Critical care

This article provides an overview of the current treatment of opioid-related conditions, including treatments provided by general practitioners and by specialists in substance-use disorders. The recent dramatic increase in misuse of prescription analgesics, the easy accessibility of opioids such as..

Acute kidney injury (AKI) is common and is associated with serious short- and long-term complications. Early diagnosis and identification of the underlying aetiology are essential to guide management. In this review, we outline the current definition of AKI and the potential pitfalls, and summarise the existing and future tools to investigate AKI in critically ill patients.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the basic physiologic events in normal wound healing. 2. Understand the differences in healing among skin, bone, cartilage, and tendon. 3. Identify factors that may compromise or delay wound healing. 4. Describe methods for optimal closure of a wound. SUMMARY: Understanding the physiology and pathophysiology of normal wound healing and potential impediments to its end will allow the plastic surgeon to maximize postoperative outcomes and, in some instances, avoid unnecessary surgical interventions...

INTRODUCTION: Presently, it is difficult to predict which patients are at increased risk of ongoing pain problems postoperatively. This study followed a group of patients from the week before their operation until 3 months after it, to identify potential risk variables. METHODS: Fifty-four patients undergoing moderate-major gynaecological surgery at Christchurch Women's Hospital were recruited and assessed preoperatively over an 11-week period. At this initial assessment, participants were subjected to a cold pressor test (CPT)...

No abstract text is available yet for this article.

Chronic low back pain (CLBP) is a chronic pain syndrome in the lower back region, lasting for at least 3 months. CLBP represents the second leading cause of disability worldwide being a major welfare and economic problem. The prevalence of CLBP in adults has increased more than 100% in the last decade and continues to increase dramatically in the aging population, affecting both men and women in all ethnic groups, with a significant impact on functional capacity and occupational activities. It can also be influenced by psychological factors, such as stress, depression and/or anxiety...

The components and reactions of the fibrinolysis system are well understood. The pathway has fewer reactants and interactions than coagulation, but the generation of a complete quantitative model is complicated by the need to work at the solid-liquid interface of fibrin. Diagnostic tools to detect disease states due to malfunctions in the fibrinolysis pathway are also not so well developed as is the case with coagulation. However, there are clearly a number of inherited or acquired pathologies where hyperfibrinolysis is a serious, potentially life-threatening problem and a number of antifibrinolytc drugs are available to treat hyperfibrinolysis...

Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer...

SUMMARY The role of gonadal hormones has slowly gathered the right attention in the study of chronic pain mechanisms. The clear presence of sex differences in chronic pain and the number of studies showing the power of gonadal hormones to modify pain-induced behavioral responses appear to have convinced clinicians and researchers. Indeed, available data strongly indicate that more studies on gonadal hormones would certainly enhance the possibility of greatly increasing the knowledge of pain mechanisms and, thus, treatments...

SUMMARY The last 10-15 years have seen an increase in the use of opioids in chronic noncancer pain. The consequences of increased use only gradually became apparent. The five pillars of pain management were developed as a convenient mechanism for the management of chronic noncancer pain and to allow for a comprehensive approach to patient care. The mnemonic ADDOP was developed: 'A' pillar one - assessment including risk and symptom assessment; 'D' pillar two - defining and treating the underlying condition; 'D' pillar three - making a pain diagnosis and going down an established path of treatment; 'O' pillar four - other treatments embracing the biopsychosocial model and treating co-morbidities; 'P' pillar five - patient self-management, personal responsibility and patient education...

Pain, and particularly chronic pain, is a difficult outcome to measure due to its subjective and multidimensional nature. The Institute of Medicine estimates that 100 million Americans have chronic pain with a cost exceeding half a trillion dollars per year. There is a pressing need to identify appropriate outcome measures to better select and evaluate treatment modalities for these patients. It is also important that we demonstrate an evidence basis for these decisions given the current practice standard. Appropriate selection and implementation of these outcome measures can help accomplish both goals...

Severe pain has profound physiologic effects on the endocrine system. Serum hormone abnormalities may result and these serve as biomarkers for the presence of severe pain and the need to replace hormones to achieve pain control. Initially severe pain causes a hyperarousal of the hypothalamic-pituitary-adrenal system which results in elevated serum hormone levels such as adrenocorticotropin, cortisol, and pregnenolone. If the severe pain does not abate, however, the system cannot maintain its normal hormone production and serum levels of some hormones may drop below normal range...

In Part One of this two-part series, we discussed skin physiology and anatomy as well as generalities concerning topical analgesics. This modality of therapy has lesser side effects and drug-drug interactions, and patients tolerate this form of therapy better than many oral options. Unfortunately, this modality is not used as often as it could be in chronic pain states, such as that from neuropathic pain. Part Two discusses specific therapies, local anesthetics, and other drugs, as well as how a clinician might use specific aspects of a patient's neuropathic pain presentation to help guide them in the selection of a topical agent...

Chronic pain is a complex disorder with multiple etiologies for which the pathologic mechanisms are still largely unknown, making effective treatment a difficult clinical task. Achieving pain relief along with improved function and quality of life is the primary goal of pain clinicians; however, most patients and healthcare professionals consider 30% pain improvement to be clinically significant-a success level that would be unacceptable in other areas of medicine. Furthermore, patients with chronic pain frequently have multiple comorbidities, including depression and sleep apnea, and most have seen several physicians prior to being seen by a pain specialist, have more than three specific pain generators, and are taking multiple medications...

New England Journal of Medicine, Volume 369, Issue 9, Page 840-851, August 2013.

No abstract text is available yet for this article.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://www.springer.com/series/8901.