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Current Opinion in Anaesthesiology Oct 2022This narrative review is an updated summary of the value of regional anesthesia and analgesia for trauma and the special considerations when optimizing pain management... (Review)
Review
PURPOSE OF REVIEW
This narrative review is an updated summary of the value of regional anesthesia and analgesia for trauma and the special considerations when optimizing pain management and utilizing regional analgesia for acute traumatic pain.
RECENT FINDINGS
In the setting of the opioid epidemic, the need for multimodal analgesia in trauma is imperative. It has been proposed that inadequately treated acute pain predisposes a patient to increased risk of developing chronic pain and continued opioid use. Enhanced Regional Anesthesia techniques along with multimodal pain therapies is thought to reduce the stress response and improve patient's short- and long-term outcomes.
SUMMARY
Our ability to save life and limb has improved, but our ability to manage acute traumatic pain continues to lag. Understanding trauma-specific concerns and tailoring the analgesia to a patient's specific injuries can increase a patient's immediate comfort and long-term outcome as well.
Topics: Acute Pain; Analgesia; Analgesics, Opioid; Anesthesia, Conduction; Humans; Pain Management; Pain, Postoperative
PubMed: 36044292
DOI: 10.1097/ACO.0000000000001172 -
European Review For Medical and... May 2021The aim of the study was to develop appropriate pain therapy and prevention plans; pain needs to be understood in terms of prevalence and associated predictor factors in...
OBJECTIVE
The aim of the study was to develop appropriate pain therapy and prevention plans; pain needs to be understood in terms of prevalence and associated predictor factors in hospital and primary care. The purpose of our research was to assess the prevalence of chronic, acute, and acute-on-chronic pain, and ascertain the effects of several factors on the likelihood of pain in an Italian Tertiary Care Hospital.
PATIENTS AND METHODS
This is a prevalence study in which the primary outcome was the prevalence rate of chronic pain inpatients. Fisher's exact tests and binomial logistic regression were performed for the prevalence measures, and to ascertain the effects of Hospital Unit, sex, age, surgery and preexisting chronic pain on the likelihood of pain during the hospitalization, respectively.
RESULTS
Chronic pain was reported in one-fifth of inpatients [21.7% (95% CI: 0.1764, 0.2625)], with a high prevalence of pain-related interference on sleep and emotional status. Nearly 70% of chronic pain patients accused acute-on-chronic pain [15.3% (95% CI: 0.1178, 0.1934)]. High pain prevalence rates were assessed at the time of the interview (37.3%; 95% CI: 0.3234, 0.4239) and in the last 24 hours of hospitalization (53.3%; 95% CI: 0.4814, 0.5850). A 2.7 and 2.6 higher odds to suffer from pain during the hospitalization were associated with surgery, and preexisting chronic, respectively.
CONCLUSIONS
This study raises awareness of the necessity to refine pain assessment and management in hospital and outpatient services. The promotion and enhancement of hospital-territory integration are essential for improving pain prescribing practices and increasing patient safety.
Topics: Acute Pain; Aged; Chronic Pain; Female; Hospitalization; Humans; Inpatients; Italy; Male; Middle Aged; Prevalence; Tertiary Care Centers
PubMed: 34109593
DOI: 10.26355/eurrev_202105_25952 -
Current Opinion in Anaesthesiology Oct 2019This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving... (Review)
Review
PURPOSE OF REVIEW
This article discussed how the knowledge and technique of a few chronic pain procedures benefited the perioperative clinicians in their care of patients receiving specific orthopaedic surgical procedures.
RECENT FINDINGS
Recent emerging interest in hip and knee denervation for chronic pain management secondary to osteoarthritis stimulates publications on the new understanding of hip and knee joint innervation. The improved understanding of the anatomy allows better precision in targeting the articular branches. The procedures for chronic joint pain such as radiofrequency ablation, chemical neurolysis and neuromodulation procedure have recently been applied to the perioperative care in orthopaedic procedures because of the potential long-lasting analgesia, opioid-sparing effect and consequent improvement in physical function and health-related quality of life after surgery.
SUMMARY
Despite the widespread use of regional anaesthesia and multimodal analgesia in the perioperative pain management, more than two-third of the patients reported severe postoperative pain. Therefore, other therapeutic strategies used in chronic pain management such as radiofrequency ablation and neuromodulation have been proposed to optimize acute postsurgical pain. The early experience with those techniques is encouraging, and more studies are required to explore the incorporation of these procedures in the perioperative care.
Topics: Acute Pain; Chronic Pain; Humans; Orthopedic Procedures; Pain Management; Pain Measurement; Pain, Postoperative; Perioperative Care; Quality of Life; Severity of Illness Index; Treatment Outcome
PubMed: 31343464
DOI: 10.1097/ACO.0000000000000772 -
Clinical Rehabilitation Jun 2024To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert... (Review)
Review Meta-Analysis
OBJECTIVE
To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions.
DATA SOURCES
A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years.
REVIEW METHODS
Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts.
RESULTS
Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain.
CONCLUSIONS
The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.
Topics: Humans; Low Back Pain; Physical Therapy Modalities; Consensus; Randomized Controlled Trials as Topic; Female; Acute Pain; Male
PubMed: 38317586
DOI: 10.1177/02692155241229398 -
Pain Practice : the Official Journal of... Sep 2019This review discusses the findings in the literature on pain and distraction tasks according to their sensory modality. Distraction tasks have been shown to reduce... (Review)
Review
BACKGROUND
This review discusses the findings in the literature on pain and distraction tasks according to their sensory modality. Distraction tasks have been shown to reduce (experimentally induced) acute pain and chronic pain. This can be influenced by nature and by the sensory modalities used in the distraction tasks. Yet the effect on reducing pain according to the sensory modality of the distraction task has received little attention.
METHODS
A bibliographic search was performed in different databases. The studies will be systematized according to the sensory modality in which the distraction task was applied.
RESULTS
The analyzed studies with auditory distractors showed a reduction of acute pain in adults. However, these are not effective at healthy children and in adults with chronic pain. Visual distractors showed promising results in acute pain in adults and children. Similarly, tactile and mixed distractors decreased acute pain in adults.
CONCLUSION
Distraction tasks by diverse sensory modalities have a positive effect on decreasing the perception of acute pain in adults. Future studies are necessary given the paucity of research on this topic, particularly with tactile distractors (there is only one study). Finally, the most rigorous methodology and the use of ecological contexts are encouraged in future research.
Topics: Acoustic Stimulation; Acute Pain; Adult; Attention; Auditory Perception; Child; Female; Humans; Male; Photic Stimulation; Visual Perception
PubMed: 31104345
DOI: 10.1111/papr.12799 -
Anesthesia and Analgesia Aug 2020Acute pain services (APS) have developed over the past 35 years. Originally implemented solely to care for patients with regional catheters or patient-controlled... (Review)
Review
Acute pain services (APS) have developed over the past 35 years. Originally implemented solely to care for patients with regional catheters or patient-controlled analgesia after surgery, APS have become providers of care throughout the perioperative period, with some institutions even taking the additional step toward providing outpatient services for patients with acute pain. Models vary considerably in terms of tasks and responsibilities, staffing, education, protocols, quality, and financing. Many challenges face today's APS, including the increasing number of patients with preexisting chronic pain, intake of analgesics and opioids before surgery, substance-dependent patients needing special care, shorter hospital stays, early discharge of patients in need of further analgesic treatment, prevention and treatment of chronic postsurgical pain, minimization of adverse events, and side effects of treatment. However, many APS lack a clear-cut definition of their structures, tasks, and quality. Development of APS in the future will require us to face urgent questions, such as, "What are meaningful outcome variables?" and, "How do we define high quality?" It is obvious that focusing exclusively on pain scores does not reflect the complexity of pain and recovery. A broader approach is needed-a common concept of surgical and anesthesiological services within a hospital (eg, procedure-specific patient pathways as indicated by the programs "enhanced recovery after surgery" or the "perioperative surgical home"), with patient-reported outcome measures as one central quality criterion. Pain-related functional impairment, treatment-induced side effects, speed of mobilization, as well as return to normal function and everyday activities are key.
Topics: Acute Pain; Analgesics; Forecasting; Humans; Pain Clinics; Pain Measurement; Patient Satisfaction; Time Factors
PubMed: 32011394
DOI: 10.1213/ANE.0000000000004655 -
American Journal of Health-system... Sep 2019Current literature and clinical practice guidelines on pediatric pain management are reviewed. (Review)
Review
PURPOSE
Current literature and clinical practice guidelines on pediatric pain management are reviewed.
SUMMARY
Acute pain is commonly present in neonatal and pediatric patients due to underlying disease states or procedures. Especially in institutions with limited pediatric pain services, it is imperative to describe the appropriate management of pain and pharmacotherapy options that are effective and safe in pediatric patients. Despite the knowledge of pain being an important aspect in the management of children, barriers exist, leading to suboptimal treatment. Addressing these barriers through education of healthcare practitioners, families, and patients will lead to optimizing the patient pain experience. Tools for pain assessment vary depending on the type of pain, the child's age and understanding of pain, and the clinical situation. Pharmacotherapy options for pain management in neonates and pediatric patients include opioid and nonopioid agents. Efficacy and safety data on the use of medications for the treatment of pain in pediatric patients is described. The delivery of medication encompasses patient-specific factors and preferences. Strategies for opioid stewardship and management of iatrogenic withdrawal pose a unique challenge in pediatric patients.
CONCLUSION
The management of acute pain in neonates and pediatric patients should be a priority for all practitioners caring for these patients. Use of age-appropriate pain assessment tools and understanding of the mechanisms of action and roles in therapy of various nonopioid and opioid therapies can help optimize treatment of pain in neonatal and pediatric patients.
Topics: Acute Pain; Age Factors; Analgesics; Child; Child, Preschool; Dose-Response Relationship, Drug; Humans; Infant, Newborn; Medication Therapy Management; Pain Management; Pain Measurement; Patient Education as Topic; Practice Guidelines as Topic
PubMed: 31504147
DOI: 10.1093/ajhp/zxz166 -
Scientific Reports Apr 2022Few studies have investigated factors associated with acute postsurgical pain (APSP) trajectories, and whether the APSP trajectory can predict chronic postsurgical pain...
Few studies have investigated factors associated with acute postsurgical pain (APSP) trajectories, and whether the APSP trajectory can predict chronic postsurgical pain (CPSP) remains unclear. We aimed to identify the predictors of APSP trajectories in patients undergoing gastrointestinal surgery. Moreover, we hypothesised that APSP trajectories were independently associated with CPSP. We conducted a prospective cohort study of 282 patients undergoing gastrointestinal surgery to describe APSP trajectories. Psychological questionnaires were administered 1 day before surgery. Meanwhile, demographic characteristics and perioperative data were collected. Average pain intensity during the first 7 days after surgery was assessed by a numeric rating scale (NRS). Persistent pain intensity was evaluated at 3 and 6 months postoperatively by phone call interview. CPSP was defined as pain at the incision site or surrounding areas of surgery with a pain NRS score ≥ 1 at rest. The intercept and slope were calculated by linear regression using the least squares method. The predictors for the APSP trajectory and CPSP were determined using multiple linear regression and multivariate logistic regression, respectively. Body mass index, morphine milligram equivalent (MME) consumption, preoperative chronic pain and anxiety were predictors of the APSP trajectory intercept. Moreover, MME consumption and preoperative anxiety could independently predict the APSP trajectory slope. The incidence of CPSP at 3 and 6 months was 30.58% and 16.42% respectively. APSP trajectory and age were predictors of CPSP 3 months postoperatively, while female sex and preoperative anxiety were predictive factors of CPSP 6 months postoperatively. Preoperative anxiety and postoperative analgesic consumption can predict APSP trajectory. In addition, pain trajectory was associated with CPSP. Clinicians need to stay alert for these predictors and pay close attention to pain resolution.
Topics: Acute Pain; Chronic Pain; Digestive System Surgical Procedures; Female; Humans; Infant; Pain Measurement; Pain, Postoperative; Prospective Studies; Risk Factors
PubMed: 35444171
DOI: 10.1038/s41598-022-10504-5 -
Journal of the American Podiatric... 2023Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the... (Review)
Review
Podiatric physicians have come to realize that opioid use disorder (OUD) is a public health crisis causing morbidity, mortality, lost productivity, and legal cost in the United States. Opioid analgesics are efficient first-line pain relievers for acute and chronic lower-extremity pain syndrome. Perioperative pain management strategies have been proposed using opioid stewardship, but there are few standardized protocols to guide podiatric medical providers treating patients with OUD. First, we describe the pharmacology of therapeutic agents used as medications for addiction treatment for OUD and substance use disorder (SUD). Second, we offer criteria for selecting acute pain and perioperative management in patients with OUD and SUD per current medical literature. Finally, we review the literature applying opioid stewardship in the context of prescribing opioid analgesics in the presence of OUD and SUD. Three hypothetical clinical scenarios grounded in clinical-based literature are described with congruent data and founded guidelines. The first and second scenarios describe acute pain and perioperative management in patients with OUD receiving methadone and buprenorphine-naloxone, respectively. The third scenario describes acute pain and perioperative management in a patient with SUD receiving intravenous naltrexone. We hope that the lower-extremity specialist will appreciate that thoughtful management of acute perioperative pain among patients who receive medications for addiction treatment for OUD is critically important given the risks of destabilization during the perioperative period. The literature reveals the lack of rigorous evidence on acute pain management in patients who receive medication for OUD; however, some clinical evidence supports the practice of continuing methadone or buprenorphine for most patients during acute pain episodes.
Topics: Humans; United States; Analgesics, Opioid; Acute Pain; Opiate Substitution Treatment; Opioid-Related Disorders; Methadone; Chronic Pain
PubMed: 37463194
DOI: 10.7547/22-150 -
Journal of Neuroscience Methods Jan 2021Advances in human neuroimaging has enabled us to study functional connections among various brain regions in pain states. Despite a wealth of studies at high anatomic...
BACKGROUND
Advances in human neuroimaging has enabled us to study functional connections among various brain regions in pain states. Despite a wealth of studies at high anatomic resolution, the exact neural signals for the timing of pain remain little known. Identifying the onset of pain signals from distributed cortical circuits may reveal the temporal dynamics of pain responses and subsequently provide important feedback for closed-loop neuromodulation for pain.
NEW METHOD
Here we developed an unsupervised learning method for sequential detection of acute pain signals based on multichannel human EEG recordings. Following EEG source localization, we used a state-space model (SSM) to detect the onset of acute pain signals based on the localized regions of interest (ROIs).
RESULTS
We validated the SSM-based detection strategy using two human EEG datasets, including one public EEG recordings of 50 subjects. We found that the detection accuracy varied across tested subjects and detection methods. We also demonstrated the feasibility for cross-subject and cross-modality prediction of detecting the acute pain signals.
COMPARISON WITH EXISTING METHODS
In contrast to the batch supervised learning analysis based on a support vector machine (SVM) classifier, the unsupervised learning method requires fewer number of training trials in the online experiment, and shows comparable or improved performance than the supervised method.
CONCLUSIONS
Our unsupervised SSM-based method combined with EEG source localization showed robust performance in detecting the onset of acute pain signals.
Topics: Acute Pain; Brain; Electroencephalography; Humans; Support Vector Machine
PubMed: 33010301
DOI: 10.1016/j.jneumeth.2020.108964