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Zuniga JR, Kim RY, Miloro M, Petrisor D, Marwan H, Young S, Hernández-Nuño de la Rosa MF. Does Immediate Long-Span Nerve Allograft Reconstruction Affect the Incidence of Chronic Postsurgical and Neuropathic Pain in the Reconstructed Mandible Following Resection for Benign and Malignant Disease. J Oral Maxillofac Surg 2023; 81:1587-1593. [PMID: 37775087 DOI: 10.1016/j.joms.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Peripheral nerve injury can lead to chronic postsurgical pain (CPSP) and neuropathic pain following major surgery. PURPOSE Determine in patients undergoing ablative mandibular operations with transection of the trigeminal nerve: do those who undergo immediate repair, when compared to those whose nerves are not repaired, have a decreased or increased risk for CPSP or post-traumatic trigeminal neuropathic pain (PTTNp)? STUDY DESIGN, SETTING, SAMPLE A multisite, retrospective cohort of patients who underwent resection of the mandible for benign or malignant disease with either no repair or immediate repair of the intentionally transected trigeminal nerve with a long-span nerve allograft were analyzed for the presence or absence of CPSP and PTTNp at 6 months. PREDICTOR VARIABLE The primary predictor was the immediate repair or no repair of the trigeminal nerve. MAIN OUTCOME VARIABLE The primary outcome was the presence or absence of CPSP and PTTNp at 6 months postsurgery. COVARIATES There were 13 covariate variables, including age, sex, ethnicity, nerve injury, type of PTTNp, malignant or benign pathology and subtypes of each, use of radiation or chemotherapy, treatment of transected nerve end, longest follow-up time, pain scale, and onset of pain. ANALYSES Two-tailed Student's t test and Welch's t test were performed on mean scores and post hoc logistics and linear regression modeling were performed when indicated. The confidence level for statistical significance was P value <.05. RESULTS There were 103 and 94 subjects in the immediate and no-repair groups, respectively. The incidence of CPSP in the no-repair group was 22.3% and PTTNp was 2.12%, while there was 3.8% CPSP and 0% PTTNp in the repair group, which was statistically significant (P = <.001). Logistic regression modeling showed a statistically significant inverse relationship between the immediate repair and the incidence of CPSP/PTTNp with an odds ratio of 0.43, 95% confidence interval 0.18 to 1.01, P = .05. Greater age, malignant pathology, and chemo/radiation treatments were covariates found more frequently in the no repair group. CONCLUSION AND RELEVANCE Immediate repair of an intentionally transected trigeminal nerve with a long-span nerve allograft during resection of the mandible for both benign and malignant disease appears to reduce CPSP and possibly eliminate the development of PTTNp.
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Affiliation(s)
- John R Zuniga
- Robert V. Walker DDS Endowed Chair in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, Professor, Departments of Surgery and Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
| | - Roderick Y Kim
- Co-Director of Fellowship in Maxillofacial Oncology and Reconstructive Surgery, Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, John Peter Smith Health Network, Fort Worth, Texas
| | - Michael Miloro
- Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, IL
| | - Daniel Petrisor
- Associate Professor, Oral and Maxillofacial Surgery, Oregon Health Sciences University, Portland, OR
| | - Hisham Marwan
- Associate Professor, Division Chief, Oral and Maxillofacial Surgery, Carl E. Schow Chair in Oral and Maxillofacial Surgery, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Simon Young
- Associate Professor, Katz Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX
| | - María F Hernández-Nuño de la Rosa
- Assistant Professor and Director of Clinical Research, Department of Oral and Maxillofacial Surgery, Tufts University School of Dental Medicine, Boston, MA
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Laude-Pagniez E, Leclerc J, Lok C, Chaby G, Arnault JP. Capsaicin 8% patch as therapy for neuropathic chronic postsurgical pain after melanoma excision surgery: A single center case series. JAAD Case Rep 2022; 30:70-75. [DOI: 10.1016/j.jdcr.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ayaden N, Sitbon P, Pages A, Tselikas L, Bourgain JL. Pain after Interventional Radiology in Oncology: A Case-Control Study from a 5-Year Cohort. Cancers (Basel) 2022; 14:cancers14112576. [PMID: 35681559 PMCID: PMC9179575 DOI: 10.3390/cancers14112576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Interventional radiology plays a major role in oncology both for curative and palliative treatment, but few reports address post-procedural pain. The purpose of this study was to quantify postoperative pain after interventional radiology procedures in oncology and to identify major pain-associated pre and intraoperative factors. Methods: From 2015 to 2019, all patients treated with interventional radiology were included retrospectively in a cohort study. Anesthetic protocols were standardized by the type of radiological procedure. Demographic data, preoperative treatments, analgesic agents, pain score levels, and morphine consumption from the post-anesthesia care unit (PACU) to hospital discharge were collected from databases. In an additional case-control study, patients reporting strong or intolerable pain in PACU were compared to those with no pain. Matching to control cases was based on the type of intervention, sex, and age. Results: From 4411 procedures, severe pain in PACU was more frequent in women (p < 0.04) and the youngest patients (p < 0.0001), after general anesthesia (p < 0.0001). Higher pain levels were associated with certain procedures, such as arterial embolization, limb cementoplasty, osteosynthesis, and abdominal tumor ablation, and when the intervention duration exceeded 160 min (p = 0.038). In the cohort study, high-dose remifentanil (≥0.055 µg/kg/min) was a risk factor for post-procedural high pain levels (p < 0.001). Intraoperative ketoprofen was associated with a decrease in high pain level incidence (p < 0.0001). Severe pain in PACU was a risk factor for severe pain in wards from day 0 until discharge. Conclusion: Severe pain depends on the type and duration of interventional radiology, type of anesthesia, and preoperative use of opiates. Limiting doses of remifentanil and injecting intraoperative analgesics, especially ketoprofen, may reduce the incidence of post-intervention severe pain.
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Affiliation(s)
- Narimane Ayaden
- Gustave Roussy, Service d’Anesthésie, F-94805 Villejuif, France; (N.A.); (J.-L.B.)
| | - Philippe Sitbon
- Gustave Roussy, Service d’Anesthésie, F-94805 Villejuif, France; (N.A.); (J.-L.B.)
- Correspondence: ; Tel.: +33-(0)1-4211-6235; Fax: +33-(0)1-4211-5209
| | - Arnaud Pages
- Gustave Roussy, Département de Biostatistiques, F-94805 Villejuif, France;
| | - Lambros Tselikas
- Gustave Roussy, Interventional Radiology, F-94805 Villejuif, France;
| | - Jean-Louis Bourgain
- Gustave Roussy, Service d’Anesthésie, F-94805 Villejuif, France; (N.A.); (J.-L.B.)
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Perrot S, Pickering G, Lantéri-Minet M, Attal Md PhD N. Real-Life Management Pathways for Chronic Peripheral Neuropathic Pain at Tertiary Pain Clinics in France. PAIN MEDICINE 2021; 22:875-882. [PMID: 33515045 DOI: 10.1093/pm/pnaa443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Peripheral neuropathic pain (PNP) represents a major public health issue. Severe or refractory cases warrant tertiary multidisciplinary management, but little information is available about real-life care pathways. The primary objective of this cross-sectional, observational study was to investigate the pathways of patients with PNP consulting for the first time or followed for less than 1 year in French tertiary specialized pain clinics. METHODS PNP was diagnosed with the NeuPSIG algorithm. Data collected included demographics, pain characteristics, and details of management before and after the study visit (e.g., drug and non-drug treatment, nature of medical visits), as well as time to referral to a pain clinic and time to a diagnosis of PNP. Factors associated with delayed referral or diagnosis were analyzed with multivariate analysis. RESULTS A total of 404 patients with PNP (age 55.8 ± 15.6 years, 60.3% females, 78.3% retired or unemployed, pain duration 43.4 ± 68.9 months) were enrolled by 84 pain specialists. Pain affected mainly the lower limbs (53.5%) and was predominantly related to surgery or trauma (59.4%). Primary care management was characterized by a high proportion of conventional analgesics (60.7%). Time to referral to a pain clinic was 43.4 ± 68.9 months since pain onset and 20.1 ± 39.4 months since the diagnosis of PNP. Delayed referral to a pain clinic was independently predicted by the clinical specialty of the referring doctor and by male gender. CONCLUSIONS This study highlights the need for accessible guidance for non-pain specialists to improve their diagnostic and management skills and for faster referral of patients with PNP to tertiary pain clinics.
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Affiliation(s)
- Serge Perrot
- Department of Pain Evaluation, Hôpital Cochin, APHP, Paris, France.,INSERM U 987 & CETD, Hôpital Ambroise Paré, APHP, Boulogne, Billancourt
| | - Gisèle Pickering
- Centre de Pharmacologie Clinique CIC Inserm 1405, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Inserm 1107, Université Clermont Auvergne Neurodol, Clermont-Ferrand, France
| | - Michel Lantéri-Minet
- Inserm 1107, Université Clermont Auvergne Neurodol, Clermont-Ferrand, France.,Pain Department CHU Nice and FHU Inov, Pain Côte Azur University, Nice, France
| | - Nadine Attal Md PhD
- INSERM U 987 & CETD, Hôpital Ambroise Paré, APHP, Boulogne, Billancourt.,Université Versailles Saint Quentin en Yvelines, Versaille, France
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Data-science-based subgroup analysis of persistent pain during 3 years after breast cancer surgery: A prospective cohort study. Eur J Anaesthesiol 2021; 37:235-246. [PMID: 32028289 DOI: 10.1097/eja.0000000000001116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persistent pain extending beyond 6 months after breast cancer surgery when adjuvant therapies have ended is a recognised phenomenon. The evolution of postsurgery pain is therefore of interest for future patient management in terms of possible prognoses for distinct groups of patients to enable better patient information. OBJECTIVE(S) An analysis aimed to identify subgroups of patients who share similar time courses of postoperative persistent pain. DESIGN Prospective cohort study. SETTING Helsinki University Hospital, Finland, between 2006 and 2010. PATIENTS A total of 763 women treated for breast cancer at the Helsinki University Hospital. INTERVENTIONS Employing a data science approach in a nonredundant reanalysis of data published previously, pain ratings acquired at 6, 12, 24 and 36 months after breast cancer surgery, were analysed for a group structure of the temporal courses of pain. Unsupervised automated evolutionary (genetic) algorithms were used for patient cluster detection in the pain ratings and for Gaussian mixture modelling of the slopes of the linear relationship between pain ratings and acquisition times. MAIN OUTCOME MEASURES Clusters or groups of patients sharing patterns in the time courses of pain between 6 and 36 months after breast cancer surgery. RESULTS Three groups of patients with distinct time courses of pain were identified as the best solutions for both clustering of the pain ratings and multimodal modelling of the slopes of their temporal trends. In two clusters/groups, pain decreased or remained stable and the two approaches suggested/identified similar subgroups representing 80/763 and 86/763 of the patients, respectively, in whom rather high pain levels tended to further increase over time. CONCLUSION In the majority of patients, pain after breast cancer surgery decreased rapidly and disappeared or the intensity decreased over 3 years. However, in about a tenth of patients, moderate-to-severe pain tended to increase during the 3-year follow-up.
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Belbachir A, Fuzier R, Biau D. Unexplained pain after scheduled limb surgery. Orthop Traumatol Surg Res 2020; 106:S13-S18. [PMID: 31843513 DOI: 10.1016/j.otsr.2019.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Abstract
Orthopedic surgery can lead to pain that is poorly if at all explicable, both in the immediate postoperative period and at longer term, impairing the surgical result and necessitating a multidisciplinary approach of multimodal analgesia throughout the patient's care pathway. Preoperatively, patients at high risk of postoperative pain need to be identified and referred to a pain specialist to optimize pain management. Surgical and anesthesiological measures then need to be taken intraoperatively to limit the risk of pain. Finally, and most importantly, when pain does occur postoperatively, the surgeon needs to be able to treat any obvious cause and then rapidly to call in a pain specialist to identify the underlying causes and treat them effectively.
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Affiliation(s)
- Anissa Belbachir
- Service d'anesthésie réanimation, UF Douleur, université Paris-Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - Régis Fuzier
- Département d'anesthésie, institut Claudius-Regaud, institut universitaire du cancer Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - David Biau
- Inserm U1153, service de chirurgie Orthopédique, université Paris-Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, Paris, France
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Chronic Pain following Chest Trauma: Prevalence, Associated Factors, and Psychosocial Impact. Pain Res Manag 2020; 2020:1030463. [PMID: 32071652 PMCID: PMC7011396 DOI: 10.1155/2020/1030463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/07/2020] [Indexed: 02/05/2023]
Abstract
Background Chronic pain (CP) is a real public health concern. It is a common cause of poor quality of life and workplace absenteeism. It is well studied in many medical and surgical fields. However, only few data are available as regards to its occurrence in trauma patients. Purpose To assess the prevalence, associated factors, and psychosocial impact of CP following chest trauma. Methods This is an observational, descriptive, and analytic cross-sectional study performed in a Tunisian department of anesthesia and intensive care over a two-month period. Adult patients admitted one year ago for isolated chest trauma were enrolled. Data were collected by a phone interview. Studied variables were sociodemographic characteristics, traumatic injuries and their management, the occurrence of CP, and its psychosocial impact. CP was diagnosed by the Brief Pain Inventory (BPI) considering an evolution period of at least 3 months. Its impact was assessed by the BPI and the Posttraumatic stress disorder Checklist Scale (PCLS). Results Fifty-four patients were included in the study. The prevalence of CP was 79.6%. The average CP intensity was 3.18 ± 1.4. It was neuropathic in 90.7%. Its main associated factors were pleural effusion (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (p=0.016), time to ICU admission (. Conclusion CP following chest trauma is frequent and severe requiring preventive measures such as high risk patients screening, better management of acute pain, and a multidisciplinary approach for patients with diagnosed CP.
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Chen X, Ren X, Ma Y, Ge L, Hu Z, Yan W. [Research progress of the role of postoperative pain in the development of postoperative cognitive dysfunction in geriatric patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:1122-1126. [PMID: 31640954 DOI: 10.12122/j.issn.1673-4254.2019.09.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies have shown that postoperative cognitive dysfunction (POCD) is related to multiple factors including age, postoperative trauma, inflammation, postoperative pain, and anesthesia, among which postoperative pain is thought to play an important role in the development of POCD. This review summarizes the recent findings in the study of the role of postoperative pain in the pathogenesis of POCD in light of nerve injuries, neural remodeling and stress, and the progress in the prevention and treatment of POCD in elderly patients. It is of vital important to assess the postoperative pain and formulate adequate analgesic regimens for effective prevention and management of POCD to protect the brain functions of elderly patients.
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Affiliation(s)
- Xiaohui Chen
- Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou 730000, China
| | - Xiaoqiang Ren
- Department of Orthopedics, Zhangye People's Hospital Affiliated to Hexi University, Zhangye 734000, China
| | - Yabing Ma
- Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou 730000, China
| | - Li Ge
- Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou 730000, China
| | - Zhongyuan Hu
- Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou 730000, China
| | - Wenjun Yan
- Department of Anesthesiology, Gansu Provincial People's Hospital, Lanzhou 730000, China
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Management of neuropathic pain induced by surgery: Review of the literature by a group of experts specialized in pain management, anesthesia and surgery. J Visc Surg 2019; 157:43-52. [PMID: 31668838 DOI: 10.1016/j.jviscsurg.2019.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic postsurgical neuropathic pain (CPSNP) is frequent. While prevalence varies considerably according to type of operation and means of evaluation, it can reach 37% following breast surgery. Identification of risk factors related to the procedure and to the patient and taking into account the development of new, minimally invasive surgical techniques is increasingly nerve-sparing and reduces the likelihood of injury. CPSNP diagnosis in daily practice is facilitated by simple and quickly usable tools such as the NP4 4-question test. Management is based on pharmacological (analgesics, antiepileptics, antidepressants, local anesthetics) and non-pharmacological (kinesitherapy, neurostimulation, psychotherapy) approaches. In light of the present review of the literature, the authors, who constitute an expert group specialized in pain management, anesthesia and surgery, express their support for topical treatments (lidocaine, capsaicin) in treatment of localized postsurgical neuropathic pain in adults.
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Chronic postsurgical pain and cancer: the catch of surviving the unsurvivable. Curr Opin Support Palliat Care 2019; 12:118-123. [PMID: 29553987 DOI: 10.1097/spc.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. RECENT FINDINGS Cancer is now not always a short-lived, fatal disease and is now moving towards a chronic illness. Poorly managed perioperative pain is the greatest risk factor for CPSP. Recent trials have examined preventive strategies for CPSP associated with breast surgery and thoracotomy, two operations used in cancer treatment. Standard antinociceptive drugs, 5% lidocaine patches and ketamine do not prevent CPSP. The evidence for gabapentinoids is conflicting. Intravenous lidocaine and, separately, regional anaesthesia appear beneficial. SUMMARY Well-managed pain, irrespective of technique, reduces the risk of CPSP. The literature is inconclusive regarding an 'optimal approach.' Regional anaesthesia, intravenous lidocaine and the aggressive management of perioperative pain using multimodal analgesia including antineuropathic pain agents such as gabapentinoids and certain antidepressants are recommended. Clinicians should not rely on general anaesthesia, opioids, NSAIDs and ketamine to prevent CPSP. A blanket approach using gabapentinoids for all patients undergoing major surgery is not indicated. Instead, the presence of perioperative neuropathic pain should be checked for regularly.
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Lötsch J, Ultsch A, Kalso E. Prediction of persistent post-surgery pain by preoperative cold pain sensitivity: biomarker development with machine-learning-derived analysis. Br J Anaesth 2019; 119:821-829. [PMID: 29121286 DOI: 10.1093/bja/aex236] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Background To prevent persistent post-surgery pain, early identification of patients at high risk is a clinical need. Supervised machine-learning techniques were used to test how accurately the patients' performance in a preoperatively performed tonic cold pain test could predict persistent post-surgery pain. Methods We analysed 763 patients from a cohort of 900 women who were treated for breast cancer, of whom 61 patients had developed signs of persistent pain during three yr of follow-up. Preoperatively, all patients underwent a cold pain test (immersion of the hand into a water bath at 2-4 °C). The patients rated the pain intensity using a numerical ratings scale (NRS) from 0 to 10. Supervised machine-learning techniques were used to construct a classifier that could predict patients at risk of persistent pain. Results Whether or not a patient rated the pain intensity at NRS=10 within less than 45 s during the cold water immersion test provided a negative predictive value of 94.4% to assign a patient to the "persistent pain" group. If NRS=10 was never reached during the cold test, the predictive value for not developing persistent pain was almost 97%. However, a low negative predictive value of 10% implied a high false positive rate. Conclusions Results provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent.
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Affiliation(s)
- J Lötsch
- Institute of Clinical Pharmacology, Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.,Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine and Pharmacology TMP, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - A Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - E Kalso
- Department of Perioperative Medicine, Intensive Care and Pain Medicine, Pain Clinic, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Beloeil H, Sion B, Rousseau C, Albaladejo P, Raux M, Aubrun F, Martinez V. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol 2018; 34:652-657. [PMID: 28437260 DOI: 10.1097/eja.0000000000000634] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acute neuropathic pain can occur in the postoperative period but any link with persistent post-surgical neuropathic pain remains unclear. OBJECTIVES The objectives of this study were to prospectively describe the incidence of acute post-surgical neuropathic pain in a large population using the DN4 (clinician administered) questionnaire and to confirm the hypothetical link between acute and persistent neuropathic pain at 2 months after surgery in a large population using the DN2 (self administered) questionnaire. DESIGN A multi-centre, prospective and observational trial. SETTING Two consecutive days in 27 hospitals in France. PATIENTS Six hundred and eight patients undergoing 13 different types of surgery. Fifteen patients were excluded as data were incomplete, and 229 (38.6%) and 260 (43.8%) were not contactable for assessment at 1 and 2 months after surgery, respectively. MAIN OUTCOME MEASURES Pain was evaluated at least 2 h postoperatively on the same day (D0),on the second day (D2) and at 1 and 2 months after surgery (M1 and M2). Pain was assessed using a 10-point Numeric Rating Scale. If the Numeric Rating Scale score was greater than 0, neuropathic pain was assessed using a DN4 (clinician administered) questionnaire or using a DN2 (self-administered) questionnaire. Acute and persistent postsurgical neuropathic pain (PPSNP) were defined respectively by a DN4 score at least 4/10 on day 0 and/or day 2 and a DN2 score at least 3/7 at 2 months after surgery. RESULTS Of the 593 patients included, 41.2% were in pain before surgery and 8.2% described neuropathic pain. Early after surgery, the majority of the 593 patients (72.2% on the day of surgery and 71.3% on day 2) experienced acute pain. It was neuropathic in nature in 5.6% of patients (95% CI, 3.6 to 8.3) on the day of surgery and 12.9% (95% CI, 9.7 to 16.7) on day 2. Two months after surgery, PPSNP was present in 33.3% of the 333 patients assessed. Multivariate analysis showed that a DN4 score at least 4/10 on the day of surgery or on day 2 was a significant risk factor for PPSNP [odds ratios 4.22 (95% CI, 2.19 to 8.12)]. CONCLUSION Our results suggest that early acute postsurgical neuropathic pain significantly increases the risk of persistent post-surgical neuropathic pain. TRIAL REGISTRATION Clinicaltrials.gov identifier: NTC NCT02826317.
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Affiliation(s)
- Helene Beloeil
- From the CHU Rennes, Pôle Anesthésie et Réanimation, Inserm, UMR 991, CIC 1414 and Université de Rennes 1 (HB), CHU Rennes, Pôle Anesthésie et Réanimation (BS), CHU Rennes, Inserm CIC 1414, Rennes (CR), Pôle Anesthésie Réanimation CHU de Grenoble BP217, Grenoble Cedex 9 (PA), Département d'Anesthésie Réanimation, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris (MR), Hospices civils de Lyon, Université Lyon 1, Groupement hospitalier Nord, Hôpital de la Croix Rousse, Lyon (FA), Service d'Anesthésie Réanimation Chirurgicale, Hôpital Raymond Poincaré, AP-HP (VM); and INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Paris, France (VM)
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[Persistent postsurgical pain in children and young people : Prediction, prevention, and management]. Schmerz 2018; 32:293-300. [PMID: 29992500 DOI: 10.1007/s00482-018-0308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hanna MN, Speed TJ, Shechter R, Grant MC, Sheinberg R, Goldberg E, Campbell CM, Theodore N, Koch CG, Williams K. An Innovative Perioperative Pain Program for Chronic Opioid Users: An Academic Medical Center’s Response to the Opioid Crisis. Am J Med Qual 2018; 34:5-13. [DOI: 10.1177/1062860618777298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased utilization of prescription opioids for pain management has led to a nationwide public health crisis with alarming rates of addiction and opioid-related deaths. In the surgical setting, opioid prescriptions have been implicated as a contributing factor to the opioid epidemic. The authors developed an innovative model to address aspects of pain management and opioid utilization during preoperative evaluation, acute surgical hospitalization, and postoperative follow-up for chronic opioid users. This program involves multidisciplinary teams that include acute and chronic pain specialists, psychiatrists, integrative medicine specialists, and physical medicine and rehabilitation services. It also features a novel infrastructure for triage and pain management education and treatment. Individualized patient plans are devised that can include preoperative opioid weaning, regional anesthesia that minimizes opioid use, and multimodal techniques for surgical pain treatment. Multidisciplinary programs such as this have the potential to both improve perioperative pain control and prevent escalation of opioid use among chronic opioid users.
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Abstract
OBJECTIVES To investigate what factors are associated with continued long-term pain after fracture nonunion surgery. DESIGN Prospective cohort study. SETTING Single Academic Institution. PATIENTS/PARTICIPANTS Three hundred forty-one patients surgically treated for fracture nonunion were prospectively followed. Demographics, radiographic evaluations, VAS pain scores, and short musculoskeletal functional assessment (SMFA) scores were collected at routine intervals. Only patients who had a minimum of 1-year follow-up and complete healing were included this analysis. Patients were divided into a high-pain and low-pain cohort for comparison. Inclusion criteria for the high-pain cohort were defined as any patient who reported a pain score greater than one standard deviation above the mean. MAIN OUTCOME MEASURES Long-term VAS pain scores and factors contributing to increased patient-reported long-term VAS pain scores. RESULTS Two hundred seventy patients met criteria and were included in this analysis, with 223 patients (82.6%) in the low-pain cohort and 47 patients (17.4%) in the high-pain cohort. The mean long-term pain score was 7.47 ± 1.2 in the high-pain group and 1.78 ± 1.9 in the low-pain group. Within the high-pain cohort, 55.6% of patients reported a net increase in pain from baseline to long-term follow-up compared with 10.5% in the low-pain cohort (P < 0.0005). High baseline pain score (P = 0.003), increased Charlson comorbidity index (CCI) (P = 0.008), lower income level (P = 0.014), and current smoking status (P = 0.033) were found to be significantly more prevalent in the high-pain cohort. CONCLUSIONS Patients with higher baseline pain scores, elevated Charlson comorbidity index, lower income level or history of smoking are at an increased risk of reporting significant and potentially debilitating long-term pain after nonunion surgery. Although patients may expect complete relieve of pain, orthopaedic surgeons must inform patients of the possibility of experiencing pain 1 year or more postoperatively. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Salvat E, Yalcin I, Muller A, Barrot M. A comparison of early and late treatments on allodynia and its chronification in experimental neuropathic pain. Mol Pain 2017; 14:1744806917749683. [PMID: 29212409 PMCID: PMC5804997 DOI: 10.1177/1744806917749683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Surgeries causing nerve injury can result in chronic neuropathic pain, which is clinically managed by using antidepressant or anticonvulsant drugs. Currently, there is a growing interest for investigating preemptive treatments that would prevent this long-term development of neuropathic pain. Our aim was to compare analgesic drugs using two distinct treatment modalities: either treatment onset at surgery time or following a couple of weeks of neuropathic pain. Methods In male C57BL/6J mice, neuropathic pain was induced by cuffing the sciatic nerve, and allodynia was assessed using von Frey filaments. We tested the effect of anticonvulsants (gabapentin 10 mg/kg and carbamazepine 40 mg/kg), antidepressants (desipramine 5 mg/kg, duloxetine 10 mg/kg, and fluoxetine 10 mg/kg), dexamethasone (2 mg/kg), and ketamine (15 mg/kg). Drugs were injected daily or twice a day, starting either at surgery time or on day 25 postsurgery (15 days of treatment for antidepressants and 10 days for other drugs). Results Ketamine was the only effective treatment during the early postsurgical period. Although early anticonvulsant treatment was not immediately effective, it prevented chronification of allodynia. When treatments started at day 25 postsurgery, desipramine, duloxetine, and anticonvulsants suppressed the mechanical allodynia. Conclusions Our data show that allodynia measured in experimental neuropathic pain model likely results from a combination of different processes (early vs. late allodynia) that display different sensitivity to treatments. We also propose that early anticonvulsant treatment with gabapentin or carbamazepine may have a prophylactic effect on the chronification of allodynia following nerve injury.
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Affiliation(s)
- Eric Salvat
- 1 Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,2 Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Ipek Yalcin
- 2 Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - André Muller
- 1 Centre d'Evaluation et de Traitement de la Douleur, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,2 Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Michel Barrot
- 2 Institut des Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique, Strasbourg, France
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Bérubé M, Gélinas C, Choinière M, Feeley N, Martorella G, Parent S, Streiner DL. The effect of psychological interventions on the prevention of chronic pain in adults: a systematic review protocol. Syst Rev 2017; 6:190. [PMID: 28934981 PMCID: PMC5609012 DOI: 10.1186/s13643-017-0583-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 09/14/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Numerous psychological risk and protective factors have been identified as contributing to or preventing the development of the prevalent issue of chronic pain. Systematic reviews of studies on psychological interventions that tackle these factors have shown limited effects on chronic pain. Therefore, implementing psychological interventions before pain becomes chronic has been put forward. However, the efficacy of such interventions in preventing the transition from acute to chronic pain has not yet been systematically assessed. METHODS The aims of this systematic review are to assess the effects of psychological interventions applied in the acute pain phase on pain severity as well as on physical, psychological, and social functions at 3 months and beyond. Randomized controlled trials including psychological intervention as a treatment of primary interest and participants with pain of less than 3 months duration will be considered. The following comparisons will be undertaken: psychological interventions with (1) standard treatment, (2) information, (3) waiting-list, and (4) active treatment. The primary outcome will be pain severity using indicators such the presence or absence of pain and self-report measures such as the numeric pain intensity rating scale. Secondary outcomes will include pain-related disability, mood, coping with pain, quality of life, health care utilization, and work capability. A systematic review of English and French articles in MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials will be conducted without date restriction. Extracted data will include demographics and clinical characteristics, sample size, intervention and control group types, assessment tools used, time interval of measurement, fidelity of the intervention, and attrition rate. Standardized mean differences (SMD) and risk ratios with 95% confidence intervals (CI) will be used to assess treatment effects. DISCUSSION This systematic review is the first in examining the effects of psychological interventions implemented in the acute pain phase with the objective of preventing chronic pain. Results of this systematic review could provide information on psychological intervention characteristics that are most helpful for individuals with pain and guidance as to when such interventions should be applied in the continuum of care. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016049312.
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Affiliation(s)
- Mélanie Bérubé
- Centre Intégré Universitaire du Nord de l'Île-de-Montréal (Hôpital du Sacré-Cœur de Montréal) and Ingram School of Nursing, McGill University, 5400 Boulevard Gouin Ouest, Montréal, Québec, H4J 1C5, Canada.
| | - Céline Gélinas
- Ingram School of Nursing, McGill University and Centre for Nursing Research, Jewish General Hospital, 3506 University Street, Montreal, Canada
| | - Manon Choinière
- Department of Anesthesiology, Centre de recherche du Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis Street, Montréal, H2X 0A9, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University and Centre for Nursing Research, Jewish General Hospital, 3506 University Street, Montreal, Canada
| | - Géraldine Martorella
- College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, USA
| | - Stefan Parent
- Centre de recherche du Centre Hospitalier Universitaire Ste-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montreal, H3T 1C5, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5th Street, Hamilton, Canada
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Persistent postsurgical pain in children and young people: prediction, prevention, and management. Pain Rep 2017; 2:e616. [PMID: 29392231 PMCID: PMC5777679 DOI: 10.1097/pr9.0000000000000616] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/28/2017] [Indexed: 12/03/2022] Open
Abstract
Ensuring optimum preoperative and postoperative pain management should always be a priority in children.
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Sahin N, Karahan AY, Devrimsel G, Gezer IA. Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain. J Phys Ther Sci 2017; 29:891-895. [PMID: 28603366 PMCID: PMC5462693 DOI: 10.1589/jpts.29.891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/16/2017] [Indexed: 12/19/2022] Open
Abstract
[Purpose] The aim of this study is to compare patients with failed back surgery syndrome
(FBSS) with those with non-specific chronic back pain (NSCBP) in terms of pain,
depression, and quality of life levels to explain the effects of surgery experience on
low-back pain. [Subjects and Methods] A total of 50 patients with FBSS and 51 patients
with NSCBP who consecutively applied to the outpatient clinic from September 2012 to April
2013 were included in the study. Patients completed questionnaires on demographics, body
mass index, education level, work history, and pain duration (in months). Lumbar pain at
rest, during movement, and at night were measured with a visual analogue scale (VAS). The
Short Form 36 scale was used for evaluating quality of life, and the Beck Depression
Inventory (BDI) was used for assessing depression. [Results] VAS scores reporting pain at
rest and at night and BDI scores were significantly higher in the FBSS group than in the
NSCBP group. Role limitations due to physical functioning, which is one of the measures of
quality of life, were significantly higher in the FBSS group than in the NSCBP group.
[Conclusion] These assessments show that surgery experience in patients with ongoing
low-back pain makes their pain and depression worse.
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Affiliation(s)
- Nilay Sahin
- Department of Physical Medicine and Rehabilitation, Balikesir University Faculty of Medicine, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation Konya, Konya Training and Research Hospital, Turkey
| | - Gul Devrimsel
- Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdogan University Faculty of Medicine, Turkey
| | - Ilknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selcuk University Faculty of Medicine, Turkey
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Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials. Pain 2017; 158:775-783. [DOI: 10.1097/j.pain.0000000000000838] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Batoz H, Semjen F, Bordes-Demolis M, Bénard A, Nouette-Gaulain K. Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study. Br J Anaesth 2016; 117:489-496. [DOI: 10.1093/bja/aew260] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/13/2022] Open
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Chatel H, Madar Y, Leyder P, Bonneau C, Barrat C, Quilichini J. Prevalence and factors associated with persistent pain following body contouring surgery. J Plast Reconstr Aesthet Surg 2016; 69:700-5. [PMID: 26923660 DOI: 10.1016/j.bjps.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/21/2015] [Accepted: 01/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Persistent postsurgical pain (PPP) has been reported by patients following various surgeries. Body contouring procedures are being performed more frequently, but no data are available regarding the effects of these procedures. Long-term disability occurring after performing "functional" procedures on healthy subjects is a particular concern. The aim of this study was to describe the risk factors, prevalence, characteristics, and effects of persistent pain after body contouring procedures. METHODS Patients who underwent body contouring surgery (e.g., abdominoplasty, lower body lift, medial thigh lift, brachioplasty, and abdominal liposuction) between January 1 2009 and December 31 2013 were included in this retrospective, monocentric cohort study. Pain evaluation was performed using a visual analog pain scale (VAS) and the Douleur Neuropathique 4 (DN4) questionnaire. Major risk factors previously identified in the literature were evaluated. RESULTS The study included 199 patients. Pain was reported by 42 patients (21%). Seventy-one percent (n = 30) of these 42 patients presented with neuropathic pain. Risk factors that were significantly associated with PPP were acute postoperative pain (p = 0.0003), medical history of bariatric surgery (p = 0.002), longer period of hospitalization (p = 0.04), depressive status during the operative period (p = 0.03), substantial stress before surgery (p = 0.03), and major complications after surgery (p = 0.03). CONCLUSION Persistent chronic pain is frequent after body contouring procedures. Preemptive approaches and early postoperative diagnosis are important measures that can be used to limit the effects of this complication on the patient's quality of life.
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Affiliation(s)
- Harold Chatel
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France.
| | - Yoni Madar
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France
| | - Patrick Leyder
- Department of Plastic Surgery, CH Ballanger, 93600 Aulnay-sous-Bois, France
| | - Claire Bonneau
- Curie Institute, 35 Rue Dailly, 92220 Saint-Cloud, France
| | - Christophe Barrat
- Department of Bariatric and Metabolic Surgery, CHU Avicenne, 93000 Bobigny, France; Paris North University, 99 Avenue Jean Baptiste Clément, 93430 Villetaneuse, France
| | - Julien Quilichini
- Department of Bariatric and Metabolic Surgery, CHU Avicenne, 93000 Bobigny, France; Paris North University, 99 Avenue Jean Baptiste Clément, 93430 Villetaneuse, France
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Fuzier R, Rousset J, Bataille B, Salces-y-Nédéo A, Maguès JP. One half of patients reports persistent pain three months after orthopaedic surgery. Anaesth Crit Care Pain Med 2015; 34:159-64. [DOI: 10.1016/j.accpm.2014.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/23/2014] [Indexed: 11/24/2022]
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Douleurs chroniques après chirurgie : état des lieux. Presse Med 2015; 44:486-91. [DOI: 10.1016/j.lpm.2014.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/09/2014] [Indexed: 11/21/2022] Open
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Adoukonou T, Gnonlonfoun D, Kpozehouen A, Adjien C, Tchaou B, Tognon-Tchegnonsi F, Adechina H, Covi R, Houinato D. Prévalence et caractéristiques des douleurs chroniques avec caractère neuropathique en population générale à Parakou au nord du Bénin en 2012. Rev Neurol (Paris) 2014; 170:703-11. [DOI: 10.1016/j.neurol.2014.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 06/04/2014] [Accepted: 07/08/2014] [Indexed: 02/01/2023]
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Recommandation de la SFORL (version courte) sur la prise en charge de la douleur post-amygdalectomie chez l’adulte. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.aforl.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Guidelines (short version) of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) for the management of post-tonsillectomy pain in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:227-32. [PMID: 25106699 DOI: 10.1016/j.anorl.2014.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The present clinical practice guidelines cover the entire field of management of post-tonsillectomy pain. Given the French and European regulatory restrictions on the use of codeine, an update appears necessary to clarify the management of post-tonsillectomy pain in adults. METHOD A work group approached the issue of pain management, following the chronological pathway from initial consultation to postoperative period. As exhaustive a study of the literature as possible assessed the pain impact of the various surgical techniques and the efficacy of the various analgesia schedules. RESULTS Guidelines on the management of post-tonsillectomy pain in adults were drawn up and graded, based on the levels of evidence of selected articles and on work group consensus. The guidelines stress the importance of patient information and seek to harmonize practice, reduce the risk of postoperative complications and above all improve control of post-tonsillectomy pain in adults.
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Artus M, Laviolle B, Maurice A, Malledant Y, Beloeil H. Risk factors for persistent pain after urological surgery. ACTA ACUST UNITED AC 2014; 33:e89-94. [DOI: 10.1016/j.annfar.2014.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/14/2014] [Indexed: 01/01/2023]
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Martinez V, Attal N, Vanzo B, Vicaut E, Gautier JM, Bouhassira D, Lantéri-Minet M. Adherence of French GPs to chronic neuropathic pain clinical guidelines: results of a cross-sectional, randomized, "e" case-vignette survey. PLoS One 2014; 9:e93855. [PMID: 24747826 PMCID: PMC3991574 DOI: 10.1371/journal.pone.0093855] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Background and aims The French Pain Society published guidelines for neuropathic pain management in 2010. Our aim was to evaluate the compliance of GPs with these guidelines three years later. Methods We used “e” case vignette methodology for this non interventional study. A national panel of randomly selected GPs was included. We used eight “e” case-vignettes relating to chronic pain, differing in terms of the type of pain (neuropathic/non neuropathic), etiology (cancer, postoperative pain, low back pain with or without radicular pain, diabetes) and symptoms. GPs received two randomly selected consecutive “e” case vignettes (with/without neuropathic pain). We analyzed their ability to recognize neuropathic pain and to prescribe appropriate first-line treatment. Results From the 1265 GPs in the database, we recruited 443 (35.0%), 334 of whom logged onto the web site (26.4%) and 319 (25.2%) of whom completed the survey. Among these GPs, 170 (53.3%) were aware of the guidelines, 136 (42.6%) were able to follow them, and 110 (34.5%) used the DN4 diagnostic tool. Sensitivity for neuropathic pain recognition was 87.8% (CI: 84.2%; 91.4%). However, postoperative neuropathic pain was less well diagnosed (77.9%; CI: 69.6%; 86.2%) than diabetic pain (95.2%; CI: 90.0%; 100.0%), cancer pain (90.6%; CI: 83.5%; 97.8%) and typical radicular pain (90.7%; CI: 84.9%; 96.5%). When neuropathic pain was correctly recognized, the likelihood of appropriate first-line treatment prescription was 90.6% (CI: 87.4%; 93.8%). The treatments proposed were pregabaline (71.8%), gabapentine (43.9%), amiptriptylline (23.2%) and duloxetine (18.2%). However, ibuprofen (11%), acetaminophen-codeine (29.5%) and clonazepam (10%) were still prescribed. Conclusions The compliance of GPs with clinical practice guidelines appeared to be satisfactory, but differed between etiologies.
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Affiliation(s)
- Valéria Martinez
- Anesthésiologie-Réanimation, Hôpital Raymond-Poincaré, Garches, France
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- * E-mail:
| | - Nadine Attal
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
| | | | - Eric Vicaut
- Unité de Recherche Clinique - Hôpital Fernand Widal, Paris, France
| | - Jean Michel Gautier
- Réseau InterCLUD Languedoc Roussillon, CHRU Montpellier, Montpellier, France
| | - Didier Bouhassira
- INSERM U-987, Centre d'Evaluation et de Traitement de la Douleur, CHU Ambroise Paré, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
| | - Michel Lantéri-Minet
- CHU de Nice, Centre d'Evaluation et Traitement de la Douleur, Nice, France
- INSERM/UdA, U1107, Neuro-Dol, Université de Clermont-Ferrand, Clermont-Ferrand, France
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Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S. Postoperative pain management in children and infants: an update. Paediatr Drugs 2014; 16:129-40. [PMID: 24407716 DOI: 10.1007/s40272-013-0062-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many factors contribute to suboptimal pain management in children. Current evidence suggests that severe pain in children has significant long-lasting effects, even more so than in adults. In particular, recent evidence suggests a lack of optimal postoperative pain management in children, especially following ambulatory surgery. This review provides simple guidelines for the management of postoperative pain in children. It discusses the long-term effects of severe pain and how to evaluate pain in both healthy and neurologically impaired children, including neonates. Currently available treatment options are discussed with reference to the efficacy and side effects of opioid and non-opioid and regional analgesic techniques. The impact of preoperative anxiety on postoperative pain, and the efficacy of some nonpharmacological techniques such as hypnosis or distraction, are also discussed. Finally, basic organizational strategies are described, aiming to promote safer and more efficient postoperative pain management in children.
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Affiliation(s)
- Christopher Brasher
- Department of Anesthesiology, Intensive Care, Robert Debré Hospital, 48 Bd Sérurier, 75019, Paris, France
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Chauvin M. [Chronic postsurgical pain: a clinical reality and a research way to develop]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2013; 32:385-386. [PMID: 23747213 DOI: 10.1016/j.annfar.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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