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Acute & Persistant Pain

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59 papers 100 to 500 followers A collection of articles of interest to those treating acute pain and concern for persistent pain
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
Elina Cv Brinck, Elina Tiippana, Michael Heesen, Rae Frances Bell, Sebastian Straube, R Andrew Moore, Vesa Kontinen
BACKGROUND: Inadequate pain management after surgery increases the risk of postoperative complications and may predispose for chronic postsurgical pain. Perioperative ketamine may enhance conventional analgesics in the acute postoperative setting. OBJECTIVES: To evaluate the efficacy and safety of perioperative intravenous ketamine in adult patients when used for the treatment or prevention of acute pain following general anaesthesia. SEARCH METHODS: We searched CENTRAL, MEDLINE and Embase to July 2018 and three trials registers (metaRegister of controlled trials, ClinicalTrials...
December 20, 2018: Cochrane Database of Systematic Reviews
Gabriel A Brat, Denis Agniel, Andrew Beam, Brian Yorkgitis, Mark Bicket, Mark Homer, Kathe P Fox, Daniel B Knecht, Cheryl N McMahill-Walraven, Nathan Palmer, Isaac Kohane
OBJECTIVE: To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population. DESIGN: Retrospective cohort study. SETTING: Surgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016. PARTICIPANTS: 1 015 116 opioid naive patients undergoing surgery. MAIN OUTCOME MEASURES: Use of oral opioids after discharge as defined by refills and total dosage and duration of use...
January 17, 2018: BMJ: British Medical Journal
A Chin, B Crooke, L Heywood, R Brijball, A M Pelecanos, W Abeypala
Ultrasound assistance for neuraxial techniques may improve technical performance; however, it is unclear which populations benefit most. Our study aimed to investigate the efficacy of neuraxial ultrasound in women having caesarean section with combined spinal-epidural anaesthesia, and to identify factors associated with improved technical performance. Two-hundred and eighteen women were randomly allocated to ultrasound-assisted or control groups. All the women had a pre-procedure ultrasound, but only women in the ultrasound group had this information conveyed to the anaesthetist...
April 2018: Anaesthesia
Adam C Steinberg, Megan O Schimpf, Amanda B White, Cara Mathews, David R Ellington, Peter Jeppson, Catrina Crisp, Sarit O Aschkenazi, Mamta M Mamik, Ethan M Balk, Miles Murphy
OBJECTIVE: The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. DATA SOURCES: Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY: We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy...
September 2017: American Journal of Obstetrics and Gynecology
Jenifer O Fahey
Pain has been documented as a major concern for women in the postpartum period. Management of postpartum pain, however, is a relatively neglected area of clinical research. As a result, evidence to support interventions to alleviate the discomforts associated with childbirth is sparse. This paucity of research on postpartum pain management is particularly surprising given that in the United States alone nearly 4 million women give birth each year. Inadequate pain relief in the hours to months following childbirth can interfere with maternal-newborn bonding and feeding and, by impeding mobility, can increase the risk of postpartum complications...
April 2017: Journal of Perinatal & Neonatal Nursing
Rikke Vibeke Nielsen, Jonna Storm Fomsgaard, Hanna Siegel, Robertas Martusevicius, Lone Nikolajsen, Jørgen Berg Dahl, Ole Mathiesen
Perioperative handling of surgical patients with opioid dependency represents an important clinical problem. Animal studies suggest that ketamine attenuates central sensitization and hyperalgesia and thereby reduces postoperative opioid tolerance. We hypothesized that intraoperative ketamine would reduce immediate postoperative opioid consumption compared with placebo in chronic pain patients with opioid dependency undergoing lumbar spinal fusion surgery. Primary outcome was morphine consumption 0 to 24 hours postoperatively...
March 2017: Pain
Stephan A Schug
No abstract text is available yet for this article.
July 2012: Pain
Michael K Urban, Jacques T Ya Deau, Barbara Wukovits, Jane Y Lipnitsky
Management of acute postoperative pain is challenging, particularly in patients with preexisting narcotic dependency. Ketamine has been used at subanesthetic doses as a N-methyl D-aspartate (NMDA) receptor antagonist to block the processing of nociceptive input in chronic pain syndromes. This prospective randomized study was designed to assess the use of ketamine as an adjunct to acute pain management in narcotic tolerant patients after spinal fusions. Twenty-six patients for 1-2 level posterior lumbar fusions with segmental instrumentation were randomly assigned to receive ketamine or act as a control...
February 2008: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Esther Pogatzki-Zahn, Chandani Chandrasena, Stephan A Schug
PURPOSE OF REVIEW: Postoperative pain remains poorly treated in many patients. One reason is the inadequate use of nonopioid analgesics. This review examines the most recent findings on nonopioid analgesics and how these translate into clinical practice. RECENT FINDINGS: Commonly used nonopioid analgesics are paracetamol, NSAIDs and metamizol (dipyrone). For paracetamol, the efficacy is obviously inferior to NSAIDs and the risk of adverse events might have been underestimated in the past...
October 2014: Current Opinion in Anaesthesiology
A Wehrfritz, S Schaefer, A Troester, N Noel, B Bessiere, G Apiou-Sbirlea, G Simonnet, J Schuettler, P Richebé
BACKGROUND: Opioids are known to relieve pain, and also aggravate pre-existing hyperalgesia. In animal studies, the N-methyl-d-aspartate-receptor antagonist nitrous oxide (N2 O) was able to prevent hyperalgesia. The present study evaluated the effect of N2 O on hyperalgesia after remifentanil infusion in healthy volunteers. METHODS: Twenty-one healthy volunteers were enrolled in this placebo-controlled cross-over study. Transcutaneous electrical stimulation at high current densities induced spontaneous acute pain and stable areas of hyperalgesia...
October 2016: European Journal of Pain: EJP
Henrik Kehlet, Girish P Joshi
No abstract text is available yet for this article.
October 2015: Anesthesia and Analgesia
C Richard Chapman, Gary W Donaldson, Jennifer J Davis, David H Bradshaw
UNLABELLED: The purpose of this study was to demonstrate a method for increasing the precision and information yield of postoperative pain assessment. We recorded pain intensity ratings over 6 days after surgery in 502 elective surgery patients and examined individual pain trajectories. A linear fit of an individual patient's scores defines a trajectory with two features: (1) the intercept or initial pain intensity; and (2) the slope, or rate of pain resolution. Three pain trajectory patterns emerged from examination of the pain trajectory slopes...
February 2011: Journal of Pain: Official Journal of the American Pain Society
C Richard Chapman, Jennifer Davis, Gary W Donaldson, Justin Naylor, Daniel Winchester
UNLABELLED: For 2 weeks following surgery, 55 patients with preexisting chronic pain (CP) reported daily postoperative pain with movement and at rest. Of these, 30 CP patients used opioid pharmacotherapy for CP management and 25 did not. We modeled pain resolution in each patient using a linear fit so that each patient yielded 2 scores for each pain rating: 1) an intercept, or initial level of pain, immediately after surgery; and 2) a slope, or rate of pain resolution. The patients not using opioid pharmacotherapy had a mean pain with movement intercept of 5...
December 2011: Journal of Pain: Official Journal of the American Pain Society
Sara Marchesan Oliveira, Carine Cristiane Drewes, Cássia Regina Silva, Gabriela Trevisan, Suelen Lucio Boschen, Camila Guimaraes Moreira, Daniela de Almeida Cabrini, Claudio Da Cunha, Juliano Ferreira
Recent studies have indicated that nearly half of all surgical patients still have inadequate pain relief; therefore, it is becoming increasingly more important to understand the mechanisms involved in postoperative pain in order to be better treated. Previous studies have shown that incisions can cause mast cell degranulation. Thus, the aim of this study was to investigate the involvement of mast cells in a model of postoperative pain in mice. The depletion of mast cell mediators produced by pre-treatment with compound 48/80 (intraplantar (i...
December 15, 2011: European Journal of Pharmacology
Nichola Elvery, Mark P Jensen, Dawn M Ehde, Melissa A Day
OBJECTIVES: It is not known whether psychosocial chronic pain treatments produce benefits through the unique mechanisms specified by theory. Fundamental to gaining an accurate understanding of this issue is to first determine whether the most widely used process measures assess unique constructs and predict unique variance in pain outcomes. This study examined the associations between the Pain Catastrophizing Scale (PCS), Five-Facet Mindfulness Questionnaire (FFMQ-SF), and the Chronic Pain Acceptance Questionnaire (CPAQ-8), and determined their unique contributions to the prediction of pain intensity, pain interference, and depression...
June 2017: Clinical Journal of Pain
M Gram, J Erlenwein, F Petzke, D Falla, M Przemeck, M I Emons, M Reuster, S S Olesen, A M Drewes
BACKGROUND: Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted...
February 2017: European Journal of Pain: EJP
Yun Wang, Laura P Sands, Linnea Vaurio, E Ann Mullen, Jacqueline M Leung
To determine risks for postoperative cognitive dysfunction (POCD), the authors conducted a prospective cohort study of 225 patients > or = 65 years of age undergoing noncardiac surgery. Cognitive testing using the Word List, Verbal Fluency, and Digit Symbol tests was conducted for each patient preoperatively and 1 and 2 days postoperatively in patients without postoperative delirium. POCD was defined as meeting statistical criteria for decline from the patient's preoperative performance levels on at least two of the three cognitive tests...
January 2007: American Journal of Geriatric Psychiatry
Marina Shpaner, Clare Kelly, Greg Lieberman, Hayley Perelman, Marcia Davis, Francis J Keefe, Magdalena R Naylor
Chronic pain is a complex physiological and psychological phenomenon. Implicit learning mechanisms contribute to the development of chronic pain and to persistent changes in the central nervous system. We hypothesized that these central abnormalities can be remedied with Cognitive Behavioral Therapy (CBT). Specifically, since regions of the anterior Default Mode Network (DMN) are centrally involved in emotional regulation via connections with limbic regions, such as the amygdala, remediation of maladaptive behavioral and cognitive patterns as a result of CBT for chronic pain would manifest itself as a change in the intrinsic functional connectivity (iFC) between these prefrontal and limbic regions...
2014: NeuroImage: Clinical
Todd Jackson, Panpan Tian, Yang Wang, Tony Iezzi, Wenyi Xie
UNLABELLED: Presurgery emotional distress has had variable associations with outcomes of surgery in past narrative reviews. This meta-analysis was designed to evaluate the overall strengths of relations between presurgical emotional distress and key postsurgical pain outcomes (ie, pain intensity, analgesic use, functional impairment) and to identify moderators that might explain effect size heterogeneity between studies. PubMed, Web of Science, PsychINFO, Google Scholar, and Science Direct databases were searched to identify studies subjected to meta-analysis...
August 2016: Journal of Pain: Official Journal of the American Pain Society
Bülent Doğan, İsmet Gün, Özkan Özdamar, Ali Yılmaz, Murat Muhçu
OBJECTIVE: To investigate whether spontaneous vaginal birth with mediolateral episiotomy has any long-term impact on urinary and/or fecal incontinence, sexual dysfunction and perineal pain in primiparous women. METHODS: This matched case-control study included 150 women between 25 and 35 years old who had a singleton childbirth at least five years previously. Patients were grouped as; women who had a spontaneous vaginal delivery with mediolateral episiotomy (Group 1), an elective cesarean delivery (Group 2), and who had no delivery (Group 3)...
February 2017: Journal of Maternal-fetal & Neonatal Medicine
2016-04-28 15:39:21
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