1
|
Yagur Y, Engel O, Burstein R, Bsharat J, Weitzner O, Daykan Y, Klein Z, Schonman R. Pain after laparoscopic endometriosis-specific vs. hysterectomy surgeries: A retrospective cohort analysis. PLoS One 2024; 19:e0301074. [PMID: 39365777 PMCID: PMC11452001 DOI: 10.1371/journal.pone.0301074] [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: 07/30/2023] [Accepted: 03/08/2024] [Indexed: 10/06/2024] Open
Abstract
OBJECTIVES To evaluate pain perception and analgesic use between patients who underwent endometriosis-specific laparoscopic surgery compared to laparoscopic hysterectomy. MATERIAL AND METHODS This retrospective cohort study included women diagnosed with endometriosis who underwent laparoscopic surgery from 1/2019 to 11/2022. The control group consisted of premenopausal women who underwent laparoscopic hysterectomy, which was considered a similarly extensive surgery. Demographics, preoperative and post-operative data were compared between groups. Post-operative pain scores on a visual analogue scale (VAS) between 0 (no pain) and 10 (worst pain) were compared between groups for each post-operative day (POD). Standard pain relief analgesia on POD 0-1 included fixed intravenous treatment with paracetamol and intramuscular diclofenac. The need for additional analgesics (morphine or dipyrone) beyond the standard pain relief protocol was compared between groups. RESULTS Among 200 patients who underwent laparoscopic surgery, 100 (50%) were in the endometriosis group and 100 (50%) in the hysterectomy group. The endometriosis group was characterized by younger age and lower parity (both, p<0.001). There was no significant difference between the groups in mean VAS scores for each post-operative day. However, among patients who needed additional analgesics beyond the standard protocol on POD 1, a higher percentage of women in the endometriosis group used opioids rather than milder analgesics, as compared to controls (1% vs. 0.2%, respectively, p = 0.03). CONCLUSION Increased post-operative morphine use was observed in patients with endometriosis following laparoscopic surgery, despite no significant difference in mean VAS scores during the post-operative days. These findings suggest that personalized pain relief protocols should be adjusted for women with endometriosis.
Collapse
Affiliation(s)
- Yael Yagur
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Offra Engel
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Burstein
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Justin Bsharat
- School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Meir Medical Center, Department of Obstetrics and Gynecology, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
2
|
Oweidat A, Kalagara H, Sondekoppam RV. Current concepts and targets for preventing the transition of acute to chronic postsurgical pain. Curr Opin Anaesthesiol 2024; 37:588-596. [PMID: 39087396 DOI: 10.1097/aco.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
PURPOSE OF REVIEW It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. RECENT FINDINGS From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain. SUMMARY A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.
Collapse
Affiliation(s)
- Adeeb Oweidat
- Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | |
Collapse
|
3
|
Wilson K, Sze Y, Regan A, Zhu C, Mazur K, Velichkova AN, Torsney C. Postsurgical tactile-evoked pain: a role for brain-derived neurotrophic factor-tropomyosin receptor kinase B-dependent novel tactile corpuscles. Pain Rep 2024; 9:e1169. [PMID: 39139363 PMCID: PMC11319325 DOI: 10.1097/pr9.0000000000001169] [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: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Millions of people undergo surgical procedures each year with many developing postsurgical pain. Dynamic allodynia can arise when, for example, clothing brushing close to the surgical site elicits pain. The allodynia circuits that enable crosstalk between afferent tactile inputs and central pain circuits have been studied, but the peripheral tactile drive has not been explored. Objective Investigate the innervation of the skin in the rat plantar hindpaw skin-muscle incision model. Results Incision increased epidermal thickness and cell layers and reduced intraepidermal nerve fibre density, identified with PGP9.5 immunostaining. Strikingly, Collagen IV immunostaining revealed the development of dermal protrusions, oriented towards the incision site, that were reminiscent of the dermal papillae that exist in glabrous footpads. S100 immunostaining for lamellar Schwann cells revealed the presence of novel tactile corpuscles (S100-positive bulb) within incision-induced putative dermal papillae. The occurrence of these novel tactile corpuscles coincided with behavioural observations of dynamic allodynia. Tactile corpuscles require brain-derived neurotrophic factor- tropomyosin receptor kinase B (BDNF-TrkB) signalling to form during development, and an increase in BDNF-immunostaining intensity was observed close to the incision site. Local acute administration of TrkB-Fc, to block BDNF-TrkB signalling, reduced, by approximately 50%, both tactile corpuscle size (S100+ bulb area) and dynamic allodynia. Conclusion Surgery induces the development of novel tactile corpuscles in the incision surround, in a BDNF-TrKB-dependent manner, that contributes to postsurgical tactile-evoked pain.
Collapse
Affiliation(s)
- Kirsten Wilson
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
| | - Ying Sze
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
- Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, United Kingdom
| | - Anna Regan
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
| | - Chunyi Zhu
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
| | - Katarzyna Mazur
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
- Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, United Kingdom
| | - Atanaska N. Velichkova
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
| | - Carole Torsney
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom. Wilson is now with the School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom. Velichkova is now with the Charles River Laboratories, Groningen, Netherlands
- Simons Initiative for the Developing Brain, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
4
|
Clement ND, Jones S, Afzal I, Kader DF. Chronic pain at 1-year following knee arthroplasty is associated with a worse joint-specific function and health-related quality of life. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39327844 DOI: 10.1002/ksa.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/22/2024] [Accepted: 08/25/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE The purpose of this study was to identify independent variables associated with chronic pain (CP) at 1 year following knee arthroplasty (KA) and whether this influenced functional outcomes. METHODS This retrospective study was conducted over a 2-year period and included 2588 patients with completed Oxford knee score (OKS) and EuroQol (EQ)-five domains (5D) preoperatively and at 1 and 2 years postoperatively. The OKS pain component score was used to define patients with CP (≤14 points). The mean age was 70.0 (range 34-94) years and there were 1553 (60.0%) females. RESULTS There were 322 (12.4%) patients with CP at 1 year. A worse preoperative EQ-5D (p = 0.025), EQ-visual analogue scale (VAS) (p = 0.005) and OKS questions relating to washing (p = 0.010), limping (p = 0.007), kneeling (p = 0.003) and night pain (p = 0.004) were independently associated with risk of CP. However, the preoperative OKS (area under the curve [AUC]: 72.0, p < 0.001) and EQ-5D score (AUC: 70.1, p < 0.001) were the most reliable predictors, with threshold values of <18-points and <0.300 being predictive of CP, respectively. Of those with CP at 1 year, 231 were followed up at 2 years, of which 92 (39.8%) had resolution of their CP. A worse response to OKS question 11 (ability to shop) and EQ-5D (p = 0.028) at 1 year was independently associated with persistent CP. Patients with CP had significantly (p < 0.001) worse OKS, EQ-5D and EQ-VAS at 1 year compared to those without. However, for those that had resolution of their CP at 2 years, their outcomes were clinically equal to those that did not have CP at 1 year. CONCLUSION One in eight patients had CP at 1 year following surgery, which was associated with clinically worse knee-specific outcomes and quality of life. However, by 2 years, two in five patients had resolution of their CP and had functional outcomes clinically equal to those without CP at 1 year. The risk factors identified could be used to inform patients of their risk for CP and the potential for resolution. LEVEL OF EVIDENCE Level III retrospective study.
Collapse
Affiliation(s)
- Nick D Clement
- South West London Elective Orthopaedic Centre, Epsom, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Samantha Jones
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Irrum Afzal
- South West London Elective Orthopaedic Centre, Epsom, UK
| | - Deiary F Kader
- South West London Elective Orthopaedic Centre, Epsom, UK
| |
Collapse
|
5
|
Clinkard D, Buckley N, Diatchenko L, Ghasemlou N. The role of acute inflammation in pain resolution: is it time to rethink the use of routine anti-inflammatories in surgical practice? Can J Anaesth 2024:10.1007/s12630-024-02837-8. [PMID: 39285126 DOI: 10.1007/s12630-024-02837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 07/15/2024] [Accepted: 08/18/2024] [Indexed: 09/25/2024] Open
Affiliation(s)
- David Clinkard
- Department of Anesthesiology and Perioperative Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
- Kingston Health Sciences Centre, Victory 2, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Norman Buckley
- Department of Anesthesia, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Luda Diatchenko
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Nader Ghasemlou
- Department of Anesthesiology and Perioperative Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| |
Collapse
|
6
|
Stivalet-Schoentgen N, Perrouin Verbe MA, Campagne-Loiseau S, Donon L, Levesque A, Rigaud J, Venara A, Thubert T, Vidart A, Bosset PO, Revel-Delhom C, Lucot JP, Deffieux X, Hermieu JF. Management of Complications of Prosthetic Mid-urethral Tape Surgery for Stress Urinary Incontinence in Women. Urology 2024:S0090-4295(24)00766-0. [PMID: 39242049 DOI: 10.1016/j.urology.2024.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/04/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To propose guidelines for the management of complications of prosthetic mid-urethral tape surgery for stress urinary incontinence in women. METHODS These guidelines are based on an exhaustive literature review on retropubic and trans-obturator mid-urethral tape complications. The expert panel rated the level of evidence of each study, summarized literature for the treatment of each complication, and proposed guidelines. RESULTS Management of these complications is complex and the first treatment is crucial to offer the best functional result to the patient. We propose a standardized approach and guidelines for the management of complications to help physicians to early identify a surgical complication, offer adequate treatment for each complication and provide clear and appropriate information to patients. We detailed management of intraoperative complications as follows: bladder, urethral, vaginal, visceral, and vascular injury; short-term post-operative complications are the following: bleeding/hematoma, voiding dysfunction, pain, infection; and long-term post-operative complications are the following: chronic voiding dysfunction, de novo overactive bladder syndrome, chronic pain, dyspareunia, vaginal, bladder, and urethral tape erosion. CONCLUSION These guidelines may help physicians to improve management of prosthetic mid-urethral sling complications that may occur following stress urinary incontinence surgery.
Collapse
Affiliation(s)
| | - M A Perrouin Verbe
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes, France
| | - S Campagne-Loiseau
- Centre Hospitalier Universitaire de Clermont Ferrand, Service de gynécologie obstétrique, Clermont-Ferrand, France
| | - L Donon
- Uropôle, Service d'urologie, Bayonne, France
| | - A Levesque
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes, France
| | - J Rigaud
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service d'urologie, Nantes, France
| | - A Venara
- Université d'Angers, Centre Hospitalier Universitaire d'Angers, Service de chirurgie digestive, Angers, France
| | - T Thubert
- Université de Nantes, Centre Hospitalier Universitaire de Nantes, Service de gynécologie-obstétrique, Nantes, France
| | - A Vidart
- Hôpital Foch, Service d'urologie, Suresnes, France
| | - P O Bosset
- Hôpital Foch, Service d'urologie, Suresnes, France
| | | | - J P Lucot
- Université catholique de Lille, Service de gynécologie-obstétrique, Lille, France
| | - X Deffieux
- Université Paris-Saclay, AP-HP, Hôpital Antoine Béclère, Service de gynécologie obstétrique, Clamart, France
| | - J F Hermieu
- Université Paris-Cité, AP-HP, Hôpital Bichat, Service d'urologie, Paris, France
| |
Collapse
|
7
|
Suzuki H, Tsujimoto T, Kanayama M, Oha F, Shimamura Y, Tanaka M, Hasegawa Y, Fukada S, Hashimoto T, Iwasaki N. Predictors of Postoperative Persistent Low Back Pain Following Lumbar Fusion in Patients Older than 75 Years: An Analysis of a Minimum 2-Year Follow-Up. World Neurosurg 2024:S1878-8750(24)01471-2. [PMID: 39186974 DOI: 10.1016/j.wneu.2024.08.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE This study aimed to evaluate preoperative and perioperative predictors associated with persistent low back pain (LBP) following lumbar fusion in patients aged >75 years. METHODS This single-center retrospective study examined 310 patients aged >75 years who underwent lumbar fusion for lumbar degenerative disease (104 males, 206 females; mean age, 79 [75-90] years). The visual analog scale (VAS) score for LBP was examined preoperatively and 2-year postoperatively. The persistent LBP group comprised patients with a 2-year postoperative LBP-VAS score ≥3. The demographic and preoperative radiographic parameters were also reviewed. A multivariate stepwise logistic regression analysis was performed of variables with values of P < 0.2 on the univariate analysis. RESULTS Ninety-nine patients (32%) experienced persistent postoperative LBP. Multivariate logistic regression analysis revealed that age <82 years, history of previous lumbar decompression, and greater preoperative VAS score for LBP were associated with greater postoperative persistent LBP after lumbar fusion, whereas other factors, such as gender, body mass index, osteoporosis, diabetes mellitus, depression, symptom duration, operative time, estimated blood loss, and spinopelvic sagittal parameters, were not. CONCLUSIONS This study showed that a relatively younger age, history of preoperative lumbar decompression, and greater preoperative VAS score for LBP were preoperative predictors of postoperative persistent LBP following lumbar fusion in elderly patients. In contrast, preoperative spinopelvic sagittal parameters were not associated with persistent postoperative LBP. Although lumbar fusion is expected to improve LBP, surgeons should pay attention to age, surgical history, and preoperative back pain intensity.
Collapse
Affiliation(s)
- Hisataka Suzuki
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Takeru Tsujimoto
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan.
| | - Masahiro Kanayama
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Fumihiro Oha
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | | | - Masaru Tanaka
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yuichi Hasegawa
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Shotaro Fukada
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Tomoyuki Hashimoto
- Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
8
|
Vittori A, Cascella M, Di Gennaro P, Marchetti G, Francia E, Mascilini I, Tarquini R, Innamorato MA, Petrucci E, Marinangeli F, Coluccia S, Picardo SG. Advanced statistical approaches for predicting pain after pediatric thoracotomy: a cross-sectional study using zero-inflated and Poisson models. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:53. [PMID: 39103959 PMCID: PMC11299347 DOI: 10.1186/s44158-024-00188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Thoracotomy is one of the surgical procedures most burdened by chronic post-operative pain. There is poor evidence regarding the possibility that even in pediatric patients, thoracotomy can be followed by post-operative pain. The primary objective of this analysis is to identify associations with home pain therapy, pain intensity, and possible protective factors acting on chronic pain in this population. METHODS A retrospective cross-sectional study was conducted at Ospedale Pediatrico Bambino Gesù IRCCS. The study included pediatric patients undergoing thoracotomy. For statistical analyses, a logistic model and a zero-inflated strategy were implemented to explore associations and predict factors related to home-based analgesic therapy and pain intensity. RESULTS Gender and age were identified as significant factors in the assignment of home therapy, with males having over seven times the risk compared to females (OR = 7.06, 95% CI = [2.11, 29.7]). At the last measurement, pain intensity was positively associated with age and the number of pain events during the week. CONCLUSIONS The study highlights significant factors influencing post-thoracotomy pain management in pediatric patients. These findings underscore the importance of tailored pain management strategies that consider gender and age to improve post-operative care and outcomes in pediatric thoracotomy patients.
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Marco Cascella
- Department of Medicine, Surgery, and Dentistry, Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, University of Salerno, Baronissi, 84081, Salerno, Italy.
| | - Piergiacomo Di Gennaro
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | | | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Riccardo Tarquini
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Massimo Antonio Innamorato
- Pain Unit, Department of Neuroscience, Santa Maria Delle Croci Hospital, AUSL Romagna, 48121, Ravenna, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100, L'Aquila, Coppito, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Coppito, Italy
| | - Sergio Coluccia
- Epidemiology and Biostatistics Unit, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, 80100, Naples, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| |
Collapse
|
9
|
Chen Y, Wang E, Sites BD, Cohen SP. Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians. Reg Anesth Pain Med 2024; 49:581-601. [PMID: 36707224 DOI: 10.1136/rapm-2022-104203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.
Collapse
Affiliation(s)
- Yian Chen
- Anesthesiology, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Wang
- Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian D Sites
- Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
10
|
Tao X, Luo G, Xiao J, Yao Y, Gao Q, Zou J, Wang T, Cheng Z, Sun D, Yan M. Chronic Postsurgical Pain Following Lung Transplantation: Characteristics, Risk Factors, Treatment, and Prevention: A Narrative Review. Pain Ther 2024; 13:719-731. [PMID: 38809395 PMCID: PMC11254876 DOI: 10.1007/s40122-024-00615-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 05/30/2024] Open
Abstract
Chronic pain after lung transplantation (LTx) can substantially reduce quality of life (QoL), yet current consensus guidelines say little about how to prevent or manage it. Research on pain after LTx has tended to focus on acute rather than chronic pain, and it has not extensively examined the factors associated with onset or resolution of chronic pain, which differ from factors influencing chronic pain after general thoracic surgery. This narrative review explores what is known about the epidemiology and risk factors of chronic pain after LTx, as well as effective ways to treat or prevent it. The review identifies key questions and issues that should be the focus of future research.
Collapse
Affiliation(s)
- Xinchen Tao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Ge Luo
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jie Xiao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuanyuan Yao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Qi Gao
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Jingcheng Zou
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Tingting Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhenzhen Cheng
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Dawei Sun
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
| | - Min Yan
- Department of Anesthesiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
11
|
Isik OG, Cassim TZ, Ahmed MT, Kreuzer M, Daramola AM, Garcia PS. Effect of transcranial direct current stimulation and narrow-band auditory stimulation on the intraoperative electroencephalogram: an exploratoratory feasibility study. Front Psychiatry 2024; 15:1362749. [PMID: 39081532 PMCID: PMC11286499 DOI: 10.3389/fpsyt.2024.1362749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction During general anesthesia, frontal electroencephalogram (EEG) activity in the alpha frequency band (8-12 Hz) correlates with the adequacy of analgesia. Transcranial direct current stimulation (tDCS) and auditory stimulation, two noninvasive neuromodulation techniques, can entrain alpha activity in awake or sleeping patients. This study evaluates their effects on alpha oscillations in patients under general anesthesia. Methods 30 patients receiving general anesthesia for surgery were enrolled in this two-by-two randomized clinical trial. Each participant received active or sham tDCS followed by auditory stimulation or silence according to assigned group (TDCS/AUD, TDCS/SIL, SHAM/AUD, SHAM/SIL). Frontal EEG was recorded before and after neuromodulation. Patients with burst suppression, mid-study changes in anesthetic, or incomplete EEG recordings were excluded from analysis. The primary outcome was post-stimulation change in oscillatory alpha power, compared in each intervention group against the change in the control group SHAM/SIL by Wilcoxon Rank Sum testing. Results All 30 enrolled participants completed the study. Of the 22 included for analysis, 8 were in TDCS/AUD, 4 were in TDCS/SIL, 5 were in SHAM/AUD, and 5 were in SHAM/SIL. The median change in oscillatory alpha power was +4.7 dB (IQR 4.4, 5.8 dB) in SHAM/SIL, +2.8 dB (IQR 1.5, 8.9 dB) in TDCS/SIL (p = 0.730), +5.5 dB in SHAM/AUD (p = 0.421), and -6.1 dB (IQR -10.2, -2.2 dB) in TDCS/AUD (p = 0.045). Conclusion tDCS and auditory stimulation can be administered safely intraoperatively. However, these interventions did not increase alpha power as administered and measured in this pilot study.
Collapse
Affiliation(s)
- Oliver G. Isik
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Tuan Z. Cassim
- Department of Psychology, School of Social and Behavioral Science, University of Utah, Salt Lake City, UT, United States
| | - Meah T. Ahmed
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Matthias Kreuzer
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich School of Medicine and Health, Munich, Germany
| | - Alice M. Daramola
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Paul S. Garcia
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| |
Collapse
|
12
|
Bao K, Yoon JS, Ahn S, Lee JH, Cross CJ, Jeong MY, Frangioni JV, Choi HS. A robotic system for automated chemical synthesis of therapeutic agents. MATERIALS ADVANCES 2024; 5:5290-5297. [PMID: 38894709 PMCID: PMC11181120 DOI: 10.1039/d4ma00099d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
The development of novel compounds for tissue-specific targeting and imaging is often impeded by a lack of lead compounds and the availability of reliable chemistry. Automated chemical synthesis systems provide a potential solution by enabling reliable, repeated access to large compound libraries for screening. Here we report an integrated solid-phase combinatorial chemistry system created using commercial and customized robots. Our goal is to optimize reaction parameters, such as varying temperature, shaking, microwave irradiation, aspirating and dispensing large-sized solid beads, and handling different washing solvents for separation and purification. This automated system accommodates diverse chemical reactions such as peptide synthesis and conventional coupling reactions. To confirm its functionality and reproducibility, 20 nerve-specific contrast agents for biomedical imaging were systematically and repeatedly synthesized and compared to other nerve-targeted agents using molecular fingerprinting and Uniform Manifold Approximation and Projection, which lays the foundation for creating reliable and reproductive chemical libraries in bioimaging and nanomedicine.
Collapse
Affiliation(s)
- Kai Bao
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School Boston MA 02114 USA
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
| | - Jong Seo Yoon
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
| | - Sung Ahn
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School Boston MA 02114 USA
| | - Jeong Heon Lee
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School Boston MA 02114 USA
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
| | - Conor J Cross
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
| | - Myung Yung Jeong
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
- Department of Cogno-Mechatronics Engineering, Pusan National University Busan 46241 South Korea
| | - John V Frangioni
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
- Curadel, LLC Natick MA 01760 USA
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School Boston MA 02114 USA
- Center for Molecular Imaging, Department of Medicine, Beth Israel Deaconess Medical Center Boston MA 02215 USA
| |
Collapse
|
13
|
Chen Z, Gao C, Zhang Y, Gao Y, Zhang L, Zhao S, Zhang H, Zhao X, Jin Y. Effects of Ultrasound-Guided Thoracic Paravertebral Nerve Block Combined with Perineural or IV Dexmedetomidine on Acute and Chronic Pain After Thoracoscopic Resection of Lung Lesions: A Double-Blind Randomized Trial. Drug Des Devel Ther 2024; 18:2089-2101. [PMID: 38882043 PMCID: PMC11177863 DOI: 10.2147/dddt.s457334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/22/2024] [Indexed: 06/18/2024] Open
Abstract
Background Thoracic paravertebral block (TPVB) analgesia can be prolonged by local anesthetic adjuvants such as dexmedetomidine. This study aimed to evaluate the two administration routes of dexmedetomidine on acute pain and chronic neuropathic pain (NeuP) prevention compared with no dexmedetomidine. Methods A total of 216 patients were randomized to receive TPVB using 0.4% ropivacaine alone (R Group), with perineural dexmedetomidine 0.5 μg·kg-1 (RD0.5 Group) or 1.0 μg·kg-1 (RD1.0 Group), or intravenous (IV) dexmedetomidine 0.5 μg·kg-1·h-1 (RDiv Group). The primary outcome was the incidence of chronic NeuP, defined as a Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain score > 12 points at 3-month after surgery. Results (1) For the primary outcome, RD0.5 Group and RD1.0 Group demonstrated a decreased incidence of chronic NeuP at 3-month after surgery; (2) Compared with R Group, RDiv Group, RD0.5 Group, and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of oral morphine equivalent (OME) and improve QOD-15 at POD1; (3) Compared with RDiv Group, RD0.5 Group and RD1.0 Group can reduce VAS scores at rest and movement and Prince-Henry Pain scores at 12 and 24-h after surgery, the consumption of postoperative OME and improve QOD-15 at POD1; (4) Compared with RD0.5 Group, RD1.0 Group effectively reduced VAS scores at rest at 12 and 24-h after surgery, VAS scores in movement and Prince-Henry Pain scores at 12-h after surgery. However, RD1.0 Group showed an increased incidence of drowsiness. Conclusion Perineural or IV dexmedetomidine are similarly effective in reducing acute pain, but only perineural dexmedetomidine reduced chronic NeuP. Moreover, considering postoperative complications such as drowsiness, perineural dexmedetomidine (0.5 μg·kg-1) may be a more appropriate choice. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR2200058982).
Collapse
Affiliation(s)
- Zheping Chen
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Changli Gao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Anesthesiology, Laoling People Hospital, Laoling, People’s Republic of China
| | - Yingchao Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Anesthesiology, Shouguang People Hospital, Weifang, People’s Republic of China
| | - Yongxu Gao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Anesthesiology, Jinan Third People’s Hospital, Laoling, People’s Republic of China
| | - Le Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Shanshan Zhao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - He Zhang
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Xin Zhao
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Yanwu Jin
- Department of Anesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
| |
Collapse
|
14
|
Peng J, Guo G, Wang Z, Zhuang L, Ma Y, Yuan B, Zhang M, Tao Q, Zhao Y, Zhao L, Dong X. Factors Associated With Radiological Lung Growth Rate After Lobectomy in Patients With Lung Cancer. J Surg Res 2024; 298:251-259. [PMID: 38636181 DOI: 10.1016/j.jss.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION This study is a retrospective study. This study aims to explore the association between lobectomy in lung cancer patients and subsequent compensatory lung growth (CLG), and to identify factors that may be associated with variations in CLG. METHODS 207 lung cancer patients who underwent lobectomy at Yunnan Cancer Hospital between January 2020 and December 2020. All patients had stage IA primary lung cancer and were performed by the same surgical team. And computed tomography examinations were performed before and 1 y postoperatively. Based on computed tomography images, the volume of each lung lobe was measured using computer software and manual, the radiological lung weight was calculated. And multiple linear regressions were used to analyze the factors related to the increase in postoperative lung weight. RESULTS One year after lobectomy, the radiological lung weight increased by an average of 112.4 ± 20.8%. Smoking history, number of resected lung segments, preoperative low attenuation volume, intraoperative arterial oxygen partial pressure/fraction of inspired oxygen ratio and postoperative visual analog scale scores at 48 h were significantly associated with postoperative radiological lung weight gain. CONCLUSIONS Our results suggest that CLG have occurred after lobectomy in adults. In addition, anesthetists should maintain high arterial oxygen partial pressure/fraction of inspired oxygen ratio during one-lung ventilation and improve acute postoperative pain to benefit CLG.
Collapse
Affiliation(s)
- Jing Peng
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Gang Guo
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Zhonghui Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Li Zhuang
- Department of Palliative Medicine, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yuhui Ma
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Bin Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Mingxiong Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Qunfen Tao
- Department of Operation Room, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yanqiu Zhao
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Li Zhao
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
| | - Xingxiang Dong
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
| |
Collapse
|
15
|
Endo T, Kanemura N, Ito T, Sato K, Miura T, Onitsuka K, Miyazawa T, Kubota K, Iwabuchi M, Shirado O. Effect of Residual Pain After Posterior Fusion Surgery for Lumbar Degenerative Disorders on Health-Related Quality of Life: A Two-Year Follow-Up Using Patient-Reported Outcome Measures. Cureus 2024; 16:e61611. [PMID: 38962602 PMCID: PMC11221397 DOI: 10.7759/cureus.61611] [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] [Accepted: 05/14/2024] [Indexed: 07/05/2024] Open
Abstract
STUDY DESIGN This is a prospective cohort study. PURPOSE The present study aimed to investigate the effects of residual pain after fusion surgery for lumbar degenerative diseases on quality of life (QOL). OVERVIEW OF LITERATURE Residual symptoms after spinal surgery often restrict patients' activities of daily living and reduce their QOL. However, few studies have comprehensively addressed physical, psychological, and social factors. METHODS The study population included a cohort of 208 patients (mean age: 67.9 years) who had undergone posterior interbody fusion for lumbar degenerative disease between 2012 and 2019. We asked the patients to complete the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form Health Survey (SF-36) preoperatively, as well as at six, 12, and 24 months postoperatively. The presence of residual postoperative pain (RPP) was determined using the low back pain score of the JOABPEQ at six months postoperatively, and patients with an improvement of < 20 points compared to preoperative assessment were classified as RPP+ based on a previous study. RESULTS In all patients, there was a notable postoperative improvement in all JOABPEQ and SF-36 domains compared to preoperative scores. The RPP+ group comprised 60 patients (69.6 years), while the RPP- group comprised 148 patients (67.2 years). In the RPP+ group, the lumbar function in the JOABPEQ and general health in the SF-36 showed limited postoperative enhancement. The pace of improvement in the role-emotional, role-physical, social functioning, vitality, and mental health scores was slower in the RPP+ group compared to the RPP- group. CONCLUSIONS In the current study, we found that the presence of residual pain at six months postoperatively affected QOL improvement up to 24 months after surgery. Lingering postoperative pain substantially impacted functional incapacity, social engagement, and psychological well-being. Notably, the lumbar function in the JOABPEQ and general health in the SF-36 showed distinct progression patterns in the RPP+ group.
Collapse
Affiliation(s)
- Tatsuya Endo
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Naohiko Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Toshikazu Ito
- Department of Physical Therapy, Hokkaido Chitose College of Rehabilitation, Chitose, JPN
| | - Keita Sato
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | - Takuya Miura
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | | | - Taku Miyazawa
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Keisuke Kubota
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Koshigaya, JPN
| | - Masumi Iwabuchi
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| | - Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, and Rehabilitation, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, JPN
| |
Collapse
|
16
|
Masaud K, Collins JM, Rubio RC, Corrigan M, Cotter PD, O'Brien N, Bluett R, Jimenez CK, O'Mahony SM, Shorten GD. The gut microbiota in persistent post-operative pain following breast cancer surgery. Sci Rep 2024; 14:12401. [PMID: 38811609 PMCID: PMC11137075 DOI: 10.1038/s41598-024-62397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
Persistent post-surgical pain (PPSP) is defined as pain which continues after a surgical operation in a significant form for at least three months (and is not related to pre-existing painful conditions). PPSP is a common, under-recognised, and important clinical problem which affects millions of patients worldwide. Preventative measures which are currently available include the selection of a minimally invasive surgical technique and an aggressive multimodal perioperative analgesic regimen. More recently, a role for the gut microbiota in pain modulation has become increasingly apparent. This study aims to investigate any relationship between the gut microbiota and PPSP. A prospective observational study of 68 female adult patients undergoing surgery for management of breast cancer was carried out. Stool samples from 45 of these patients were obtained to analyse the composition of the gut microbiota. Measures of pain and state-trait anxiety were also taken to investigate further dimensions in any relationship between the gut microbiota and PPSP. At 12 weeks postoperatively, 21 patients (51.2%) did not have any pain and 20 patients (48.8%) reported feeling pain that persisted at that time. Analysis of the gut microbiota revealed significantly lower alpha diversity (using three measures) in those patients reporting severe pain at the 60 min post-operative and the 12 weeks post-operative timepoints. A cluster of taxa represented by Bifidobacterium longum, and Faecalibacterium prausnitzii was closely associated with those individuals reporting no pain at 12 weeks postoperatively, while Megamonas hypermegale, Bacteroides pectinophilus, Ruminococcus bromii, and Roseburia hominis clustered relatively closely in the group of patients fulfilling the criteria for persistent post-operative pain. We report for the first time specific associations between the gut microbiota composition and the presence or absence of PPSP. This may provide further insights into mechanisms behind the role of the gut microbiota in the development of PPSP and could inform future treatment strategies.
Collapse
Affiliation(s)
- Khaled Masaud
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - James M Collins
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Raul Cabrera Rubio
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
- Department of Biotechnology, Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), Valencia, Spain
| | - Mark Corrigan
- Cork Breast Research Centre, University College Cork, Cork, Ireland
| | - Paul D Cotter
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Niall O'Brien
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Ronan Bluett
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Clare Keaveney Jimenez
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Siobhain M O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - George D Shorten
- Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland.
| |
Collapse
|
17
|
Chen YH, Xenitidis A, Hoffmann P, Matthews L, Padmanabhan SG, Aravindan L, Ressler R, Sivam I, Sivam S, Gillispie CF, Sadhasivam S. Opioid use disorder in pediatric populations: considerations for perioperative pain management and precision opioid analgesia. Expert Rev Clin Pharmacol 2024; 17:455-465. [PMID: 38626303 PMCID: PMC11116045 DOI: 10.1080/17512433.2024.2343915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/12/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Opioids are commonly used for perioperative analgesia, yet children still suffer high rates of severe post-surgical pain and opioid-related adverse effects. Persistent and severe acute surgical pain greatly increases the child's chances of chronic surgical pain, long-term opioid use, and opioid use disorder. AREAS COVERED Enhanced recovery after surgery (ERAS) protocols are often inadequate in treating a child's severe surgical pain. Research suggests that 'older' and longer-acting opioids such as methadone are providing better methods to treat acute post-surgical pain. Studies indicate that lower repetitive methadone doses can decrease the incidence of chronic persistent surgical pain (CPSP). Ongoing research explores genetic components influencing severe surgical pain, inadequate opioid analgesia, and opioid use disorder. This new genetic research coupled with better utilization of opioids in the perioperative setting provides hope in personalizing surgical pain management, reducing pain, opioid use, adverse effects, and helping the fight against the opioid pandemic. EXPERT OPINION The opioid and analgesic pharmacogenomics approach can proactively 'tailor' a perioperative analgesic plan to each patient based on underlying polygenic risks. This transition from population-based knowledge of pain medicine to individual patient knowledge can transform acute pain medicine and greatly reduce the opioid epidemic's socioeconomic, personal, and psychological strains globally.
Collapse
Affiliation(s)
- Yun Han Chen
- Department of Anesthesiology and Pain Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Paul Hoffmann
- Department of Anesthesiology and Pain Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Leslie Matthews
- Department of Anesthesiology and Pain Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Ruth Ressler
- Department of Biochemistry and Molecular Biology, The College of Wooster, Wooster, Ohio, USA
| | - Inesh Sivam
- North Allegheny High School, Pittsburgh, Pennsylvania, USA
| | - Sahana Sivam
- North Allegheny High School, Pittsburgh, Pennsylvania, USA
| | - Chase F. Gillispie
- Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia 25701
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Pain Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
18
|
Liu J, Wang Z, Huang W, Cheng N, Chen W, Wu W, Li S. Analgesia nociception index is an indicator of laparoscopic trocar insertion-induced transient nociceptive stimuli. Open Med (Wars) 2024; 19:20240933. [PMID: 38681026 PMCID: PMC11048736 DOI: 10.1515/med-2024-0933] [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: 10/21/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 05/01/2024] Open
Abstract
Objective This study aimed to investigate whether analgesia nociception index (ANI) could be an indicator of perioperative pain during laparoscopic trocar insertion. Methods A total of 280 participants of anesthesia receiving laparoscopic surgery were enrolled. Anesthesia induction and maintenance were performed using the Marsh model for target propofol and the Minto model for remifentanil. Systolic blood pressure (SBP), heart rate (HR), and ANI were recorded at skin incision, the first-, second, the last-trocar insertion, and 5 min after the last trocar insertion. Results ANI was significantly different among the five groups in the last four time points (all P < 0.05). Pearson's correlation showed that ANI was negatively correlated with SBP (r = -0.114, P = 0.077) and HR (r = -0.247, P < 0.001). The area under the curve of ANI was positively correlated with those of SBP (r = 0.493, P < 0.001) and HR (r = -0.420, P < 0.001). Multivariate logistic regression showed that the ANI was an independent factor associated with intraoperative hemodynamic adverse events only at 5 min after the last trocar insertion. Conclusions Under general anesthesia, the change in ANI was consistent with changes in the balance between analgesia and nociceptive stimuli. The ANI can reflect the extent of transient pain but had a poor predictive performance for hemodynamic adverse events.
Collapse
Affiliation(s)
- Jun Liu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong Province, 510630, China
| | - Zhuodan Wang
- Department of Anesthesiology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou City, Guangdong Province, 510260, China
| | - Wan Huang
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou City, Guangdong Province, 510060, China
| | - Nan Cheng
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong Province, 510630, China
| | - Weiqiang Chen
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong Province, 510630, China
| | - Weijun Wu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen City, Guangdong Province, 518000, China
| | - Shangrong Li
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou City, Guangdong Province, 510630, China
| |
Collapse
|
19
|
Shaker H, Said NOE, ElSaeed KO. Combination of pregabalin and Amitriptyline in management of chronic idiopathic pain following penile prosthesis implantation: a pilot study. Basic Clin Androl 2024; 34:7. [PMID: 38565989 PMCID: PMC10986100 DOI: 10.1186/s12610-024-00223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Chronic post-penile prosthesis pain is de novo pain persisting > 2 months post-operatively. This pain is inadequately reported, poorly understood and undermanaged. The purpose of this current pilot study was to improvise a medical approach to alleviate the condition and assess the combination of Pregabalin and Amitriptyline in its management. RESULTS The study enrolled 9 patients complaining of idiopathic penile, pelvic, or scrotal pain persisting > 2 months after penile prosthesis implantation. Patients were prescribed pregabalin 75mg/12h (escalated after 1 week to 150mg/12h upon demand) and Amitriptyline 25mg once daily for 3 months. The pain was reassessed after 10, 30 and 100 days. The dose of pregabalin required and the side effects of the medication were noted. Findings revealed a significant decrease in pain duration (p = 0.007), frequency (p < 0.001), and intensity (p < 0.001); in glanular (p = 0.008), shaft pain (p = 0.046) but not scrotal (p = 0.112). Moreover, a significant decrease was found in sharp pain (p = 0.003) and pain aggravated by touch (p = 0.008) but not aching pain (p = 0.277). Additionally, significant improvement was reported in QoL (p < 0.001) and dose escalation of pregabalin to 150mg/12h was required in only 1 case (11%). CONCLUSION The combination of pregabalin and amitriptyline is very effective in the management of chronic idiopathic pain following penile prosthesis implantation. However, due to the ambiguity and lack of reporting of the condition, we recommend a multicentric contribution to acknowledge the condition, and weigh its prevalence accurately, whilst evaluating the efficacy of our approach. This study received ethical approval from Ain Shams University Research Ethics Committee (REC) FWA 000017585, on 04/13/2023 (REC-FMASU@med.asu.edu.eg). TRIAL REGISTRATION no FMASU R98/2023.
Collapse
Affiliation(s)
- Hassan Shaker
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran Omar El Said
- Pharmacy Practice & Clinical Pharmacy, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Karim Omar ElSaeed
- Urology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| |
Collapse
|
20
|
Tokuishi K, Wakahara JI, Ueda Y, Miyahara S, Nakashima H, Masuda Y, Waseda R, Shiraishi T, Sato T. Factors related to post-thoracotomy pain following robotic-assisted thoracic surgery. Asian J Endosc Surg 2024; 17:e13302. [PMID: 38523354 DOI: 10.1111/ases.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Robotic-assisted thoracic surgery (RATS) is a minimally invasive procedure; however, some patients experience persistent postoperative pain. This study aimed to investigate factors related to postoperative pain following RATS. METHODS The data of 145 patients with lung cancer, who underwent RATS with a four-port (one in the sixth intercostal space [ICS] and three in the eighth ICS) lobectomy or segmentectomy between May 2019 and December 2022, were retrospectively analyzed. Factors associated with analgesic use for at least 2 months following postoperative pain (PTP group) were analyzed. RESULTS Patients who underwent preoperative pain control for any condition or chest wall resection were excluded. Among the 138 patients, 45 (32.6%) received analgesics for at least 2 months after surgery. Patient height and transverse length of the thorax correlated with PTP in the univariate analysis (non-PTP vs. PTP; height, 166 vs. 160 cm; p < .001; transverse length of the thorax, 270 vs. 260 mm, p = .016). In the multivariate analysis, height was correlated with PTP (p = .009; odds ratio, 0.907; 95% confidence interval, 0.843-0.976). Height correlated with the transverse length of the thorax (r = .407), anteroposterior length of the thorax (r = .294), and width of the eighth ICS in the middle axillary line (r = .210) using Pearson's correlation coefficients. When utilizing a 165-cm cutoff value for height to predict PTP using receiver operating characteristic curve analysis, the area under the curve was 0.69 (95% confidence interval, 0.601-0.779). CONCLUSION Short stature is associated with a high risk of postoperative pain following RATS.
Collapse
Affiliation(s)
- Keita Tokuishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jun-Ichi Wakahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuichiro Ueda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - So Miyahara
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroyasu Nakashima
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yoshiko Masuda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryuichi Waseda
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Takeshi Shiraishi
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Toshihiko Sato
- Department of General Thoracic Surgery, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| |
Collapse
|
21
|
Zeng M, Xu X, Li R, Zhang X, Ma T, Cui Q, Wang J, Li S, Peng Y. Dexmedetomidine Prevents Chronic Incisional Pain After Brain Tumor Resection: A Secondary Analysis of the Randomized Control Trial. Anesth Analg 2024; 138:839-847. [PMID: 37307232 DOI: 10.1213/ane.0000000000006563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dexmedetomidine was reported to reduce postoperative acute pain after neurosurgery. However, the efficacy of dexmedetomidine for preventing chronic incisional pain is uncertain. METHODS This article is a secondary analysis of a randomized, double-blind, placebo-controlled trial. Eligible patients were randomly allocated to either the dexmedetomidine group or the placebo group. Patients assigned to the dexmedetomidine group were given a 0.6 μg kg -1 dexmedetomidine bolus followed by a 0.4 μg kg -1 h -1 maintenance dose until dural closure; placebo patients were given comparable amounts of normal saline. The primary end point was the incidence of incisional pain at 3 months after craniotomy evaluated by numerical rating scale scores and defined as any score >0. The secondary end points were postoperative acute pain scores, sleep quality, and Short-Form McGill Pain Questionnaire (SF-MPQ-2) at 3 months after craniotomy. RESULTS From January 2021 to December 2021, a total of 252 patients were included in the final analysis: the dexmedetomidine group (n = 128) and the placebo group (n = 124). The incidence of chronic incisional pain was 23.4% (30 of 128) in the dexmedetomidine group versus 42.7% (53 of 124) in the placebo group (risk ratio, 0.55; 95% confidence interval, 0.38-0.80; P = .001). The overall severity of chronic incisional pain was mild in both groups. Patients in the dexmedetomidine group had lower acute pain severity on movement than those in the placebo group for the first 3 days after surgery (all adjusted P < .01). Sleep quality did not differ between groups. However, the SF-MPQ-2 total sensory ( P = .01) and neuropathic pain descriptor ( P = .023) scores in the dexmedetomidine group were lower than those in the placebo group. CONCLUSIONS Prophylactic intraoperative dexmedetomidine infusion reduces the incidence of chronic incisional pain as well as acute pain score after elective brain tumor resections.
Collapse
Affiliation(s)
- Min Zeng
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xin Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ruowen Li
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xingyue Zhang
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tingting Ma
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qianyu Cui
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Juan Wang
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shu Li
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yuming Peng
- From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
22
|
Ho KY, Gyanwali B, Dimayuga C, Eufemio EM, Bernardo E, Raju G, Chong KW, Waithayayothin K, Ona L, Castro MAL, Sawaddiruk P, Salvador RC, Roohi SA, Tangwiwat S, Wilairatana V, Oon ZH, Gupta A, Nagrale D. REKOVER study protocol: a pRospective patient treatment rEgistry of tramadol and dexKetoprofen trometamol oral fixed-dose combination (SKUDEXA) in mOderate to seVere acutE pain in Real-world setting in Asia. BMJ Open 2024; 14:e080620. [PMID: 38508619 PMCID: PMC10952884 DOI: 10.1136/bmjopen-2023-080620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Satisfactory management of acute pain remains a major medical challenge despite the availability of multiple therapeutic options including the fixed-dose combination (FDC) drugs. Tramadol and dexketoprofen trometamol (TRAM/DKP) 75/25 mg FDC was launched in 2018 in Asia and is widely used in the management of moderate to severe acute pain. There are limited data on its effectiveness and safety in Asian patients, and therefore, a need to better understand its usage patterns in clinical practice. We aim to understand the usage pattern of TRAM/DKP FDC, its effectiveness and tolerability in patients with moderate to severe acute pain in Asia. METHODS AND ANALYSIS REKOVER is a phase-IV, multicountry, multicentre, prospective, real-world observational study. A total of 750 postsurgical and non-surgical patients (male and female, aged 18-80 years) will be recruited from 13 tertiary-care hospitals (15 sites) in Singapore, Thailand, the Philippines and Malaysia. All patients prescribed with TRAM/DKP FDC and willing to participate in the study will be enrolled. The recruitment duration for each site will be 6 months. The severity of pain will be collected using Numeric Pain Rating Scale through the treatment period from day 1 to day 5, while satisfaction with the treatment will be evaluated using Patient Global Evaluation Scale at the end of treatment. Any adverse event reported during the study duration will be recorded for safety analysis (up to day 6). The study data will be entered into the ClaimIt portal and mobile application (app) (ObvioHealth, USA). All the inpatient data will be entered into the portal by the study site and for outpatient it will be done by patients through an app. ETHICS AND DISSEMINATION The study has been approved by the local ethics committee from each study sites in Singapore, Thailand, the Philippines and Malaysia. Findings will be disseminated through local and global conference presentations, publications in peer-reviewed scientific journals and continuing medical education.
Collapse
Affiliation(s)
- Kok Yuen Ho
- The Pain Clinic, Mount Alvernia Medical Centre, Singapore
| | - Bibek Gyanwali
- Medical Affairs, A Menarini Asia Pacific Holdings Pte Ltd, Singapore
| | - Cesar Dimayuga
- Department of Orthopedics, The Medical City, Pasig City, Philippines
| | | | - Edwin Bernardo
- Department of General Surgery, The Medical City, Pasig City, Philippines
| | - Gopinathan Raju
- Pain Care Center, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | | | - Leonardo Ona
- Department of Surgery, Adventist Medical Center Manila, Manila, Philippines
| | - Marc Anthony L Castro
- Department of Orthopedic, Philippine Orthopedics Institute, Quezon City, Philippines
| | - Passakorn Sawaddiruk
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roehl C Salvador
- Department of General Surgery, Manila Doctors Hospital, Manila, Philippines
| | | | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vajara Wilairatana
- Department of Orthopedic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Zhi Hao Oon
- Department of Anaesthesia, National University Hospital, Singapore
| | - Ankur Gupta
- Medical Affairs, A Menarini Asia Pacific Holdings Pte Ltd, Singapore
| | - Dinesh Nagrale
- Medical Affairs, A Menarini Asia Pacific Holdings Pte Ltd, Singapore
| |
Collapse
|
23
|
Schäfer WLA, Johnson JK, Ager MS, Iroz CB, Huang R, Balbale SN, Stulberg JJ. Learning from the implementation of a surgical opioid reduction initiative in an integrated health system: a qualitative study among providers and patients. Implement Sci Commun 2024; 5:22. [PMID: 38468284 PMCID: PMC10926556 DOI: 10.1186/s43058-024-00561-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Surgical opioid overprescribing can result in long-term use or misuse. Between July 2018 and March 2019, the multicomponent intervention, Minimizing Opioid Prescribing in Surgery (MOPiS) was implemented in the general surgery clinics of five hospitals and successfully reduced opioid prescribing. To date, various studies have shown a positive outcome of similar reduction initiatives. However, in addition to evaluating the impact on clinical outcomes, it is important to understand the implementation process of an intervention to extend sustainability of interventions and allow for dissemination of the intervention into other contexts. This study aims to evaluate the contextual factors impacting intervention implementation. METHODS We conducted a qualitative study with semi-structured interviews held with providers and patients of the general surgery clinics of five hospitals of a single health system between March and November of 2019. Interview questions focused on how contextual factors affected implementation of the intervention. We coded interview transcripts deductively, using the Consolidated Framework for Implementation Research (CFIR) to identify the relevant contextual factors. Content analyses were conducted using a constant comparative approach to identify overarching themes. RESULTS We interviewed 15 clinicians (e.g., surgeons, nurses), 1 quality representative, 1 scheduler, and 28 adult patients and identified 3 key themes. First, we found high variability in the responses of clinicians and patients to the intervention. There was a strong need for intervention components to be locally adaptable, particularly for the format and content of the patient and clinician education materials. Second, surgical pain management should be recognized as a team effort. We identified specific gaps in the engagement of team members, including nurses. We also found that the hierarchical relationships between surgical residents and attendings impacted implementation. Finally, we found that established patient and clinician views on opioid prescribing were an important facilitator to effective implementation. CONCLUSION Successful implementation of a complex set of opioid reduction interventions in surgery requires locally adaptable elements of the intervention, a team-centric approach, and an understanding of patient and clinician views regarding changes being proposed.
Collapse
Affiliation(s)
- Willemijn L A Schäfer
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA.
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | | | - Cassandra B Iroz
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | - Reiping Huang
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- American College of Surgeons, Chicago, IL, USA
| | - Salva N Balbale
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
24
|
Sun M, Chen WM, Wu SY, Zhang J. The influence of advanced age on long-term postsurgical analgesic use in patients receiving neuraxial anaesthesia for elective surgery. Eur J Pain 2024; 28:408-420. [PMID: 37830408 DOI: 10.1002/ejp.2191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the relationship between age and long-term postsurgical analgesic use in patients who underwent elective surgery with neuraxial anaesthesia. DESIGN Retrospective observational study using data from the National Health Insurance Research Database of Taiwan from 2015 to 2019. SETTING National Health Insurance Research Database of Taiwan. PATIENTS A total of 12,810 patients (6405 younger and 6405 older) matched using propensity score matching. INTERVENTIONS Older (≥65 years). MEASUREMENTS The use of long-term (3 or 6 months) postoperative analgesics, including opioids, as a surrogate marker of chronic postsurgical pain (CPSP) was analysed using logistic regression. MAIN RESULTS After 3 months of surgery, older adults had higher use of all analgesics (odds ratio [OR] = 1.15; 95% CI = 1.03-1.28) and opioids (OR = 1.18; 95% CI = 1.09-1.28) compared to younger patients. Similar results were observed after 6 months of surgery (all analgesic use: OR = 1.11; 95% CI = 1.03-1.20; opioid use: OR = 1.33; 95% CI = 1.07-1.81). CONCLUSION The findings from this study suggest that older adults are more likely to experience CPSP and have increased use of long-term analgesics, including opioids, after undergoing elective surgery with neuraxial anaesthesia. The study highlights the need for improved pain management strategies for older adults after surgery. SIGNIFICANCE Older age is an independent risk factor for long-term analgesic use after surgery under neuraxial anaesthesiaanesthesia, indicating an increased risk for chronic postsurgical pain.
Collapse
Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
25
|
Hartup S, Briggs M. Managing chronic pain after breast cancer treatments: are web-based interventions the future? Curr Opin Support Palliat Care 2024; 18:47-54. [PMID: 38170201 DOI: 10.1097/spc.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
PURPOSE OF THE REVIEW Chronic post-treatment pain in breast cancer affects a high proportion of patients. Symptom burden and financial costs are increasingly impacting patients and healthcare systems because of improved treatments and survival rates. Supporting long-term breast cancer symptoms using novel methodology has been examined, yet few have explored the opportunity to utilise these interventions for prevention. This review aims to explore the need for, range of, and effectiveness of such interventions. RECENT FINDINGS Three papers describe risk factors for chronic pain, with six recent papers describing the use of interventions for acute pain in the surgical setting. The evidence for the effectiveness of these interventions to improve pain management in this setting is limited but tentatively positive. The results have to take into account the variation between systems and limited testing. SUMMARY Multiple types of intervention emerged and appear well accepted by patients. Most assessed short-term impact and did not evaluate for reduction in chronic pain. Such interventions require rigorous effectiveness testing to meet the growing needs of post-treatment pain in breast cancer. A detailed understanding of components of web-based interventions and their individual impact on acute pain and chronic pain is needed within future optimisation trials. Their effectiveness as preventative tools are yet to be decided.
Collapse
Affiliation(s)
- Sue Hartup
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Michelle Briggs
- Pain Research Institute, School of Health Sciences, Faculty of Health and Life Science University of Liverpool
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
26
|
Mao P, Zhang Y, Liu B, Li Y, Chang Y, Zhu M, Zhang Y, Fan B. Effect and safety profile of topical lidocaine on post-surgical neuropathic pain and quality of life: A systematic review and meta-analysis. J Clin Anesth 2024; 92:111219. [PMID: 37827033 DOI: 10.1016/j.jclinane.2023.111219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 10/14/2023]
Abstract
STUDY OBJECTIVE Post-surgical chronic pain with a neuropathic component is usually more severe and leads to worse quality of life. We conducted this systematic review to examine the evidence of topical lidocaine for post-surgical neuropathic pain. DESIGN Systematic review with meta-analysis. SETTING Published randomized controlled trials (RCTs) comparing topical lidocaine with placebo or no topical lidocaine for post-surgical neuropathic pain. PATIENTS Seven RCTs including 585 patients. INTERVENTIONS We systematically searched databases for randomized controlled trials (RCTs) investigating the effect and safety outcomes of topical lidocaine compared with placebo or no intervention. MEASUREMENTS We conducted meta-analyses to evaluate the effect of topical lidocaine on pain intensity, adverse events, and quality of life. Standardized mean difference (SMD) and relative risk (RR) with 95% CIs were effect measures for continuous and dichotomous outcomes, respectively. We assessed the risk of bias of included trials and the certainty of evidence for each outcome. MAIN RESULTS Our review included 7 studies with 585 participants. There is moderate certainty evidence that topical lidocaine may increase the likelihood of global pain relief, with a relative risk (RR) of 1.98 (95% confidence interval (CI): 1.04, 3.76; I2 = 70%, P = 0.04). Low certainty evidence suggested topical lidocaine may lead to more reduction in pain intensity (SMD: -0.70; 95% confidence interval: -1.46, 0.06; I2 = 93%, P = 0.07). High certainty evidence showed that topical lidocaine did not increase the adverse event risk (RR: 1.04; 95% CI: 0.93, 1.16; I2 = 0%, P = 0.51). CONCLUSIONS Topical lidocaine may lead to pain relief and is safe to use for patient with post-surgical pain, though its impact on quality of life is unclear. This review supports the use of topical lidocaine for patients with post-surgical pain, and reveals the evidence gap in topical lidocaine use. (Registration: PROSPERO CRD42021294100).
Collapse
Affiliation(s)
- Peng Mao
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yi Zhang
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Botao Liu
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yifan Li
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Meng Zhu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Yuan Zhang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Bifa Fan
- Department of Pain Management, China-Japan Friendship Hospital, Beijing, China.
| |
Collapse
|
27
|
Mamoun N, Rosser MA, Manning M, Raghunathan K, McCartney S, Mehta S, Ingle K, Bottiger B. Pain trajectories after bilateral orthotopic lung transplantation surgery performed via a clamshell incision. Clin Transplant 2024; 38:e15262. [PMID: 38369849 DOI: 10.1111/ctr.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION The nature, intensity, and progression of acute pain after bilateral orthotopic lung transplantation (BOLT) performed via a clamshell incision has not been well investigated. We aimed to describe acute pain after clamshell incisions using pain trajectories for the study cohort, in addition to stratifying patients into separate pain trajectory groups and investigating their association with donor and recipient perioperative variables. METHODS After obtaining IRB approval, we retrospectively included all patients ≥18 years old who underwent primary BOLT via clamshell incision at a single center between January 1, 2017, and June 30, 2022. We modeled the overall pain trajectory using pain scores collected over the first seven postoperative days and identified separate pain trajectory classes via latent class analysis. RESULTS Three hundred one adult patients were included in the final analysis. Three separate pain trajectory groups were identified, with most patients (72.8%) belonging to a well-controlled, stable pain trajectory. Uncontrolled pain was either observed in the early postoperative period (10%), or in the late postoperative period (17.3%). Late postoperative peaking trajectory patients were younger (p = .008), and sicker with a higher lung allocation score (p = .005), receiving preoperative mechanical ventilation (p < .001), or VV-ECMO support (p < .001). CONCLUSION Despite the extensive nature of a clamshell incision, most pain trajectories in BOLT patients had a well-controlled stable pain profile. The benign nature of pain profiles in our patient population may be attributed to the routine institutional practice of early thoracic epidural analgesia for BOLT patients unless contraindicated.
Collapse
Affiliation(s)
- Negmeldeen Mamoun
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Morgan A Rosser
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Manning
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sharon McCartney
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sachin Mehta
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Krista Ingle
- Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina, USA
| | - Brandi Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
28
|
Khan JS, Dana E, Xiao MZX, Rao V, Djaiani G, Seltzer Z, Ladha K, Huang A, McRae K, Cypel M, Katz J, Wong D, Clarke H. Prevalence and Risk Factors for Chronic Postsurgical Pain After Thoracic Surgery: A Prospective Cohort Study. J Cardiothorac Vasc Anesth 2024; 38:490-498. [PMID: 39093584 DOI: 10.1053/j.jvca.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 08/04/2024]
Abstract
OBJECTIVE Thoracic surgery is associated with one of the highest rates of chronic postsurgical pain (CPSP) among all surgical subtypes. Chronic postsurgical pain carries significant medical, psychological, and economic consequences, and further interventions are needed to prevent its development. This study aimed to determine the prevalence, characteristics, and risk factors associated with CPSP after thoracic surgery. DESIGN A prospective cohort study. SETTING Single-center tertiary care hospital. PARTICIPANTS This study included 285 adult patients who underwent thoracic surgery at Toronto General Hospital in Toronto, Canada, between 2012 and 2020. MEASUREMENTS AND MAIN RESULTS Demographic, psychological, and clinical data were collected perioperatively, and follow-up evaluations were administered at 3, 6, and 12 months after surgery to assess CPSP. Chronic postsurgical pain was reported in 32.4%, 25.4%, and 18.2% of patients at 3, 6, and 12 months postoperatively, respectively. Average CPSP pain intensity was rated to be 3.37 (SD 1.82) at 3 months. Features of neuropathic pain were present in 48.7% of patients with CPSP at 3 months and 71% at 1 year. Multivariate logistic regression models indicated that independent predictors for CPSP at 3 months were scores on the Hospital Anxiety and Depression Scale (adjusted odds ratio [aOR] of 1.07, 95% CI of 1.02 to 1.14, p = 0.012) and acute postoperative pain (aOR of 2.75, 95% CI of 1.19 to 6.36, p = 0.018). INTERVENTIONS None. CONCLUSIONS Approximately 1 in 3 patients will continue to have pain at 3 months after surgery, with a large proportion reporting neuropathic features. Risk factors for pain at 3 months may include preoperative anxiety and depression and acute postoperative pain.
Collapse
Affiliation(s)
- James S Khan
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Elad Dana
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel. Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maggie Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - George Djaiani
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ze'ev Seltzer
- Centre for the Study of Pain, University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada
| | - Karim Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Huang
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen McRae
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for the Study of Pain, University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada
| | - Dorothy Wong
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Miyazaki T, Matsumoto K, Sato T, Sano I, Furukawa K, Shimoyama K, Kamohara R, Suzuki M, Kondou M, Ikeda N, Tabata S, Shiosakai K, Nagayasu T. Efficacy and safety of add-on mirogabalin to conventional therapy for the treatment of peripheral neuropathic pain after thoracic surgery: the multicenter, randomized, open-label ADMIT-NeP study. BMC Cancer 2024; 24:80. [PMID: 38225552 PMCID: PMC10788972 DOI: 10.1186/s12885-023-11708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/03/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND For chronic pain after thoracic surgery, optimal timing of its diagnosis and effective treatment remains unresolved, although several treatment options are currently available. We examined the efficacy and safety of mirogabalin, in combination with conventional pain therapy (nonsteroidal anti-inflammatory drugs and/or acetaminophen), for treating peripheral neuropathic pain (NeP) after thoracic surgery. METHODS In this multicenter, randomized, open-label, parallel-group study, patients with peripheral NeP were randomly assigned 1:1 to mirogabalin as add-on to conventional therapy or conventional treatment alone. RESULTS Of 131 patients of consent obtained, 128 were randomized (mirogabalin add-on group, 63 patients; conventional treatment group, 65 patients). The least squares mean changes (95% confidence interval [CI]) in Visual Analogue Scale (VAS) score for pain intensity at rest from baseline to Week 8 (primary endpoint) were - 51.3 (- 54.9, - 47.7) mm in the mirogabalin add-on group and - 47.7 (- 51.2, - 44.2) mm in the conventional group (between-group difference: - 3.6 [95% CI: - 8.7, 1.5], P = 0.161). However, in patients with Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score (used for the screening of NeP) ≥ 12 at baseline, the greater the S-LANSS score at baseline, the greater the decrease in VAS score in the mirogabalin add-on group, while no such trend was observed in the conventional treatment group (post hoc analysis). This between-group difference in trends was statistically significant (interaction P value = 0.014). Chronic pain was recorded in 7.9% vs. 16.9% of patients (P = 0.171) at Week 12 in the mirogabalin add-on vs. conventional treatment groups, respectively. Regarding activities of daily living (ADL) and quality of life (QOL), changes in Pain Disability Assessment Scale score and the EQ-5D-5L index value from baseline to Week 8 showed significant improvement in the mirogabalin add-on group vs. conventional treatment group (P < 0.001). The most common adverse events (AEs) in the mirogabalin add-on group were dizziness (12.7%), somnolence (7.9%), and urticaria (3.2%). Most AEs were mild or moderate in severity. CONCLUSIONS Addition of mirogabalin to conventional therapy did not result in significant improvement in pain intensity based on VAS scores, but did result in significant improvement in ADL and QOL in patients with peripheral NeP after thoracic surgery. TRIAL REGISTRATION Japan Registry of Clinical Trials jRCTs071200053 (registered 17/11/2020).
Collapse
Affiliation(s)
- Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
- Department of Thoracic Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Isao Sano
- Department of Respiratory Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Katsuro Furukawa
- Department of Thoracic Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Koichiro Shimoyama
- Chest Surgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Ryotaro Kamohara
- Department of Thoracic Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Makoto Suzuki
- Department of Thoracic Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Masamichi Kondou
- Department of Thoracic and Breast Surgery, Ureshino Medical Center, Ureshino, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shunsuke Tabata
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | | | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| |
Collapse
|
30
|
McElhinney KL, Zeineddin S, Ahle SL, Goldstein SD, Lautz TB. Intercostal nerve cryoablation reduces opioid utilization after thoracotomy in children with cancer. Pediatr Blood Cancer 2024; 71:e30722. [PMID: 37843290 PMCID: PMC10841358 DOI: 10.1002/pbc.30722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/10/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Intercostal nerve cryoablation (INC) has shown promise as an adjunct method for analgesia in adults undergoing thoracotomy, but has yet to be widely used in children for this indication. We hypothesize that INC decreases opioid utilization in children undergoing thoracotomy for cancer operations. METHODS A retrospective review was performed of children who underwent thoracotomy for cancer diagnosis at a freestanding children's hospital from 2018 to 2023. Patient characteristics, intraoperative data, and data on clinical course were collected. Patients were divided into those who underwent INC and those who underwent routine care for comparison. RESULTS Twenty-six patients underwent 38 procedures at a median age of 16 years (range 5-21 years). INC was performed in 23 cases over a median of five intercostal levels (range 2-7). Total oral morphine equivalents during inpatient admission were significantly lower in INC patients (137.6 vs. 514.5 mg, p = .002). Routine care patients were more likely to be discharged with an opioid prescription (30.4% vs. 80.0%, p = .008). Length of stay was similar between patients with INC and routine care (4 vs. 5 days, p = .15). There were no differences in rates of reoperation or 30-day re-admission (emergency department or inpatient). CONCLUSTIONS INC is a feasible and safe adjunct for children undergoing thoracotomy for cancer. INC is associated with reduced postoperative opioid utilization with respect to both inpatient use and outpatient prescriptions.
Collapse
Affiliation(s)
- Kathryn L McElhinney
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Samantha L Ahle
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Seth D Goldstein
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| |
Collapse
|
31
|
Zhou X, Iida H, Li Y, Ota A, Zhuo L, Nobuhara R, Terajima Y, Naiki M, Reddi AH, Kimata K, Ushida T. Neurotropin ® ameliorates chronic pain associated with scar formation in a mouse model: A gene expression analysis of the inflammatory response. Mol Pain 2024; 20:17448069241245420. [PMID: 38511285 PMCID: PMC11080750 DOI: 10.1177/17448069241245420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/21/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Scar formation after trauma and surgery involves an inflammatory response and can lead to the development of chronic pain. Neurotropin® (NTP) is a nonprotein extract of inflamed skin of rabbits inoculated with vaccinia virus. It has been widely used for the treatment of chronic pain. However, the in vivo effects of NTP on painful scar formation have not been determined. To investigate the molecular mechanisms underlying the effects of NTP on the inflammatory response, we evaluated gene expression in the scar tissues and dorsal root ganglions (DRGs) of mice administered NTP and control mice. Methods and results: Mice injected with saline or NTP were used as controls; other mice were subjected to surgery on the left hind paw to induce painful scar formation, and then injected with saline or NTP. Hind paw pain was evaluated by measuring the threshold for mechanical stimulation using the von Frey test. The paw withdrawal threshold gradually returned to pre-operative levels over 4 weeks post-operation; NTP-treated mice showed a significantly shortened recovery time of approximately 3 weeks, suggesting that NTP exerted an analgesic effect in this mouse model. Total RNA was extracted from the scarred hind paw tissues and DRGs were collected 1 week post-operation for a microarray analysis. Gene set enrichment analysis revealed that the expression of some gene sets related to inflammatory responses was activated or inhibited following surgery and NTP administration. Quantitative real-time reverse transcription-polymerase chain reaction analysis results for several genes were consistent with the microarray results. Conclusion: The administration of NTP to the hind paws of mice with painful scar formation following surgery diminished nociceptive pain and reduced the inflammatory response. NTP inhibited the expression of some genes involved in the response to surgery-induced inflammation. Therefore, NTP is a potential therapeutic option for painful scar associated with chronic pain.
Collapse
Affiliation(s)
- Xuan Zhou
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Hiroki Iida
- Department Rehabilitation Center, Aichi Medical University Hospital, Nagakute, Japan
| | - Yuqiang Li
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention, Ministry of Education, School of Physical Education and Health, East China Normal University, Shanghai, China
| | - Akinobu Ota
- Department Biochemistry, Aichi Medical University, Nagakute, Japan
- Department of Food and Nutritional Environment, College of Human Life and Environment, Kinjo Gakuin University, Nagoya, Japan
| | - Lisheng Zhuo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reiko Nobuhara
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Yuki Terajima
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Mitsuru Naiki
- Institute of Bio-Active Science, Nippon Zoki Pharmaceutical Co., Ltd (Project Researcher), Osaka, Japan
| | - A Hari Reddi
- Department of Orthopedic Surgery, Center for Tissue Regeneration and Repair, School of Medicine, University of California at Davis, Sacramento, CA, USA
| | - Koji Kimata
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| | - Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University, Nagakute, Japan
| |
Collapse
|
32
|
Engel S, Jacobsen HB, Reme SE. Cosmetic surgery and associated chronic postsurgical pain: A cross-sectional study from Norway. Scand J Pain 2024; 24:sjpain-2023-0099. [PMID: 38452288 DOI: 10.1515/sjpain-2023-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/01/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Chronic postsurgical pain (CPSP) is a common postoperative sequela. Despite the increasing popularity of cosmetic surgeries, there is a notable lack of research on CPSP in this context, with existing studies focusing on breast surgeries only. To address existing gaps in knowledge, the objective of the present study was to investigate the self-reported prevalence of cosmetic surgery and associated CPSP among Norwegian adults. METHODS An online questionnaire consisting of three questions inquiring prior cosmetic surgeries, associated CPSP, and whether participants had sought for pain management was constructed and distributed among adults residing in Norway. RESULTS Between November 30, 2022 and December 16, 2022, 1,746 participants were recruited. 10% of respondents, 73.3% of which were female, affirmed to have undergone cosmetic surgery. About 1 in 4 of these was aged 18-29 years. The prevalence of CPSP was 12.6%. CPSP was five times more common among male, compared to female respondents. While about two thirds of participants indicating to have experienced CPSP were aged 18-29 years, CPSP was much less common among individuals of other ages. CONCLUSION Consistent with international trends, there appears to be a young and growing population of cosmetic surgery consumers in Norway. According to our results, about 1 in 8 of these might be affected by CPSP, a condition that is notoriously hard to treat and weighting heavily on public healthcare and social welfare systems. Large-scale longitudinal studies further investigating the topic are thus urgently needed.
Collapse
Affiliation(s)
- Sophia Engel
- The Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
| | - Henrik Børsting Jacobsen
- The Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Silje Endresen Reme
- The Mind Body Lab, Department of Psychology, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
33
|
Wildemeersch D, Meeus I, Wauters E, Vanlommel L, Roelant E, Dankerlui R, Saldien V, Vandervelde L, Verhaegen I, Hans GH. Evaluating the Predictive Value of a Short Preoperative Holistic Risk Factor Screening Questionnaire in Preventing Persistent Pain in Elective Adult Surgery: Study Protocol for a Prospective Observational Pragmatic Trial [PERISCOPE]. J Pain Res 2023; 16:4281-4287. [PMID: 38107366 PMCID: PMC10725748 DOI: 10.2147/jpr.s439824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Background The global incidence of persistent pain after surgery is approximately 10%, with considerable clinical and socioeconomic impacts. Despite identifying many risk factors in its development and the challenging management of the often neuropathic pain complaints, preoperative recognition of high-risk patients in various surgical populations using a standardized risk factor assessment questionnaire is lacking. This study evaluates the predictive value of a short holistic risk factor screening questionnaire as a first step in preventing and treating persistent pain in adults undergoing elective surgery. Methods This prospective observational pragmatic trial will include 560 adults undergoing elective surgery. The primary endpoint is the evaluation of the predictive value of the screening questionnaire, including the optimal cut-off determination in terms of sensitivity and specificity for inclusion in a perioperative high-vigilance program. Secondary endpoints are postoperative pain (intensity and characterization using the NRS and DN4), postoperative analgesic usage, and well-being using the EQ-5D-5 L. To assess the performance of the designed screening questionnaire in the identification of psychosocial pain aspects, HADs, and STAI-trait are being surveyed. Additionally, the multidimensional pain inventory (MPI, part 1) is being used to assess the impact of pain on daily life in patients. Discussion This pragmatic clinical trial will evaluate a short preoperative screening questionnaire to predict persistent postoperative pain after elective surgery in adults. Suppose high-risk patients could be identified earlier using this short preoperative holistic screening questionnaire. In that case, it might contribute to a more widespread implementation of standardized preoperative assessment and awareness for preventing persistent postoperative pain. Trial Registration Local ethics committee: B3002022000112. ClinicalTrials.gov identifier: NCT05526976. Registered on: 02 September 2022. Start of recruitment: 22 December 2022. Trial Status This paper is based on protocol version 4.0. The first patient was assigned to the research project on the 22 of December 2022. We anticipate including the last patient in October 2023 and plan to finalize the study by January 2024.
Collapse
Affiliation(s)
- Davina Wildemeersch
- Multidisciplinary Pain Centre (PCT), Antwerp University Hospital (UZA), Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp (UA), Wilrijk, Belgium
| | - Ine Meeus
- Multidisciplinary Pain Centre (PCT), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Eva Wauters
- Clinical Trial Centre (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Lotte Vanlommel
- Clinical Trial Centre (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Ella Roelant
- Department of Statistics, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Rowan Dankerlui
- Department of Anaesthesiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Vera Saldien
- Department of Anaesthesiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Leen Vandervelde
- Department of Anaesthesiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Iris Verhaegen
- Clinical Trial Centre (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| | - Guy H Hans
- Multidisciplinary Pain Centre (PCT), Antwerp University Hospital (UZA), Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp (UA), Wilrijk, Belgium
- Clinical Trial Centre (CTC), Antwerp University Hospital (UZA), Edegem, Belgium
| |
Collapse
|
34
|
Michel-Cherqui M, Fessler J, Dorges P, Szekély B, Sage E, Glorion M, Fischler M, Martinez V, Labro M, Vallée A, Le Guen M. Chronic pain after posterolateral and axillary approaches to lung surgery: a monocentric observational study. J Anesth 2023; 37:687-702. [PMID: 37573522 DOI: 10.1007/s00540-023-03221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 06/28/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Post-thoracotomy pain syndrome (PTPS) and chronic postsurgical neuropathic pain (CPNP) were evaluated 4 months after thoracic surgery whether the approach was a posterolateral (PL) incision or the less invasive axillary (AX) one. METHODS Patients, 79 in each group, undergoing a thoracotomy between July 2014 and November 2015 were analyzed 4 months after surgery in this prospective monocentric cohort study. RESULTS More PL patients suffered PTPS (60.8% vs. 40.5%; p = 0.017) but CPNP was equally present (45.8% and 46.9% in the PL and AX groups). Patients with PTPS have more limited daily activities (p < 0.001) but a similar psychological disability (i.e., catastrophism). Patients with CPNP have an even greater limitation of daily activities (p = 0.007) and more catastrophism (p = 0.0002). Intensity of pain during mobilization of the homolateral shoulder at postoperative day 6 (OR = 1.40, CI 95% [1.13-1.75], p = 0.002); age (OR = 0.97 [0.94-1.00], p = 0.022), and presence of pain before surgery (OR = 2.22 [1.00-4.92], p = 0.049) are related to the occurrence of PTPS; while, height of hypoesthesia area on the breast line measured 6 days after surgery is the only factor related to that of CPNP (OR = 1.14 [1.01-1.30], p = 0.036). CONCLUSION Minimally invasive surgery was associated with less frequent PTPS, but with equal risk of CPNP. Pain before surgery and its postoperative intensity are associated with PTPS. This must lead to a more aggressive care of pain patients before surgery and of a better management of postoperative pain. CPNP can be forecasted according to the early postoperative height of hypoesthesia area on the breast line.
Collapse
Affiliation(s)
- Mireille Michel-Cherqui
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Julien Fessler
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Pascaline Dorges
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Barbara Szekély
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Matthieu Glorion
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Marc Fischler
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France.
| | - Valéria Martinez
- Department of Anesthesiology and Pain Unit, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 92380, Garches, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| | - Mathilde Labro
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, 92150, Suresnes, France
| | - Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, 92150, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Management, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France
- Université Versailles-Saint-Quentin-en-Yvelines, 78000, Versailles, France
| |
Collapse
|
35
|
Babino JM, Thornton JD, Putney K, Bethany Taylor R, Wanat MA. Evaluation of Discharge Opioid Prescribing in Coronary Artery Bypass Patients Following an Opioid Stewardship Intervention for Providers. J Pharm Pract 2023; 36:1077-1084. [PMID: 35410543 DOI: 10.1177/08971900221088797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Introduction: Opioid stewardship efforts can promote safe and effective use of opioids to optimize pain control and minimize unintended consequences. The purpose of this study is to assess the difference in post-operative opioid discharge prescribing in patients undergoing coronary artery bypass graft (CABG) surgery following implementation of a tripartite opioid stewardship intervention. Methods: This was a single-center, quality improvement study at a large, quaternary academic medical center. Adult patients undergoing CABG from July 2019 to June 2020 (pre-intervention) and November 2020 to February 2021 (post-intervention) were included. The intervention included adopting hospital-wide post-surgical opioid discharge prescribing guidelines, discharge prescriber education, and electronic medical record changes. The primary outcome was the proportion of patients receiving an opioid prescription at discharge. Secondary outcomes included total morphine milligram equivalents (MME) prescribed and non-opioid analgesics prescribed at discharge. Results: A total of 200 patients were included in the study; 100 pre- and 100 post-intervention. There was no difference in opioid discharge prescribing at discharge (74% pre-intervention vs. 72% post-intervention; P = .87). There was no difference in MMEs prescribed at discharge (145.6 ± 57 pre- vs. 162.2 ± 95 post-; P = .202). No difference was seen in non-opioid analgesic prescriptions prescribed at discharge (35% pre- vs. 40% post-; P = .56). Conclusion: A multipronged opioid stewardship intervention did not lead to a reduction in opioid prescribing at discharge. Post-intervention, there was a non-statistically significant increase in the proportion of patients who received non-opioid analgesics discharge. Future studies should assess the effect of different stewardship interventions on prescribing and patient outcomes.
Collapse
Affiliation(s)
- Justin M Babino
- Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA
| | - James Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
| | - Kimberly Putney
- Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA
| | | | - Matthew A Wanat
- Prescription Drug Misuse Education and Research Center, University of Houston College of Pharmacy, Houston, TX, USA
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| |
Collapse
|
36
|
Fetz K, Lefering R, Kaske S. Pre-Trauma Pain Is the Strongest Predictor of Persistent Enhanced Pain Patterns after Severe Trauma: Results of a Single-Centre Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1327. [PMID: 37512138 PMCID: PMC10383629 DOI: 10.3390/medicina59071327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/21/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients' quality of life, affecting physical, emotional, and social functioning. This study aimed to investigate the pain patterns of trauma patients before and after severe trauma, and identify the predictors of persisting pain after injury. Materials and Methods: A total of 596 patients of a level-one trauma centre with severe trauma were included in this study. The Trauma Outcome Profile Scale was used to assess pain severity before and after trauma, and a logistic regression analysis was performed to determine the most significant predictors of relevant pain after severe trauma. Results: The mean age of the included patients was 48.2 years, and 72% were males. The most frequent cause of injury was traffic accidents, and the mean Injury Severity Score was 17.6. Nearly half of the patients experienced reduced pain-related quality of life after trauma, with persisting pain predominantly occurring in the neck, spine, shoulder, pelvis, hip, knee, and feet. Even minor injuries led to increased pain scores. Preexisting pain before injury (OR: 5.43; CI: 2.60-11.34), older age (OR: 2.09, CI: 1.22-3.27), female gender (OR: 1.08, CI: 0.73-1.59), and high injury severity (OR: 1.80, CI: 1.20-2.69) were identified as significant predictors of enhanced pain. Conclusions: These findings highlight the importance of considering pre-existing pain, body area, and injury severity in assessing the risk of persistent pain in trauma patients.
Collapse
Affiliation(s)
- Katharina Fetz
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, 51109 Cologne, Germany
- Chair of Research Methodology and Statistics, Department of Psychology, Witten/Herdecke University, 58448 Witten, Germany
- Department of Anaesthesiology and Operative Intensive Care, Cologne Merheim Medical Centre, 51109 Cologne, Germany
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, 24118 Kiel, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, 51109 Cologne, Germany
| | - Sigune Kaske
- Department of Trauma Surgery, Cologne Merheim Medical Centre, 51109 Cologne, Germany
| |
Collapse
|
37
|
Fuller AM, Bharde S, Sikandar S. The mechanisms and management of persistent postsurgical pain. FRONTIERS IN PAIN RESEARCH 2023; 4:1154597. [PMID: 37484030 PMCID: PMC10357043 DOI: 10.3389/fpain.2023.1154597] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
An estimated 10%-50% of patients undergoing a surgical intervention will develop persistent postsurgical pain (PPP) lasting more than 3 months despite adequate acute pain management and the availability of minimally invasive procedures. The link between early and late pain outcomes for surgical procedures remains unclear-some patients improve while others develop persistent pain. The elective nature of a surgical procedure offers a unique opportunity for prophylactic or early intervention to prevent the development of PPP and improve our understanding of its associated risk factors, such as pre-operative anxiety and the duration of severe acute postoperative pain. Current perioperative pain management strategies often include opioids, but long-term consumption can lead to tolerance, addiction, opioid-induced hyperalgesia, and death. Pre-clinical models provide the opportunity to dissect mechanisms underpinning the transition from acute to chronic, or persistent, postsurgical pain. This review highlights putative mechanisms of PPP, including sensitisation of peripheral sensory neurons, neuroplasticity in the central nervous system and nociceptive signalling along the neuro-immune axis.
Collapse
|
38
|
Hu JH, Shi HJ, Han ZY, Liu H, Ji FH, Peng K. Protocol for Development and Validation of Multivariable Prediction Models for Chronic Postsurgical Pain Following Video-Assisted Thoracic Surgery. J Pain Res 2023; 16:2251-2256. [PMID: 37425224 PMCID: PMC10328098 DOI: 10.2147/jpr.s416450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Chronic postsurgical pain (CPSP) is a common complication after thoracic surgery and associated with long-term adverse outcomes. This study aims to develop two prediction models for CPSP after video-assisted thoracic surgery (VATS). Methods and Analysis This single-center prospective cohort study will include a total of 500 adult patients undergoing VATS lung resection (n = 350 for development and n = 150 for external validation). Patients will be enrolled continuously at The First Affiliated Hospital of Soochow University in Suzhou, China. The cohort for external validation will be recruited in another time period. The outcome is CPSP, which is defined as pain with the numerical rating scale score of 1 or higher 3 months after VATS. Univariate and multivariable logistic regression analyses will be performed to develop two CPSP prediction models based on patients' data of postoperative day 1 and day 14, respectively. For internal validation, we will use the bootstrapping validation technique. For external validation, the discrimination capability of the models will be assessed using the area under the receiver operating characteristic curve, and the calibration will be evaluated using the calibration curve and Hosmer-Lemeshow goodness-of-fit statistic. The results will be presented in model formulas and nomograms. Conclusion Based on the development and validation of the prediction models, our results contribute to early prediction and treatment of CPSP after VATS. Trial Registration Chinese Clinical Trial Register (ChiCTR2200066122).
Collapse
Affiliation(s)
- Jing-Hui Hu
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hai-Jing Shi
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Zhen-Yu Han
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Fu-Hai Ji
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ke Peng
- Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China
| |
Collapse
|
39
|
Sun M, Chen WM, Wu SY, Zhang J. Chronic pain following elective surgery under general anesthesia in older adults. J Anesth 2023:10.1007/s00540-023-03215-2. [PMID: 37354352 DOI: 10.1007/s00540-023-03215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/03/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between age and chronic postsurgical pain (CPSP) in patients who underwent elective surgery under general anesthesia, with a focus on long-term postsurgical analgesic use. To our knowledge, no previous study has examined this relationship in detail between older and younger patients. METHODS We conducted a propensity score-matched (PSM) study to compare the rates of long-term (3 or 6 months) postoperative analgesic use between older adult (≥ 65 years) and younger (< 65 years) patients. Multivariate logistic regression was used to assess the use of analgesics as a surrogate indicator of CPSP. RESULTS The PSM analysis included 62,784 surgical patients (31,392 in each group). Three months after surgery, the rates of analgesic use were significantly higher in the older age group (adjusted odds ratio [aOR], 1.45; 95% confidence interval [CI], 1.41-1.49) as well as for opioid use specifically (aOR, 1.34; 95% CI, 1.29-1.39). Six months after surgery, the rates of analgesic use remained higher in the older age group (aOR, 1.52; 95% CI, 1.47-1.58), and similarly for opioid use specifically (aOR, 1.42; 95% CI, 1.36-1.48). CONCLUSIONS Our findings suggest that older adults have higher rates of long-term analgesic use for CPSP after elective surgery under general anesthesia. This study highlights the importance of addressing CPSP in older adult patients and considering age-related factors when managing postoperative pain.
Collapse
Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan.
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| |
Collapse
|
40
|
Castaño-Asins JR, Sanabria-Mazo JP, Luciano JV, Barceló-Soler A, Martín-López LM, Del Arco-Churruca A, Lafuente-Baraza J, Bulbena A, Pérez-Solà V, Montes-Pérez A. Effectiveness of Acceptance and Commitment Therapy (ACT) for the Management of Postsurgical Pain: Study Protocol of a Randomized Controlled Trial (SPINE-ACT Study). J Clin Med 2023; 12:4066. [PMID: 37373758 DOI: 10.3390/jcm12124066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Research on the use of Acceptance and Commitment Therapy (ACT) for patients with degenerative lumbar pathology awaiting surgery are limited. However, there is evidence to suggest that this psychological therapy may be effective in improving pain interference, anxiety, depression, and quality of life. This is the protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of ACT compared to treatment as usual (TAU) for people with degenerative lumbar pathology who are candidates for surgery in the short term. A total of 102 patients with degenerative lumbar spine pathology will be randomly assigned to TAU (control group) or ACT + TAU (intervention group). Participants will be assessed after treatment and at 3-, 6-, and 12-month follow-ups. The primary outcome will be the mean change from baseline on the Brief Pain Inventory (pain interference). Secondary outcomes will include changes in pain intensity, anxiety, depression, pain catastrophizing, fear of movement, quality of life, disability due to low back pain (LBP), pain acceptance, and psychological inflexibility. Linear mixed models will be used to analyze the data. Additionally, effect sizes and number needed to treat (NNT) will be calculated. We posit that ACT may be used to help patients cope with the stress and uncertainty associated with their condition and the surgery itself.
Collapse
Affiliation(s)
| | - Juan P Sanabria-Mazo
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
- Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
- Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Juan V Luciano
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 St. Boi de Llobregat, Spain
- Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Clinical & Health Psychology, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
| | | | | | | | | | - Antonio Bulbena
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Cerdanyola del Vallès, Spain
| | | | | |
Collapse
|
41
|
Rubione J, Sbrascini SM, Miguel B, Leiguarda C, Coronel MF, McCarthy CJ, Montaner A, Villar MJ, Brumovsky PR. Modulation of the Inflammatory Response by Pre-emptive Administration of IMT504 Reduces Postoperative Pain in Rats and has Opioid-Sparing Effects. THE JOURNAL OF PAIN 2023; 24:991-1008. [PMID: 36706889 DOI: 10.1016/j.jpain.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
Despite the available knowledge on underlying mechanisms and the development of several therapeutic strategies, optimal management of postoperative pain remains challenging. This preclinical study hypothesizes that, by promoting an anti-inflammatory scenario, pre-emptive administration of IMT504, a noncoding, non-CpG oligodeoxynucleotide with immune modulating properties, will reduce postincisional pain, also facilitating therapeutic opioid-sparing. Male adult Sprague-Dawley rats with unilateral hindpaw skin-muscle incision received pre-emptive (48 and 24 hours prior to surgery) or postoperative (6 hours after surgery) subcutaneous vehicle (saline) or IMT504. Various groups of rats were prepared for pain-like behavior analyses, including subgroups receiving morphine or naloxone, as well as for flow-cytometry or quantitative RT-PCR analyses of the spleen and hindpaws (for analysis of inflammatory phenotype). Compared to vehicle-treated rats, pre-emptive IMT504 significantly reduced mechanical allodynia by 6 hours after surgery, and accelerated recovery of basal responses from 72 hours after surgery and onwards. Cold allodynia was also reduced by IMT504. Postoperative administration of IMT504 resulted in similar positive effects on pain-like behavior. In IMT504-treated rats, 3 mg/kg morphine resulted in comparable blockade of mechanical allodynia as observed in vehicle-treated rats receiving 10 mg/kg morphine. IMT504 significantly increased hindpaw infiltration of mesenchymal stem cells, CD4+T and B cells, and caused upregulated or downregulated transcript expressions of interleukin-10 and interleukin-1β, respectively. Also, IMT504 treatment targeted the spleen, with upregulated or downregulated transcript expressions, 6 hours after incision, of interleukin-10 and interleukin-1β, respectively. Altogether, pre-emptive or postoperative IMT504 provides protection against postincisional pain, through participation of significant immunomodulatory actions, and exhibiting opioid-sparing effects. PERSPECTIVE: This preclinical study introduces the noncoding non-CpG oligodeoxynucleotide IMT504 as a novel modulator of postoperative pain and underlying inflammatory events. The opioid-sparing effects observed for IMT504 appear as a key feature that could contribute, in the future, to reducing opioid-related adverse events in patients undergoing surgical intervention.
Collapse
Affiliation(s)
- Julia Rubione
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Sandra M Sbrascini
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina; Hospital Universitario Austral, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Bernardo Miguel
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Candelaria Leiguarda
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - María F Coronel
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Carly J McCarthy
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Alejandro Montaner
- Instituto de Ciencia y Tecnología "Dr. César Milstein", CONICET, Fundación Pablo Cassará, Pilar, Buenos Aires, Argentina
| | - Marcelo J Villar
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina
| | - Pablo R Brumovsky
- Instituto de Investigaciones en Medicina Traslacional (IIMT) CONICET, Universidad Austral, Pilar, Buenos Aires, Argentina.
| |
Collapse
|
42
|
Corcoran TB, Martin C, O'Loughlin E, Ho K, Chan M, Forbes A, Leslie K, Myles P. Dexamethasone and persistent wound pain: a prespecified analysis of the randomised Perioperative Administration of Dexamethasone and Infection (PADDI) trial. Br J Anaesth 2023:S0007-0912(23)00177-0. [PMID: 37230849 DOI: 10.1016/j.bja.2023.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/14/2023] [Accepted: 03/27/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Dexamethasone is commonly administered intraoperatively to prevent postoperative nausea and vomiting and is believed to have analgesic properties. It is unknown whether it has an impact on chronic wound pain. METHODS In this prespecified embedded superiority substudy of the randomised PADDI trial, patients undergoing non-urgent noncardiac surgery received dexamethasone 8 mg or placebo intravenously after induction of anaesthesia, and were followed up for 6 months postoperatively. The primary outcome was the incidence of pain in the surgical wound at 6 months. Secondary outcomes included acute postoperative pain and correlates of chronic postsurgical pain. RESULTS We included 8478 participants in the modified intention-to-treat population (4258 in the dexamethasone group and 4220 in the matched placebo group). The primary outcome occurred in 491 subjects (11.5%) in the dexamethasone arm and 404 (9.6%) subjects in the placebo arm (relative risk 1.2, 95% confidence interval 1.06-1.41, P=0.003). Maximum pain scores at rest and on movement in the first 3 postoperative days were lower in the dexamethasone group compared with the control group {median 5 (inter-quartile range [IQR] 3.0-8.0) vs 6 (IQR 3.0-8.0) and median 7 (IQR 5.0-9.0) vs 8 (IQR 6.0-9.0), P<0.001 for both}. Severity of postoperative pain was not predictive of chronic postsurgical pain. The severity of chronic postsurgical pain and the frequency of neuropathic features did not differ between treatment groups. CONCLUSION Administration of dexamethasone 8 mg i.v. was associated with an increase in the risk of pain in the surgical wound 6 months after surgery. CLINICAL TRIAL REGISTRATION ACTRN12614001226695.
Collapse
Affiliation(s)
- Tomás B Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Catherine Martin
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Edmond O'Loughlin
- Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Kwok Ho
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; Discipline of Emergency Medicine, University of Western Australia, Perth, Western Australia, Australia; Department of Anaesthesia, Fiona Stanley Hospital, Perth, Western Australia, Australia; School of Veterinary and Life sciences, Murdoch University, Perth, Western Australia, Australia
| | - Matthew Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Special Administrative Region, China
| | - Andrew Forbes
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Kate Leslie
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Paul Myles
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| |
Collapse
|
43
|
Sun M, Chen WM, Wu SY, Zhang J. Sarcopenia is associated with an increase in long-term use of analgesics after elective surgery under general anesthesia. Reg Anesth Pain Med 2023; 48:205-210. [PMID: 36631231 DOI: 10.1136/rapm-2022-104144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To elucidate the association of presurgical sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia. METHODS We conducted this population-based propensity score matched to investigate the effects of sarcopenia and long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia between 1 October 2016 and 31 December 2019 from Taiwan's National Health Insurance Research Database. Sarcopenia is a disease and coded as M62.84 in the International Classification of Diseases, 10th Revision, Clinical Modification. The primary outcome was the combined rate of the long-term use of all non-opioid analgesics or opioids over 3 and 6 months after elective surgery. By performing a logistic regression analysis, we calculated the adjusted ORs (aORs) with 95% CIs to identify the independent predictors for long-term non-opioid analgesic and opioid use after surgery. RESULTS In total, 2860 patients underwent elective surgery. The 3-month non-opioid analgesic and opioid use rates were respectively 49.7% and 1.8% in the sarcopenia group and 37.9% and 0.9% in the non-sarcopenia group; by contrast, 6-month non-opioid analgesic and opioid use rates were respectively 31.6% and 1.2% in the sarcopenia group and 17.2% and 0.3% in the non-sarcopenia group. Moreover, presurgical sarcopenia increased the risk of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia (aORs for non-opioid analgesic use over 3 and 6 months after surgery: 1.17 (95% CI 1.05 to 2.23) and 1.26 (95% CI 1.04 to 1.45), respectively; aORs for opioid use over 3 and 6 months after surgery: 1.17 (95% CI 1.07 to 2.21) and 1.23 (95% CI 1.10 to 3.64), respectively). CONCLUSION Sarcopenia is associated with higher rates of long-term non-opioid analgesic and opioid use after elective surgery under general anesthesia. SUMMARY The aim of this study was to compare the long-term use of non-opioid analgesics and opioids after elective surgery under general anesthesia between patients with and without sarcopenia. Results suggest that patients with sarcopenia are more likely to have increased use of non-opioid analgesics and opioids after surgery. Further research is needed to determine if sarcopenia can be modified prior to surgery and if this impacts the need for long-term pain management with these medications.
Collapse
Affiliation(s)
- Mingyang Sun
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, Yilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Management, College of Management, Fo Guang University, Yilan, Taiwan
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
44
|
Kong Y, Shi W, Zheng L, Zhang D, Jiang X, Liu B, Xue W, Kuss M, Li Y, Sorgen PL, Duan B. In situ delivery of a curcumin-loaded dynamic hydrogel for the treatment of chronic peripheral neuropathy. J Control Release 2023; 357:319-332. [PMID: 37028453 PMCID: PMC10164707 DOI: 10.1016/j.jconrel.2023.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/09/2023]
Abstract
Patients with peripheral nerve injuries would highly likely suffer from chronic neuropathic pain even after surgical intervention. The primary reasons for this involve sustained neuroinflammatory and dysfunctional changes in the nervous system after the nerve injury. We previously reported an injectable boronic ester-based hydrogel with inherent antioxidative and nerve protective properties. Herein, we first explored the anti-neuroinflammatory effects of Curcumin on primary sensory neurons and activated macrophages in vitro. Next, we incorporated thiolated Curcumin-Pluronic F-127 micelles (Cur-M) into our boronic ester-based hydrogel to develop an injectable hydrogel that serves as sustained curcumin release system (Gel-Cur-M). By orthotopically injecting the Gel-Cur-M to sciatic nerves of mice with chronic constriction injuries, we found that the bioactive components could remain on the nerves for at least 21 days. In addition, the Gel-Cur-M exhibited superior functions compared to Gel and Cur-M alone, which includes ameliorating hyperalgesia while simultaneously improving locomotor and muscular functions after the nerve injury. This could stem from in situ anti-inflammation, antioxidation, and nerve protection. Furthermore, the Gel-Cur-M also showed extended beneficial effects for preventing the overexpression of TRPV1 as well as microglial activation in the lumbar dorsal root ganglion and spinal cord, respectively, which also contributed to its analgesic effects. The underlying mechanism may involve the suppression of CC chemokine ligand-2 and colony-stimulating factor-1 in the injured sensory neurons. Overall, this study suggests that orthotopic injection of the Gel-Cur-M is a promising therapeutic strategy that especially benefits patients with peripheral neuropathy who require surgical interventions.
Collapse
Affiliation(s)
- Yunfan Kong
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Wen Shi
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Li Zheng
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Dongze Zhang
- Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Xiping Jiang
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Bo Liu
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Wen Xue
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mitchell Kuss
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Yulong Li
- Department of Emergency Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Paul L Sorgen
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program University of Nebraska Medical Center, Omaha, NE 68198, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA; Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA; Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, USA.
| |
Collapse
|
45
|
Edinoff AN, Flanagan CJ, Sinnathamby ES, Pearl NZ, Jackson ED, Wenger DM, Cornett EM, Kaye AM, Kaye AD. Treatment of Acute Pain in Patients on Naltrexone: A Narrative Review. Curr Pain Headache Rep 2023; 27:183-192. [PMID: 37115486 DOI: 10.1007/s11916-023-01110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW The tissue damage and trauma associated with surgery almost always result in acute postoperative pain. The intensity of postoperative pain can range from mild to severe. Naltrexone is suitable for patients who do not wish to be on an agonist treatment such as methadone or buprenorphine. However, naltrexone has been shown to complicate postoperative pain management. RECENT FINDINGS Multiple studies have found that the use of naltrexone can increase the opioid requirement for postoperative pain control. Other modalities exist that can help outside of opioids such as ketamine, lidocaine/bupivacaine, duloxetine, and non-pharmacological management can help manage pain. Multimodal pain regiments should also be employed in patients. In addition to traditional methods for postoperative pain management, other methods of acute pain control exist that can help mitigate opioid dependence and help control pain in patients who use naltrexone for their substance use disorders.
Collapse
Affiliation(s)
- Amber N Edinoff
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
- Louisiana Addiction Research Center, Shreveport, LA, 71103, USA.
| | - Chelsi J Flanagan
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, 78235, USA
| | - Evan S Sinnathamby
- School of Medicine, Louisiana State University Health Science Center at New Orleans, New Orleans, LA, 70112, USA
| | - Nathan Z Pearl
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Eric D Jackson
- University of Arizona College of Medicine- Phoenix, Phoenix, AZ, 85004, USA
| | - Danielle M Wenger
- University of Arizona College of Medicine- Phoenix, Phoenix, AZ, 85004, USA
| | - Elyse M Cornett
- Louisiana Addiction Research Center, Shreveport, LA, 71103, USA
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| | - Adam M Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, Department of Pharmacy Practice, University of the Pacific, Stockton, CA, 95211, USA
| | - Alan D Kaye
- Louisiana Addiction Research Center, Shreveport, LA, 71103, USA
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, 71103, USA
| |
Collapse
|
46
|
Qu T, Han T, Yang W, Wei Z, He H, Yuan X. Efficacy and safety of Extrapleural block in patients with coronary artery disease after thoracoscopic surgery. Ann Noninvasive Electrocardiol 2023; 28:e13050. [PMID: 36745525 DOI: 10.1111/anec.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/22/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the efficacy and safety of extrapleural block (EPB) application in patients with coronary artery disease after thoracoscopic surgery. METHODS Patients with typical symptoms of angina and myocardial ischemia who underwent thoracoscopic surgery at our institution between December 2018 and December 2020 were screened for eligibility and they received paravertebral blocking (PVB), EPB, and patient-controlled intravenous analgesia (PCIA). Visual analog scale (VAS) scores were used to assess the analgesic effect and safety outcomes included heart rate, incidence of postoperative rescue analgesics, cardiac complications, and adverse reactions such as nausea and vomiting. RESULTS In total, 76 patients (age: 66.5 [61.3, 71] years; male: 63.2%) were eligible, including the PVB group (n = 22), EPB group (n = 25), and PVIA group (n = 29) with comparable baseline characteristics. There was a significantly higher proportion of patients with a VAS score of 1 in the EPB group compared with the other groups at 4 h (88.0% vs. 10.3% for PCIA and 45.5% for PVB; p < .001) and 6 h after the surgery (32.0% vs. 3.4% for PCIA and 13.6% for PVB; p = .012). The preoperative heart rate in the EPB group (81 [71, 94] beats/min) was slightly higher than those in the PVB (76 [70, 85] beats/min) and PCIA groups (76 [69, 84 beats/min]) but without significant difference (p = .193). There was no significant difference in the incidence of rescue analgesia, adverse events, and cardiac complications among the three groups (p = .296, .808, and .669, respectively.) CONCLUSION: Compared with PVB and PCIA, the EPB could more effectively relieve acute pain after thoracoscopic surgery in patients with coronary artery disease and offer comparable safety benefits in the management of postoperative heart rate, adverse events, and cardiac complications.
Collapse
Affiliation(s)
- Tianfang Qu
- Department of Anesthesiology, Baoding No.2 central hospital, Zhuozhou, China
| | - Tian Han
- Department of Anesthesiology, Baoding No.2 central hospital, Zhuozhou, China
| | - Wenqu Yang
- Department of Anesthesiology, Shanxi Bethune hospital, Taiyuan, China
| | - Zhihui Wei
- Department of Anesthesiology, Baoding No.2 central hospital, Zhuozhou, China
| | - Huizhen He
- Department of Anesthesiology, Baoding No.2 central hospital, Zhuozhou, China
| | - Xin Yuan
- Department of Thoracic Surgery, Baoding No.2 central hospital, Zhuozhou, China
| |
Collapse
|
47
|
Arasegawa Y, Muramatsu K, Inoue K, Ueda T, Jyouichi K, Kinoshita D. The Relationship of Patient Characteristics and Prolonged Pain after Treatment of Carpometacarpal Joint Arthritis of the Thumb. J Hand Surg Asian Pac Vol 2023; 28:53-60. [PMID: 36803472 DOI: 10.1142/s242483552350008x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background: The carpometacarpal (CMC) joint of the thumb is the second most common site of osteoarthritis in the hand. Clinical severity stage of CMC joint arthritis has not been correlated with the pain level of the patient. Recently, the association of joint pain with patient psychological factor, such as depression or case-specific personality, has been investigated. This study was designed to determine the impact of psychological factors to residual pain after treatment of CMC joint arthritis, using pain catastrophizing scale (PCS) and the Yatabe-Guilford (YG) personality test. Methods: Twenty-six patients (7 males and 19 females) with 26 hands were included. Thirteen patients classified as Eaton stage 3 underwent suspension arthroplasty and 13 patients as Eaton stage 2 underwent conservative treatment using a custom fitted orthosis. Clinical evaluation was assessed using Visual Analogue Scale (VAS) and the quick Disabilities of the Arm, Shoulder and Hand Questionnaire Score (QuickDASH) at initial evaluation, at 1 month and at 3 months after treatment. We compared both groups using the PCS and YG test. Results: The PCS showed significant difference in the VAS scores only at initial evaluation in both surgical and conservative treatment. There was a significant difference in VAS at 3 months between the two groups in both surgical and conservative treatment and in QuickDASH at 3 months in conservative treatment. Conclusions: The YG test has been used mainly in psychiatry. Although this test has not yet been used worldwide, its usefulness has been recognised and applied clinically, especially in Asia. Patient characteristics are strongly associated with residual pain of the CMC joint arthritis of the thumb. The YG test is a useful tool to analyse pain-related patient characteristics and can be utilised to determine the therapeutic modalities and most effective rehabilitation programme for pain control. Level of Evidence: Level III (Therapeutic).
Collapse
Affiliation(s)
- Yoshito Arasegawa
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Keiichi Muramatsu
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kiyotaka Inoue
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Takeshi Ueda
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Kouhei Jyouichi
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| | - Daisuke Kinoshita
- Department of Rehabilitation and Hand Surgery, Nagato General Hospital, Nagato, Japan
| |
Collapse
|
48
|
Admiraal M, Hermanides J, Hollmann MW, Hermanns H. Evaluation of Health Care Providers Satisfaction with the Implementation of a Transitional Pain Service. J Clin Med 2023; 12:jcm12020537. [PMID: 36675465 PMCID: PMC9864635 DOI: 10.3390/jcm12020537] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Chronic postsurgical pain develops in 10% of patients undergoing surgery. Recently, multidisciplinary, patient-tailored interventions, such as a Transitional Pain Service (TPS) have been developed and implemented to improve perioperative pain management and thereby prevent chronic postsurgical pain. The purpose of this survey was to analyse health care providers satisfaction and learn from their experiences on the implementation of a TPS. In the TRUST study, a randomized controlled trial investigating the effectiveness of a TPS, 176 patients were enrolled. Afterwards, a satisfaction survey was internally developed, which consisted of eight items. Satisfaction was measured using a Likert scale with five response options from never (1 point) to always (5 points). Surveys were sent to all anaesthetists and anaesthesia residents in our department that were faced with the consequences of TPS implementation. In May 2022, 36 caregivers of the Department of Anaesthesiology returned the survey after four rounds of distribution, with a response rate of 82.3%. Thirty staff members (81.0%) strongly felt that patient care had improved with the introduction of a TPS and 33 (86.8%) would like to see the TPS to be continued in the future. Health care provider satisfaction improved after implementation of a TPS in our hospital.
Collapse
|
49
|
Zagorulko OI, Medvedeva LA, Tsedinova YB, Kotenko KV. [Reflexology in patient rehabilitation with postoperative pain. (Literature review)]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:103-106. [PMID: 38289312 DOI: 10.17116/kurort2023100061103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Postoperative pain is a pressing medical problem, as it significantly reduces the quality of life of patients after surgical treatment. Chronic postoperative pain further disables patients and impairs their functional activity. Being a widespread interdisciplinary problem, postoperative pain requires the integration of various pain management methods in complex multimodal pain management in the acute period and treatment programs for its chronicity. The paper examines the possibilities of reflexology methods for the relief of acute and treatment of chronic postoperative pain. Integration of reflex effects from the first days after surgery makes it possible to more effectively and safely solve the problems of acute and chronic postoperative pain.
Collapse
Affiliation(s)
- O I Zagorulko
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - L A Medvedeva
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Yu B Tsedinova
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - K V Kotenko
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| |
Collapse
|
50
|
Li X, Li Q, Song S, Stevens AO, Broemmel Z, He Y, Wesselmann U, Yaksh T, Zhao C. Emulsion-induced polymersomes taming tetrodotoxin for prolonged duration local anesthesia. ADVANCED THERAPEUTICS 2023; 6:2200199. [PMID: 36819711 PMCID: PMC9937052 DOI: 10.1002/adtp.202200199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 11/06/2022]
Abstract
Injectable local anesthetics that can provide a continuous nerve block approximating the duration of a pain state would be a life-changing solution for patients experiencing post-operative pain or chronic pain. Tetrodotoxin (TTX) is a site 1 sodium channel blocker that is extremely potent compared to clinically used local anesthetics. Challengingly, TTX doses are limited by its associated systemic toxicity, thus shortening the achievable duration of nerve blocks. Here, we explore emulsion-induced polymersomes (EIP) as a drug delivery system to safely use TTX for local anesthesia. By emulsifying hyperbranched polyglycerol-poly (propylene glycol)-hyperbranched polyglycerol (HPG-PPG-HPG) in TTX aqueous solution, HPG-PPG-HPG self-assembled into micrometer-sized polymersomes within seconds. The formed polymersomes have microscopically visible internal aqueous pockets that encapsulate TTX with an encapsulation efficiency of up to 94%. Moreover, the polymersomes are structurally stable, enabling sustained TTX release. In vivo, the freshly prepared EIP/TTX formulation can be directly injected and increased the tolerated dose of TTX in Sprague-Dawley rats to 11.5 μg without causing any TTX-related systemic toxicity. In the presence of the chemical penetration enhancer (CPE) sodium octyl sulfate (SOS), a single perineural injection of EIP/TTX/SOS formulation produced a reliable sciatic nerve block for 22 days with minimal local toxicity.
Collapse
Affiliation(s)
- Xiaosi Li
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Qi Li
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Shenghan Song
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Amy O. Stevens
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Zach Broemmel
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
| | - Yi He
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM 87131, USA
- Translational Informatics Division, Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87131, USA
| | - Ursula Wesselmann
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, and Department of Neurology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Tony Yaksh
- Department of Anesthesiology, University of California at San Diego, La Jolla, CA 92093, USA
| | - Chao Zhao
- Department of Chemical and Biological Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
- Center for Convergent Biosciences and Medicine, University of Alabama, Tuscaloosa AL 35487
- Alabama Life Research Institute, University of Alabama, Tuscaloosa AL 35487
| |
Collapse
|