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British Journal of Anaesthesia, 2003, Vol. 91, No. 2 279-281
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Short Communications

Pain disaggregation theory—statistical nonsense or a pointer to a paradigm for quantum nociception?

I. D. Conacher*,1, G. Sudarshan2 and A. K. Soni3

1 Department of Thoracic Anaesthesia, Freeman Hospitals Trust, Freeman Road, Newcastle upon Tyne NE7 7DN, UK. 2 University Cincinnati College of Medicine, Ohio, USA. 3 Westwood, Massachusetts, USA

Corresponding author. E-mail: i.d.conacher@btinternet.com

Background. The various patterns of patients’ experience of treated acute post-thoracotomy pain exemplify the phenomenon of disaggregation. The intent in this study was to define a theory of disaggregation with a hard-wired neuroanatomical model of thoracotomy pain.

Methods. In order to distinguish the disaggregated nociception conducted along one of three possible pathways, the vagus, the phrenic and, in this study, the intercostal nerves, data from 143 patients undergoing thoracic surgery, and that from two previously conducted studies of multimodal analgesic regimens, were reviewed. The values of one subjective outcome measure (verbal rating score) at different stress levels—at rest, on raising the arm, and on coughing (dynamic pain scores)—were used to construct individuals’ charts (pain profiles) of the progress of pain relief over time. These were batched, and analysed using statistics of summary measures.

Results. This was a crude exercise in the handling of redundant data, but there is a suggestion that it is possible to distinguish a disaggregated route by an effect of a treatment on a mass of nociception.

Conclusions. This information could underpin a paradigm of quantum nociception, and has potential to quantify aspects of analgesia practice and current and future neurophysiological theories of pain. Prospective studies are warranted.

Br J Anaesth 2003; 91: 279–81


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