• Shireen Ahmad, Gildasio S De Oliveira, Jane M Bialek, and Robert J McCarthy.
• Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
• Pain Med. 2014 May 1;15(5):857-64.

ObjectiveTo evaluate the relationship of preoperative thermal quantitative sensory testing (QST) values with postoperative pain and opiate consumption in opiate-naïve patients following gynecologic surgery.DesignSingle blind observational study.SettingsSurgical center of an academic medical center.MethodsQST was performed preoperatively on 124 opioid-naïve patients. Pain outcomes were assessed on arrival to the post-anesthesia care unit and at 6 hourly intervals for 24 hours. Subjects were reclassified to three groups: Group 1 had a heat pain threshold above and a cold pain threshold below the median; Group 2 had either a heat pain threshold below or a cold pain threshold above the median; Group 3 had a heat pain threshold below and a cold pain threshold above the median. The primary outcome measure was the 24-hour morphine consumption.ResultsOne hundred twenty subjects were evaluated. Median (interquartile range) warm and cold pain thresholds were 44.8 (42.4-46.9) °C and 10.5 (3.2-19.0) °C, respectively. Heat pain thresholds demonstrated a negative (rho = -0.23, P = 0.01) and cold thresholds a positive correlation (rho = 0.21, P = 0.02) with 24-hour morphine consumption. Median morphine consumption was 19 (2-33) mg (P = 0.004) equivalents greater in subjects (N = 46) with heat pain thresholds <45 °C and cold pain thresholds >10 °C than subjects with heat pain thresholds >45 °C and cold pain thresholds <10 °C.DiscussionReduced tolerance to both heat and cold thermal pain stimulus was associated with increased postoperative analgesic requirements. Combined responses to multiple pain modalities may be more useful than a single stimulus paradigm.Wiley Periodicals, Inc.

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