deficiency were three times more likely to report moderate to severe postoperative pain at any time point during the first 24 hours than those with sufficient vitamin D levels, the study found.

The researchers noted, however, that no patient in either group reported severe pain (7 or over on a scale of 0 to 10) so the difference was due entirely to a reduction in moderate pain (4-6 on the pain scale).

Vitamin D deficient patients received, on average, 8 μg more fentanyl during surgery, which the researchers described as a modest difference.

However, the study found those in the vitamin D deficient group used substantially more tramadol (112mg) after surgery than those who had sufficient vitamin D levels. This strong opioid was controlled directly by the patient up to a maximum dose of 50mg per hour.

Opioid drugs can cause a number of side effects including nausea, vomiting, drowsiness and confusion, while also carrying risks of dependency and addiction.

Postoperative nausea was more common in the vitamin D deficient group, and vomiting occurred only in that group, although the difference in vomiting was small and not statistically significant.

The study had some limitations. It was observational and conducted at a single centre, so no firm conclusion can be drawn about cause and effect. The researchers also did not assess inflammatory markers so could not explore the mechanisms underlying the relationship between vitamin D and pain. Data was also not collected on anxiety, depression, cancer stage, treatment or sleep disturbance before the surgery was carried out.

Nevertheless, the researchers conclude, “Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.”

They suggest, “Preoperative vitamin D supplementation in breast cancer patients with vitamin D levels below 30 nmol/L may have a role in modulating postoperative pain.”

Source: The BMJ Group

Categories : Genetics Pain ManagementTags :

Whether Hypnosis for Pain is Effective Depends on a Patient’s Genetics

On By ModernMedia
Photo by Bruce Christianson on Unsplash

Studies have shown that hypnosis is an effective treatment for pain for many individuals – but it depends on the patient’s susceptibility to hypnosis. Testing for hypnotisability requires special training and in-person evaluation rarely available in the clinical setting. Now, investigators have developed a fast, point-of-care molecular diagnostic test that identifies a subset of individuals. Their study, published in The Journal of Molecular Diagnostics, also found that a subset of highly hypnotisable individuals may be more likely to experience high levels of postoperative pain.

“Since hypnotisability is a stable cognitive trait with a genetic basis, our goal was to create a molecular diagnostic tool for objectively identifying individuals who would benefit from hypnosis by determining ‘treatability’ at the point-of-care,” explained co-lead investigator Dana L. Cortade, a recently graduated PhD at Stanford University. “The advancement of nonpharmacological adjuvant treatments for pain is of the utmost importance in light of the opioid epidemic.”

Prior research established that the genetic basis for hypnotisability includes four specific single-nucleotide polymorphisms (SNPs), or genetic variations, found in the catechol-o-methyltransferase (COMT) gene for a brain enzyme responsible for dopamine metabolism in the prefrontal cortex. Although SNPs can contain valuable information on disease risk and treatment response, cost, complexity and time prevent widespread use.

The investigators developed a SNP genotyping assay on a giant magnetoresistive (GMR) biosensor array to detect the optimal combination of the COMT SNPs in patient DNA samples. GMR biosensor arrays are reliable, cheaper, sensitive, and can be easily deployed in point-of-care settings using saliva or blood samples.

The study investigated the association between COMT diplotypes and hypnotisability using a clinical hypnotisability scale called the Hypnotic Induction Profile (HIP) in individuals who had participated in one of the three previous clinical trials in which an HIP was administered. An additional exploratory study of the association between perioperative pain, COMT genotypes, and HIP scores was conducted with the patients in the third cohort, who had undergone total knee arthroplasty (TKA). DNA was extracted from blood samples previously collected in the first cohort, and saliva samples were collected by mail from participants in the other two trials. Participants were considered treatable by hypnosis if they had HIP scores of 3 or higher on a scale of zero to 10.

For participants identified with the optimal COMT diplotypes by the GMR biosensor array, 89.5% scored highly on the HIP, which identified 40.5% of the treatable population. The optimal COMT group mean HIP score was significantly higher than that in the suboptimal COMT group. Interestingly, further analysis revealed that the difference was observed only in women.

“Although we had expected some difference in effect between females and males, the association between hypnotisability and COMT genotypes was strongest in the females in the cohort,” said co-lead investigator Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine, Stanford, CA, USA. “The difference may be due to lower numbers of males in the cohort, or because COMT is known to have interactions with oestrogen and to differ in activity by sex. Additional gene targets including COMT, with stratification by sex, could be the focus of future study.”

In the exploratory analysis of the relationship between COMT genotypes and pain after TKA surgery, the same optimal COMT individuals had significantly higher postoperative pain scores than the suboptimal group, indicating a greater need for treatment. “This supports the body of evidence that COMT genotypes impact pain, and it is also known that COMT genotypes affect opioid use after surgery. Pain researchers can use this technology to correlate genetic predisposition to pain sensitivity and opioid use with response to an evidence-based, alternative remedy: hypnosis,” Dr Cortade said.

COMT SNPs alone are not a complete biomarker for identifying all individuals who will score highly on a hypnotisability scale and experience high pain sensitivity. The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is possible that other SNPs, such as those for dopamine receptors, are needed to further stratify individuals.

The investigators observe that this study highlights the utility and potential of the evolving applications of precision medicine. “It is a step towards enabling researchers and healthcare professionals to identify a subset of patients who are most likely to benefit from hypnotic analgesia,” Dr Markovits said. “Precision medicine has made great strides in identifying differences in drug metabolism that can impact medication decisions for perioperative pain. We hope to provide similar precision in offering hypnosis as an effective, non-pharmacological treatment that can improve patient comfort while reducing opioid use.”

Source: Elsevier