1
|
Tsai AWW, Kobayashi R, Liu IAW, Fim M, Liggieri AC, Machado ES. Update on Musculoskeletal Pain Management. Rev Bras Ortop 2024; 59:e160-e171. [PMID: 38606122 PMCID: PMC11006528 DOI: 10.1055/s-0043-1776135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/25/2023] [Indexed: 04/13/2024] Open
Abstract
Pain is the most common complaint reported to orthopedists in the outpatient clinic, emergency room, or booth. Numerous publications report the inadequate management of both acute and chronic pain by health professionals. This updated article aims to provide information about musculoskeletal pain, its classification, evaluation, diagnosis, and the multimodal therapeutic approach for each case. For acute pain, adequate control allows for earlier rehabilitation to work and reduces the rates of pain chronification. For chronic pain, the goal is to reduce its intensity and improve the quality of life. Currently, some procedures are increasingly used and aided by imaging tests for diagnostic and therapeutic purposes.
Collapse
Affiliation(s)
| | - Ricardo Kobayashi
- Centro de Dor, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | - Márcio Fim
- Cirurgia de Ombro e Cotovelo, Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG), Belo Horizonte, MG, Brasil
| | - André Cicone Liggieri
- Centro de Dor, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Edilson Silva Machado
- Serviço de Dor e Cuidados Paliativos, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil
| |
Collapse
|
2
|
Iatrogenic constipation in gastrointestinal surgery. J Visc Surg 2022; 159:S51-S57. [DOI: 10.1016/j.jviscsurg.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
3
|
Vernant M, Lepoupet M, Creveuil C, Alix A, Gourio C, Peyro-Saint-Paul L, Lelong-Boulouard V, Guillaumé C. Intravenous versus subcutaneous route pharmacokinetics of paracetamol (acetaminophen) in palliative care patients: study protocol for a randomized trial (ParaSCIVPallia). Trials 2020; 21:138. [PMID: 32019598 PMCID: PMC6998185 DOI: 10.1186/s13063-019-3969-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Among palliative care (PC) patients who are administered paracetamol, the subcutaneous (SC) route is often an alternative to the intravenous (IV) route. Yet pharmacological and clinical data on whether these are equivalent pharmacokinetically are lacking. Many French palliative teams are now empirically using paracetamol by the SC route, but there are no data to support this practice. This trial aims to compare the pharmacokinetic (PK) parameters of paracetomol between the IV and SC routes in PC patients. METHODS/DESIGN This is a randomized, open, crossover study in two PC centers. The primary endpoints are AUC0-t, AUC0-∞, Cmax, Vd, and t1/2. All adverse events will be reported for a safety analysis. Twenty adult PC patients with an IV device having spontaneous pain not related to care, with a numeric pain rate scale > 3/10, or having a systematic prescription of paracetamol as the usual treatment will be included. All patients also have to meet all eligibility criteria. CONCLUSION This is the first study comparing PK parameters for IV paracetamol versus SC paracetamol in PC patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT03944044. Registered on 4 June 2019. Committee for the protection of persons (CPP) 18.09.05.58206 approval 4 October 2018. National Drug Safety Agency (ANSM; Agence Nationale de Sécurité Médicament) MEDAECNAT-2018-09-00009 approval 29 November 2018.
Collapse
Affiliation(s)
- Marine Vernant
- Pain and Palliative Care Department and Regional Palliative Care Unit (RPCU) Maurice Abiven of Fondation de la Miséricorde, Caen University Hospital, CHU de Caen- avenue de la côte de Nacre, 14000, Caen, France.
| | - Marie Lepoupet
- Pain and Palliative Care Department, Caen University Hospital, 14000, Caen, France
| | - Christian Creveuil
- Clinical Research Department, Caen University Hospital, 14000, Caen, France
| | - Antoine Alix
- Caen University Hospital, Pharmacy, 14000, Caen, France
| | | | | | | | - Cyril Guillaumé
- Pain and Palliative Care Department, Caen University Hospital, 14000, Caen, France
| |
Collapse
|
4
|
Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian Spine J 2018; 12:574-585. [PMID: 29879788 PMCID: PMC6002183 DOI: 10.4184/asj.2018.12.3.574] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/20/2017] [Accepted: 09/12/2017] [Indexed: 12/28/2022] Open
Abstract
The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients’ clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.
Collapse
|
5
|
García CA, Santos Garcia JB, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C, Rocío Guillén Núnez MD, Hernández Castro JJ, Kraychete DC, Lara-Solares A, Lech O, Rico Pazos MA, Gallegos MS, Marcondes LP. Undertreatment of pain and low use of opioids in Latin America. Pain Manag 2018; 8:181-196. [PMID: 29774774 DOI: 10.2217/pmt-2017-0043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.
Collapse
Affiliation(s)
| | | | | | - Frantz Colimon
- Centro Oncológico de Antioquia, Medellín, Antioquia, Colombia
| | | | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia
| | | | | | - Durval Campos Kraychete
- Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil
| | - Argelia Lara-Solares
- Department of Pain Medicine & Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - Osvandré Lech
- Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil
| | | | | | | |
Collapse
|
6
|
Ruiz Iban MA, Benavides J, Forero JP, Bittelman S, Martinez R, Mite MA, Diaz Heredia J, Ulloa S, Lizárraga Ferrand MM. Use of strong opioids for chronic pain in osteoarthritis: an insight into the Latin American reality. Expert Rev Clin Pharmacol 2017; 11:47-59. [PMID: 28920710 DOI: 10.1080/17512433.2018.1381556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Osteoarthritis is the most common cause of arthritis and one of the main causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids. Areas covered: In this article we review the epidemiology of osteoarthritis, its socioeconomic burden, its impact as a chronic pain cause and the pharmacological treatment options, giving emphasis to the role of strong opioids, their safety and efficacy, especially in Latin American countries, where restrictions regulate their usage. Expert commentary: Usage of strong opioids is safe and effective in the short-term management of osteoarthritis with moderate to severe pain, when other pharmacological treatments are inadequate and surgery is contraindicated, provided their use adheres to existing guidelines. Educational programs for patients and physicians and further research on treating chronic pain with opioids should be implemented to reduce adverse effects and improve care quality.
Collapse
Affiliation(s)
- Miguel Angel Ruiz Iban
- a Shoulder and Elbow Unit, Orthopaedic Surgery and Traumatology Service , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | | | - Juan Pablo Forero
- c Servicios Rehabilitación Organización Sanitas Colombia , Clínica Reina Sofía , Bogotá , Colombia
| | - Sacha Bittelman
- d Orthopaedic Surgery in Hip and Knee Replacement , Hospital Instituto de Seguridad del Trabajo (IST) and Clínica Tabancura, Orthopaedic and traumatology department at the University Diego Portales , Santiago de Chile , Chile
| | - Rafael Martinez
- e Facultad de Medicina , Universidad Finis Terrae, Clínica Avansalud, Clínica Bicentenario, Instituto de Seguridad del Trabajo , Santiago de Chile , Chile
| | - Miguel Angel Mite
- f Orthopaedic and Traumatology department at the University of Guayaquil, Orthopaedic Surgery the Hip and Knee Replacement Team , Hospital IESS Dr. Teodoro Maldonado Carbo , Guayaquil , Ecuador
| | - Jorge Diaz Heredia
- a Shoulder and Elbow Unit, Orthopaedic Surgery and Traumatology Service , Hospital Universitario Ramón y Cajal , Madrid , Spain
| | - Sergio Ulloa
- g Rheumatology Department , Médica Sur. Comité técnico de Funsalud , México D.F , México
| | | |
Collapse
|