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Perioperative and chronic pain

Catherine E Ferland, Diana-Luk Ye, Jean A Ouellet
This case report illustrates the value of a comprehensive perioperative pain assessment composed of quantitative sensory testing and self-reported measures that highlight the impact of pain experienced by a 14-year-old boy suffering from chronic low back pain and sciatica. Before surgery, the pain assessment revealed inefficient endogenous inhibitory pain control with presence of temporal summation of pain. The severe pain was constant and lasted for 18 months. The patient was in a high-anxiety state, and reported significant functional disability and poor sleep quality...
March 12, 2018: Journal of Pediatric Health Care
Vito Chiantera, Marco Petrillo, Elene Abesadze, Giulio Sozzi, Margherita Dessole, Mariano Catello Di Donna, Giovanni Scambia, Jalid Sehouli, Sylvia Mechsner
OBJECTIVE: Evaluation of clinical presentation and surgical outcome in patients with deep lateral pelvic endometriosis (dLPE). DESIGN: Retrospective multicentric study (Canadian Task Force Classification II-2). SETTING: University tertiary referral centres. PATIENTS: 148 women with deep infiltrating endometriosis (DIE). INTERVENTION: Laparoscopic excision of DIE. Disease Distribution was classified as: Central Pelvic Endometriosis (CPE) when DIE involved one of these anatomic sites: cervix, vagina, uterosacral ligaments, rectum, bladder and pelvic peritoneum; superficial Lateral Pelvic Endometriosis (sLPE) when parametria, ureters or hypogastric plexus were involved; deep Lateral Pelvic Endometriosis (dLPE) in presence of sacral plexus and/or sciatic nerve infiltration...
March 1, 2018: Journal of Minimally Invasive Gynecology
Katherine T Martucci, Sean C Mackey
Neuroimaging research has demonstrated definitive involvement of the central nervous system in the development, maintenance, and experience of chronic pain. Structural and functional neuroimaging has helped elucidate central nervous system contributors to chronic pain in humans. Neuroimaging of pain has provided a tool for increasing our understanding of how pharmacologic and psychologic therapies improve chronic pain. To date, findings from neuroimaging pain research have benefitted clinical practice by providing clinicians with an educational framework to discuss the biopsychosocial nature of pain with patients...
March 1, 2018: Anesthesiology
Birgitte Brandsborg, Lone Nikolajsen
PURPOSE OF REVIEW: Hysterectomy is a common surgical procedure with a low risk of major complications. However, some women experience long-lasting complications, including chronic postsurgical pain, which can have a negative impact on their quality of life. This review aims to present the recent literature on chronic pain following hysterectomy for benign indications. RECENT FINDINGS: Chronic pain following hysterectomy is reported in 10-50% of women. Risk factors include preoperative pelvic pain, pain elsewhere, acute postoperative pain, surgical procedure, and psychological factors such as anxiety and depression...
February 22, 2018: Current Opinion in Anaesthesiology
Lorraine R Feeney, Shona M Tormey, Dominic C Harmon
BACKGROUND: More patients are surviving breast cancer; however, many complain of persistent pain, which significantly impacts on their lives. Studies have predominantly examined risk factors alone. This mixed methods study will systematically compare prospective and retrospective studies of chronic pain following breast cancer treatment. A wider scope than risk factors alone is included in a narrative review element. RESULTS: Common risk factors and themes were identified, and these were compared with some of the retrospective literature available...
February 5, 2018: Irish Journal of Medical Science
Judith L Nicholls, Muhammad A Azam, Lindsay C Burns, Marina Englesakis, Ainsley M Sutherland, Aliza Z Weinrib, Joel Katz, Hance Clarke
Background: Inadequately managed pain is a risk factor for chronic postsurgical pain (CPSP), a growing public health challenge. Multidisciplinary pain-management programs with psychological approaches, including cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based psychotherapy, have shown efficacy as treatments for chronic pain, and show promise as timely interventions in the pre/perioperative periods for the management of PSP. We reviewed the literature to identify randomized controlled trials evaluating the efficacy of these psychotherapy approaches on pain-related surgical outcomes...
2018: Patient related Outcome Measures
Arnaud Steyaert, Patricia Lavand'homme
Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management...
January 29, 2018: Drugs
D J Zhou, M A Carlson
PURPOSE: To review the published data describing the incidence, etiology, management, and outcomes of flank hernia. METHODS: A retrospective review of articles identified with an online search (using the terms "flank hernia", "flank bulge", "lateral hernia", "retroperitoneal aorta hernia", and "open radical nephrectomy") was performed. Studies exclusively on lumbar hernia or subcostal hernia were excluded. RESULTS: All articles retained for analysis (N = 26) were uncontrolled series or case reports; there were no controlled trials...
January 27, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
L Reist, J Erlenwein, W Meissner, T Stammschulte, F Stüber, U M Stamer
PURPOSE: Nonopioid analgesics are frequently used for the treatment of acute and chronic pain. Dipyrone is an alternative to NSAIDs and paracetamol, however, data on the frequency of its usage by anaesthesiologists in the perioperative and chronic pain setting are lacking and its adverse reactions are a matter of debate. METHODS: The link to a questionnaire on the use of nonopioid analgesics (NSAIDs, COX-2 inhibitors, paracetamol, dipyrone) and the safety of dipyrone in the perioperative and chronic pain setting was mailed to anaesthesiologists and pain physicians...
January 29, 2018: European Journal of Pain: EJP
Adrian B Jonan, Alan D Kaye, Richard D Urman
BACKGROUND: Starting with approval for clinical use in the treatment of opioid dependence in October 2002 by the Food and Drug Administration (FDA), buprenorphine has become an integral treatment option and in recent years, in chronic pain management. Buprenorphine possesses a unique pharmacodynamic and pharmacokinetic profile that can potentially make perioperative analgesia challenging. OBJECTIVES: To date no unified guidelines or recommendations are available for buprenorphine product management during the perioperative period...
January 2018: Pain Physician
Panagiotis Paliogiannis, Giorgio C Ginesu, Alessandro Fancellu, Aldo Pischedda, Mario Maiore, Eleonora Maiore, Antonio Pinna, Michele Barmina, Alberto Porcu
Chronic mesenteric ischemia is a rare intestinal disorder, with a potential evolution toward intestinal infraction. The choice of the appropriate treatment is currently the most crucial issue in the management of patients with chronic mesenteric ischemia. We describe our experience with 16 cases, and we discuss the current diagnostic and therapeutic approaches. A retrospective review of the clinical records was performed, and demographic, clinical, therapeutic, and prognostic data were collected. Six patients were females (37%), and the mean age was 62 years...
December 1, 2017: American Surgeon
(no author information available yet)
INTRODUCTION: Worldwide, more than 20 million patients undergo groin hernia repair annually. The many different approaches, treatment indications and a significant array of techniques for groin hernia repair warrant guidelines to standardize care, minimize complications, and improve results. The main goal of these guidelines is to improve patient outcomes, specifically to decrease recurrence rates and reduce chronic pain, the most frequent problems following groin hernia repair. They have been endorsed by all five continental hernia societies, the International Endo Hernia Society and the European Association for Endoscopic Surgery...
February 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
Syed Azim, James Nicholson, Mario J Rebecchi, William Galbavy, Tian Feng, Sabeen Rizwan, Ruth A Reinsel, Martin Kaczocha, Helene Benveniste
BACKGROUND: Identifying drivers of pain that can serve as novel drug targets is important for improving perioperative analgesia. Total knee arthroplasty (TKA) is associated with significant postoperative pain. Cytokines contribute to the pathophysiology of osteoarthritis (OA) and associated pain. However, the influence of perioperative cytokine levels after TKA surgery upon postoperative pain remains unexplored. METHODS: We designed a prospective observational study to profile three proinflammatory cytokines, interleukin-6 (IL-6), tumor necrosis factor α (TNFα), and leptin in serum, synovial, and cerebrospinal fluid of TKA patients perioperatively to determine associations between cytokine levels and pain...
January 8, 2018: Knee
Lindsey B Armstrong, Pradeep Dinakar, David P Mooney
INTRODUCTION: Anterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized etiology of chronic abdominal pain that causes great morbidity to those affected. We sought to determine the outcome of neurectomy for ACNES in children. METHODS: Demographic and clinical data on children who underwent neurectomy for ACNES by a single surgeon from 10/2011 to 01/2017 were reviewed. RESULTS: Twenty-six patients underwent neurectomy for ACNES...
December 8, 2017: Journal of Pediatric Surgery
Nicole E George, Cheryle Gurk-Turner, Jennifer I Etcheson, Chukwuweike U Gwam, Randal De Souza, Spencer S Smith, James Nace, Ronald E Delanois
INTRODUCTION: Total knee arthroplasty (TKA) is a commonly-performed orthopaedic procedure in the United States. However, inadequate postoperative pain management following TKA has been associated with a number of negative consequences, including chronic postoperative pain requiring long-term opioid use. Multimodal pain control is a recently-popularized means of maximizing analgesia and postoperative outcomes. We aimed to evaluate the outcomes of a multimodal pain regimen incorporating diclofenac, including: 1) length of stay (LOS); 2) pain intensity; and 3) opioid consumption in primary TKA patients...
December 22, 2017: Surgical Technology International
Jennifer Hah, Sean C Mackey, Peter Schmidt, Rebecca McCue, Keith Humphreys, Jodie Trafton, Bradley Efron, Debra Clay, Yasamin Sharifzadeh, Gabriela Ruchelli, Stuart Goodman, James Huddleston, William J Maloney, Frederick M Dirbas, Joseph Shrager, John Costouros, Catherine Curtin, Ian Carroll
Importance: Guidelines recommend using gabapentin to decrease postoperative pain and opioid use, but significant variation exists in clinical practice. Objective: To determine the effect of perioperative gabapentin on remote postoperative time to pain resolution and opioid cessation. Design, Setting, and Participants: A randomized, double-blind, placebo-controlled trial of perioperative gabapentin was conducted at a single-center, tertiary referral teaching hospital...
December 13, 2017: JAMA Surgery
Marzia Umari, Valentina Carpanese, Valeria Moro, Gaia Baldo, Stefano Addesa, Enrico Lena, Stefano Lena, Umberto Lucangelo
Video-assisted thoracoscopic surgery is a widespread technique that has been linked to improved postoperative respiratory function, reduced hospital length of stay and a higher level of tolerability for the patients. Acute postoperative pain is of considerable significance, and the late development of neuropathic pain syndrome is also an issue. As anaesthesiologists, we have investigated the available evidence to optimize postoperative pain management. An opioid-sparing multimodal approach is highly recommended...
December 8, 2017: European Journal of Cardio-thoracic Surgery
I Stoica, F O'Kelly, M B McDermott, F M J Quinn
BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney. It was first described in 1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations are varied, and with a limited number of cases in the literature, the optimal diagnosis and management of XGP in the paediatric cohort is still unknown. MATERIAL AND METHODS: The medical records of children who were diagnosed and treated for XGP at the current unit during the period 1963-2016, inclusive, were retrospectively reviewed...
November 24, 2017: Journal of Pediatric Urology
Heath McAnally
The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative "acute-on-chronic" pain and fueling worsened chronic pain and opioid dependence...
2017: Perioperative Medicine
Cary S Politzer, Beau J Kildow, Daniel E Goltz, Cynthia L Green, Michael P Bolognesi, Thorsten M Seyler
BACKGROUND: Opioids are a mainstay in perioperative pain management among patients undergoing total knee arthroplasty (TKA). However, patterns in opioid use before and after TKA have not been well-studied. The objectives of this study are to characterize prescribing trends preoperatively and postoperatively and identify risk factors for chronic postoperative opioid use. METHODS: A review of the prescription-tracking database of a large private payer from 2007 to 2013 was performed using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes...
November 14, 2017: Journal of Arthroplasty
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