Brief Overview of Clinical Issue
Non-ischemic pain is one of the most prevalent symptoms following sternotomy and its etiology is complex. The theoretical rationale thought to be responsible for persistent post-sternotomy pain is directly related to the sensitization of central pain-signaling neurons from intense and prolonged nociceptive activity. This prolonged sensory input produces an abnormal response to low-threshold mechanoreceptor activity (allodynia and hyperalgesia) and central nervous system remodeling that contributes to a persistent pain state. Pain following sternotomy can persist for months and even years and it can be debilitating for many individuals.
Heart failure is also complex syndrome associated with sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS) hyperactivity. Interestingly, people with diabetes also have an increased risk of developing heart failure independently of other cardiovascular risk factors, such as coronary artery disease or hypertension. Recent evidence suggests that individuals with diabetes develop cardiac autonomic neuropathies (CAN) as a result of microvascular disease. Sub-optimal glycemic control appears to be one of the predictors to the development of CAN and subsequent heart failure. New evidence also suggests that some of the anti-hyperglycemic medications used to treat diabetes are increasing heart failure hospitalizations.