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Current Opinion in Anaesthesiology Jun 2014This review highlights the current trends of efficient and safe perioperative pediatric pain therapy in the context of a multimodal pain therapy concept. (Review)
Review
PURPOSE OF REVIEW
This review highlights the current trends of efficient and safe perioperative pediatric pain therapy in the context of a multimodal pain therapy concept.
RECENT FINDINGS
A multimodal pain therapy concept should be easy to apply and safe regarding the occurrence of side-effects. The administration of nonopioid analgesics should be obligatory, regional anesthesia techniques - under ultrasound guidance - should be performed whenever possible, opioids should be given immediately and sufficiently whenever necessary, the administration of co-analgesics like lidocaine, dexamethasone or ketamine should be considered, and most importantly, each pain therapy should be performed according to pain assessment and long enough until adequate pain relief.
SUMMARY
Safe and simple pediatric pain management in the perioperative period combines not only easy to apply and safe stepwise pain therapy itself, but also adequate pain assessment and the implementation of continuous hospital quality improvement strategies.
Topics: Acute Pain; Adolescent; Analgesics; Anesthesia, Conduction; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Pain Management; Pain Measurement; Pain, Postoperative; Pediatrics
PubMed: 24709667
DOI: 10.1097/ACO.0000000000000074 -
Journal of Clinical Hypertension... Aug 2013The relationship between pain and hypertension is potentially of great pathophysiological and clinical interest, but is poorly understood. The perception of acute pain... (Review)
Review
The relationship between pain and hypertension is potentially of great pathophysiological and clinical interest, but is poorly understood. The perception of acute pain initially plays an adaptive role, which results in the prevention of tissue damage. The consequence of ascending nociception is the recruitment of segmental spinal reflexes through the physiological neuronal connections. In proportion to the magnitude and duration of the stimulus, these spinal reflexes cause the activation of the sympathetic nervous system, which increases peripheral resistances, heart rate, and stroke volume. The response also involves the neuroendocrine system, and, in particular, the hypothalamic-pituitary-adrenal axis, in addition to further activation of the sympathetic system by adrenal glands. However, in proportion to an elevation in resting blood pressure, there is a contemporary and progressive reduction in sensitivity to acute pain, which could result in a tendency to restore arousal levels in the presence of painful stimuli. The pathophysiological pattern is significantly different in the setting of chronic pain, in which the adaptive relationship between blood pressure and pain sensitivity is substantially reversed. The connection between acute or chronic pain and cardiovascular changes is supported observationally, but some of this indirect evidence is confirmed by experimental models and human studies. The pain regulatory process and functional interaction between cardiovascular and pain regulatory systems are briefly reviewed. Various data obtained are described, together with their potential clinical implications.
Topics: Acute Pain; Animals; Blood Pressure; Chronic Pain; Humans; Hypertension
PubMed: 23889724
DOI: 10.1111/jch.12145 -
Pain Research & Management 2020Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute...
OBJECTIVES
Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis.
METHODS
We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes.
RESULTS
One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. . Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.
Topics: Acute Pain; Adolescent; Back Pain; Child; Chronic Pain; Female; Humans; Male; Pain Measurement; Pain, Postoperative; Scoliosis; Self Report; Spinal Fusion
PubMed: 32184913
DOI: 10.1155/2020/9874739 -
PloS One 2023An improved understanding of behaviors reflecting acute pain in cats is a priority for feline welfare. The aim of this study was to create and validate a comprehensive... (Review)
Review
An improved understanding of behaviors reflecting acute pain in cats is a priority for feline welfare. The aim of this study was to create and validate a comprehensive ethogram of acute pain behaviors in cats that can discriminate painful versus non-painful individuals. An inventory of behaviors (ethogram) with their respective descriptors was created based on a literature review of PubMed, Web of Science and CAB Abstracts databases. The ethogram was divided into ten behavior categories that could be evaluated by duration and/or frequency: position in the cage, exploratory behaviors, activity, posture and body position, affective-emotional states, vocalization, playing (with an object), feeding, post-feeding and facial expressions/features. Thirty-six behaviors were analyzed independently by four veterinarians with postgraduate qualifications in feline medicine and/or behavior as (1) not relevant, (2) somewhat relevant, (3) quite relevant or (4) highly relevant and used for content (I-CVI) and face validity. Items with I-CVI scores > 0.67 were included. Twenty-four behaviors were included in the final ethogram. Thirteen items presented full agreement (i.e., I-CVI = 1): positioned in the back of the cage, no attention to surroundings, feigned sleep, grooming, attention to wound, crouched/hunched, abnormal gait, depressed, difficulty grasping food, head shaking, eye squinting, blepharospasm and lowered head position. Seven descriptors were reworded according to expert suggestions. The final ethogram provides a detailed description of acute pain behaviors in cats after content and face validity and can be applied to the characterization of different acute painful conditions in hospitalized cats.
Topics: Animals; Cats; Acute Pain; Behavior, Animal; Consensus; Exploratory Behavior; Gait; Humans
PubMed: 37768967
DOI: 10.1371/journal.pone.0292224 -
Rheumatology International Apr 2022Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative... (Observational Study)
Observational Study
Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012-December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS ≤ 4) or moderate/severe (NRS > 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [-12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [-9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain.
Topics: Acute Pain; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chronic Pain; Cohort Studies; Humans; Osteoarthritis; Pain, Postoperative
PubMed: 35218380
DOI: 10.1007/s00296-022-05094-4 -
Medicine May 2017Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pregabalin has been used as an adjunct for the management of acute pain in laparoscopic cholecystectomy. This meta-analysis aimed to illustrate the efficacy and safety of pregabalin for pain management following laparoscopic cholecystectomy.
METHODS
In March 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google databases. Data on patients prepared for laparoscopic cholecystectomy in studies that compared pregabalin versus placebo were retrieved. The primary endpoints were the visual analog scale (VAS) score with rest or mobilization at 6, 12, and 24 hours and total morphine consumption. The secondary outcomes were the morphine-related complications (i.e., nausea, vomiting, dizziness, somnolence, headache, pruritus, urine retention, respiratory depression, and blurred vision). Continuous outcomes were expressed as the weighted mean difference (WMD) with a corresponding 95% confidence interval (CI), and discontinuous outcomes were expressed as a risk ratio (RR) with a corresponding 95% CI.
RESULTS
Twelve clinical studies with 938 patients (gabapentin group = 536, control group = 402) were ultimately included in the meta-analysis. Pregabalin was associated with reduced pain scores with rest at 6, 12, and 24 hours, which corresponded to a reduction of 11.27 points at 6 hours, 9.46 points at 12 hours, and 3.99 points at 24 hours on a 100-point VAS. Moreover, pregabalin was associated with reduced pain scores with mobilization at 6, 12, and 24 hours, which corresponded to a reduction of 8.74 points, 5.80 points and 6.37 points at 6, 12, and 24 hours, respectively, on a 110-point VAS. Furthermore, pregabalin reduced the occurrence of nausea and vomiting. There were no significant differences in the occurrence of respiratory depression, pruritus, dizziness, blurred vision, and headache.
CONCLUSIONS
Pregabalin was efficacious in the reduction of postoperative pain, total morphine consumption, and morphine-related complications following laparoscopic cholecystectomy. In addition, a high dose of pregabalin was more effective than a low dose. The dose of pregabalin differed across the studies, and the heterogeneity was large. More studies are needed to verify the optimal dose of pregabalin in laparoscopic cholecystectomy patients.
Topics: Acute Pain; Analgesics; Cholecystectomy, Laparoscopic; Humans; Morphine; Pain, Postoperative; Pregabalin; Randomized Controlled Trials as Topic
PubMed: 28538404
DOI: 10.1097/MD.0000000000006982 -
Pain Feb 2015Osteoarthritis (OA) of the knee is a progressive disease that is associated with inflammation of the joints and lower extremity pain. Total knee arthroplasty (TKA) is a... (Observational Study)
Observational Study
Osteoarthritis (OA) of the knee is a progressive disease that is associated with inflammation of the joints and lower extremity pain. Total knee arthroplasty (TKA) is a surgical procedure that aims to reduce pain and restore motor function in patients suffering from OA. The immediate postoperative period can be intensely painful leading to extended recovery times including persistent pain. The endocannabinoid system regulates nociception, and the activation of cannabinoid receptors produces antinociceptive effects in preclinical models of OA. To date, the influence of the endocannabinoid tone on pain and disability in OA patients and on acute postoperative pain in humans has not been explored. In this study, we provide the first comprehensive profile of endocannabinoids in serum, cerebrospinal fluid, and synovial fluid of patients with painful end-stage OA undergoing TKA and examine correlations between endocannabinoid levels, interleukin 6, functional disability, acute postoperative pain, and postoperative opioid use. Our results reveal that central (cerebrospinal fluid) and peripheral (synovial fluid) levels of the endocannabinoid 2-arachidonoyl glycerol were significantly elevated in patients who developed higher postoperative pain after TKA. In addition, synovial fluid 2-arachidonoyl glycerol levels were positively correlated with postoperative opioid use. Similarly, synovial fluid levels of the anti-inflammatory lipid palmitoylethanolamide correlated with functional disability in OA. Taken together, our results are the first to reveal associations between central and peripheral endocannabinoid levels and postoperative pain. This suggests that endocannabinoid metabolism may serve as a target for the development of novel analgesics both for systemic or local delivery into the joint.
Topics: Acute Pain; Aged; Arthroplasty, Replacement, Knee; Biomarkers; Endocannabinoids; Female; Humans; Male; Middle Aged; Pain, Postoperative; Prospective Studies; Synovial Fluid
PubMed: 25599456
DOI: 10.1097/01.j.pain.0000460315.80981.59 -
Acupuncture in Medicine : Journal of... Aug 2022This document describes the consensus process and intervention for a National Institutes of Health (NIH)-funded multi-site feasibility study utilizing acupuncture for te... (Review)
Review
PURPOSE
This document describes the consensus process and intervention for a National Institutes of Health (NIH)-funded multi-site feasibility study utilizing acupuncture for te pan in he Emergenc Department (ACUITY). The acupuncture intervention is designed to be flexible and responsive to the most common Emergency Department (ED) scenarios, including trauma, acute pain of the low back, abdomen and/or musculoskeletal system, renal colic and headache.
BACKGROUND
Opioids remain a primary treatment for acute ED pain with attendant risk of adverse effects, addiction liability, diversion and death. Effective/safer options for acute pain are needed. Although acupuncture therapy has shown promise for acute pain in the ED alone or in conjunction with usual care, pragmatic trials are needed to obtain definitive and generalizable evidence.
METHODS
An Acupuncture Advisory Panel was convened that included nine acupuncture experts with 5-44 years of experience in practice and 2-16 years of experience in the acute pain care setting. A modified Delphi process was used with provision of a literature review, surveys of our panel members, three online discussions and email discussion as needed. The STandards for Reporting Interventions in Controlled Trials (STRICTA) checklist was used as a guide.
RESULTS
A responsive acupuncture intervention was agreed on for ACUITY. Session forms were fashioned in REDCap (Research Electronic Data Capture program to capture essential treatment data, assess fidelity and inform our design for a future pragmatic multi-site randomized controlled trial (RCT) of acupuncture in the ED, and for use by other future researchers.
CONCLUSION
Development of a responsive manualization intervention provides the appropriate framework for conducting a future, pragmatic, multi-site, definitive RCT of acupuncture in the ED.
TRIAL REGISTRATION NUMBER
NCT04880733 (ClinicalTrials.gov).
Topics: Acupuncture Therapy; Acute Pain; Consensus; Emergency Service, Hospital; Feasibility Studies; Humans; Randomized Controlled Trials as Topic
PubMed: 35229658
DOI: 10.1177/09645284221076507 -
British Journal of Anaesthesia Sep 2019We conducted a cohort study of adult patients presenting for orthopaedic trauma surgery at a statewide trauma centre, with the aims of determining (i) the incidence and...
BACKGROUND
We conducted a cohort study of adult patients presenting for orthopaedic trauma surgery at a statewide trauma centre, with the aims of determining (i) the incidence and risk factors for severe acute pain in the PACU, and (ii) the incidence and risk factors for persistent post-surgical pain at 3 months.
METHODS
Data were collected before operation, in the PACU, 72 h after surgery and 3 months after surgery, and included numerical rating scale (NRS) scores for pain, and modified Brief Pain Inventory-Short Form, Kessler Psychological Distress Scale, World Health Organization Disability Assessment Schedule, and Pain Catastrophizing Scale scores.
RESULTS
Severe acute pain in the PACU was reported by 171 (56%; 95% confidence interval [CI]: 51%, 62%) of the 303 included patients. Female sex (odds ratio [OR]: 1.86; 95% CI: 1.06, 3.26) and prior post-injury surgery (OR: 2.21; 95% CI: 1.11, 4.41) remained associated with severe acute pain after multivariable adjustment. Persistent post-surgical pain at 3 months was reported by 149 (65%; 95% CI: 59%, 71%) of the 229 included patients. The preoperative NRS score (OR: 1.17; 95% CI: 1.03, 1.32) remained associated with persistent pain after multivariable adjustment.
CONCLUSIONS
We identified three easy-to-measure risk factors: female sex, prior post-injury surgery for severe acute pain, and preoperative NRS scores for persistent pain. Further research is required to identify pain management strategies and psychosocial interventions to reduce the burden of pain, disability, and distress in these patients.
Topics: Acute Pain; Adult; Chronic Pain; Cohort Studies; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Musculoskeletal System; Orthopedic Procedures; Pain Measurement; Pain, Postoperative; Risk Factors; Sex Factors; Trauma Centers; Victoria
PubMed: 31248645
DOI: 10.1016/j.bja.2019.05.030 -
BMJ Open Jul 2022Opioid analgesics are often used to treat moderate-to-severe acute non-cancer pain; however, there is little high-quality evidence to guide clinician prescribing. An...
INTRODUCTION
Opioid analgesics are often used to treat moderate-to-severe acute non-cancer pain; however, there is little high-quality evidence to guide clinician prescribing. An essential element to developing evidence-based guidelines is a better understanding of pain management and pain control among individuals experiencing acute pain for various common diagnoses.
METHODS AND ANALYSIS
This multicentre prospective observational study will recruit 1550 opioid-naïve participants with acute pain seen in diverse clinical settings including primary/urgent care, emergency departments and dental clinics. Participants will be followed for 6 months with the aid of a patient-centred health data aggregating platform that consolidates data from study questionnaires, electronic health record data on healthcare services received, prescription fill data from pharmacies, and activity and sleep data from a Fitbit activity tracker. Participants will be enrolled to represent diverse races and ethnicities and pain conditions, as well as geographical diversity. Data analysis will focus on assessing patients' patterns of pain and opioid analgesic use, along with other pain treatments; associations between patient and condition characteristics and patient-centred outcomes including resolution of pain, satisfaction with care and long-term use of opioid analgesics; and descriptive analyses of patient management of leftover opioids.
ETHICS AND DISSEMINATION
This study has received approval from IRBs at each site. Results will be made available to participants, funders, the research community and the public.
TRIAL REGISTRATION NUMBER
NCT04509115.
Topics: Acute Pain; Analgesics, Opioid; Emergency Service, Hospital; Humans; Multicenter Studies as Topic; Observational Studies as Topic; Opioid-Related Disorders; Pain Management; Patient-Centered Care; Prospective Studies
PubMed: 35790333
DOI: 10.1136/bmjopen-2021-058782