Chronic pain after surgery. More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture, Dr Bill Macrae discusses the magnitude of the problem.
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
Regional Anesthesia in the Prevention of Persistent Postsurgical PainEdward R. Mariano, MD
Persistent postsurgical pain (PPSP), or chronic pain that develops after surgery, occurs more frequently than one may expect: up to 50% after relatively common operations. For anesthesiologists, surgeons, and pain physicians, there is an urgent need to discover methods to prevent the development of PPSP which is considered one of the more dreaded adverse outcomes following elective surgery.
Acute pain management requires a multimodal and multidisciplinary approach with a clear organization framework. Regional anesthesia techniques for surgical anesthesia are a highly effective component of acute pain management.
With the advancement of ultrasonographic technology with higher resolution and penetration imaging, there is increasing use of ultrasonography (US) in acute and chronic pain blocks.
Chronic pain after surgery. More than just a nuisance?
Chronic pain can complicate a third of even relatively minor surgical procedures with far-reaching consequences for patient and family. Why does it happen? What can be done to mitigate the problem?
A seminar in three movements held jointly with the Glasgow Southern Medical Society:
'Magnitude' Dr William Macrae, Dundee
'Molecules' Dr Mick Serpell, Glasgow
'Meaning' Dr David Craig, Glasgow
In this lecture, Dr Bill Macrae discusses the magnitude of the problem.
CPSP is a new emerging disease but can be a silent epidemic.
Optimal perioperative management may reduce the incidence of CPSP.
Minimal invasive surgical techniques
Agressive perioperative multimodal analgesia, inluding epidural or nerve blocks.
Appropriate management of acute pain is therefore not only a humane obligation, but also may prevent of chronic pain!
Regional Anesthesia in the Prevention of Persistent Postsurgical PainEdward R. Mariano, MD
Persistent postsurgical pain (PPSP), or chronic pain that develops after surgery, occurs more frequently than one may expect: up to 50% after relatively common operations. For anesthesiologists, surgeons, and pain physicians, there is an urgent need to discover methods to prevent the development of PPSP which is considered one of the more dreaded adverse outcomes following elective surgery.
Acute pain management requires a multimodal and multidisciplinary approach with a clear organization framework. Regional anesthesia techniques for surgical anesthesia are a highly effective component of acute pain management.
With the advancement of ultrasonographic technology with higher resolution and penetration imaging, there is increasing use of ultrasonography (US) in acute and chronic pain blocks.
While anesthesiologists globally have had similar interests over the years, the unifying challenge continues to be the selection of outcomes and demonstration of improvement due to the anesthesiologist’s role and/or choice of anesthetic or analgesic technique.
Knee replacement is one of the most commonly performed operations in the United States with over 700,000 procedures performed annually. In 2012, the American Society of Anesthesiologists (ASA) published its guidelines for acute pain management in the perioperative setting. This document recommends “multimodal analgesia” which means that two or more classes of pain medications or therapies, working with different mechanisms of action, should be used in the treatment of acute pain. The ASA also strongly recommends the use of regional analgesic techniques as part of the multimodal analgesic protocol when indicated.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
ESP block - future direction and remaining questionsAmit Pawa
This Talk was delivered by Dr Pawa on 5th June 2021 as part of the ISURA 2021 hybrid conference held in Toronto.
The Future Direction of this block and remaining questions to be answered are covered here
Get Rid of Your Traditional Acute Pain Service and Broaden Your Vision!Edward R. Mariano, MD
Our biggest challenge (and also opportunity) is to demonstrate our value as anesthesiologists and pain medicine specialists in the evolving healthcare landscape. Going forward, physician anesthesiologists need to take on leadership roles in coordinating patient care, including by not limited to pain medicine, by collaborating with primary care, surgery, nursing, physical therapy, pharmacy, social work, and other hospital-based services.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
Update on regional anesthesia for breast surgery - Michael Herrick - SSAI2017scanFOAM
A talk by Michael Herrick at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Effectiveness and safety of CPNB and continuous local wound infusion
Basal infusion with PCA option
Types of pumps – elastomeric vs. electronic
Outpatient and home infusion pumps
At the conclusion of this activity, learners will be able to: discuss the benefits of regional anesthesia on pain and rehabilitative outcomes; identify applications of “big data” in outcomes assessment; and critically evaluate the evidence related to regional anesthesia and analgesia and long-term outcomes.
Pain Physicians should consider nerve blocks when systemic analgesics are failing. (Adjuvant therapy)
Careful selection of patients
Benefits should outweigh the risks
Thorough knowledge of the limitations and side effects
Need for randomized controlled clinical trials.
While anesthesiologists globally have had similar interests over the years, the unifying challenge continues to be the selection of outcomes and demonstration of improvement due to the anesthesiologist’s role and/or choice of anesthetic or analgesic technique.
Knee replacement is one of the most commonly performed operations in the United States with over 700,000 procedures performed annually. In 2012, the American Society of Anesthesiologists (ASA) published its guidelines for acute pain management in the perioperative setting. This document recommends “multimodal analgesia” which means that two or more classes of pain medications or therapies, working with different mechanisms of action, should be used in the treatment of acute pain. The ASA also strongly recommends the use of regional analgesic techniques as part of the multimodal analgesic protocol when indicated.
Total knee replacement (TKR) is one of the most commonly done surgical procedures, with over 150,000 total knee replacements and THR performed annually in England and Wales in the National Health Service (NHS). In India although clear-cut data is not available but the incidence is increasing. In the US, 431,000 TKRs are performed yearly and the utilization of TKR has increased over the last two decades, especially among younger patients .TKR may be associated with severe post-operative pain. The International Association for the Study of Pain (IASP) has defined pain as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made adequate pain management a priority and has deemed monitoring pain as the “fifth” vital sign.
ESP block - future direction and remaining questionsAmit Pawa
This Talk was delivered by Dr Pawa on 5th June 2021 as part of the ISURA 2021 hybrid conference held in Toronto.
The Future Direction of this block and remaining questions to be answered are covered here
Get Rid of Your Traditional Acute Pain Service and Broaden Your Vision!Edward R. Mariano, MD
Our biggest challenge (and also opportunity) is to demonstrate our value as anesthesiologists and pain medicine specialists in the evolving healthcare landscape. Going forward, physician anesthesiologists need to take on leadership roles in coordinating patient care, including by not limited to pain medicine, by collaborating with primary care, surgery, nursing, physical therapy, pharmacy, social work, and other hospital-based services.
This presentation was delivered during a webinar held by the association of anaesthetists in association with RA-UK entitled "New Blocks - Friend or Foe?".
This took place on 19th October 2021.
In this short presentation - Dr Pawa covers: a brief overview of the history of Paravertebral blocks; how he got introduced to them; some updates on our understanding on the anatomy; and whether they still have a role in modern anaesthetic practice.
Update on regional anesthesia for breast surgery - Michael Herrick - SSAI2017scanFOAM
A talk by Michael Herrick at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Effectiveness and safety of CPNB and continuous local wound infusion
Basal infusion with PCA option
Types of pumps – elastomeric vs. electronic
Outpatient and home infusion pumps
At the conclusion of this activity, learners will be able to: discuss the benefits of regional anesthesia on pain and rehabilitative outcomes; identify applications of “big data” in outcomes assessment; and critically evaluate the evidence related to regional anesthesia and analgesia and long-term outcomes.
Pain Physicians should consider nerve blocks when systemic analgesics are failing. (Adjuvant therapy)
Careful selection of patients
Benefits should outweigh the risks
Thorough knowledge of the limitations and side effects
Need for randomized controlled clinical trials.
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION THERAPY IN TEMPOROMANDIBULAR DISO...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
The Anesthesiologist, especially young, faces a major challenge when faced with very ill/ severly moribund, elderly, cachwexic patients with history of fall and lower extremity fractures for elective or ortho surgical procedure. Prof. mridul m. panditrao, explains various problems faced especially with GA, and the best alternatives. Two different approaches of Combined spinal epidual are discussed, with use of adjuvants and also his own randomizede trial and experience.
To improving postoperative pain management, we need to;
- Always applies multi-modal analgesia. (get the advantages of multimodal analgesia)
- Implementation of the existing EB regarding the use of non-opioid + opioid on as needed basis.
- Use available specific evidence for optimizing multimodal pain management procedure (PROSPECT Web site).
Sternal Fractures & Dislocations - EMGuidewire Radiology Reading RoomSean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Sternal Fractures and Dislocations and is brought to you by Carrie Bissell, MD, Aaron Fox, MD, Kendrick Lim, MD, Stephanie Jensen, MD, and Olivia Rice, MD. It is has special guest editor: Sean Dieffenbaugher, MD and Laurence Kempton, MD
ALKAMAGIC PLAN 1350.pdf plan based of door to door delivery of alkaline water...rowala30
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Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
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DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
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Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
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Feeding plate for a newborn with Cleft Palate.pptxSatvikaPrasad
A feeding plate is a prosthetic device used for newborns with a cleft palate to assist in feeding and improve nutrition intake. From a prosthodontic perspective, this plate acts as a barrier between the oral and nasal cavities, facilitating effective sucking and swallowing by providing a more normal anatomical structure. It helps to prevent milk from entering the nasal passage, thereby reducing the risk of aspiration and enhancing the infant's ability to feed efficiently. The feeding plate also aids in the development of the oral muscles and can contribute to better growth and weight gain. Its custom fabrication and proper fitting by a prosthodontist are crucial for ensuring comfort and functionality, as well as for minimizing potential complications. Early intervention with a feeding plate can significantly improve the quality of life for both the infant and the parents.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
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Veterinary Diagnostics Market PPT 2024: Size, Growth, Demand and Forecast til...IMARC Group
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Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
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Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac Care
Chronic pain 2019
1. Colin J.L. McCartneyColin J.L. McCartney
MBChB PhD FCARCSI FRCA FRCPCMBChB PhD FCARCSI FRCA FRCPC
Professor and Chair of Anesthesiology and Pain MedicineProfessor and Chair of Anesthesiology and Pain Medicine
University of OttawaUniversity of Ottawa
Head of Anesthesiology and Pain MedicineHead of Anesthesiology and Pain Medicine
The Ottawa HospitalThe Ottawa Hospital
Scientist, Ottawa Hospital Research InstituteScientist, Ottawa Hospital Research Institute
Chronic Pain after Surgery:Chronic Pain after Surgery:
Does it matter and can weDoes it matter and can we
prevent it?prevent it?
3. Objectives (40 mins)Objectives (40 mins)
Understand incidence of CPSP (10 mins)Understand incidence of CPSP (10 mins)
Who are the populations at risk? (10 mins)Who are the populations at risk? (10 mins)
What new approaches exist for preventingWhat new approaches exist for preventing
CPSP? (15 mins)CPSP? (15 mins)
What does the future hold? (15 mins)What does the future hold? (15 mins)
4. SummarySummary
Chronic pain is a $10 billion burden perChronic pain is a $10 billion burden per
year to Canadian Health Careyear to Canadian Health Care
CPSP defined as pain >2 months afterCPSP defined as pain >2 months after
surgerysurgery
312 million major surgical procedures per312 million major surgical procedures per
year worldwideyear worldwide
1 year incidence of CPSP 12-22%1 year incidence of CPSP 12-22%
20% of adults and 17% children at pain20% of adults and 17% children at pain
clinics have CPSPclinics have CPSP
5. SummarySummary
CPSP common and varies by type of surgeryCPSP common and varies by type of surgery
Preoperative pain and psychological factorsPreoperative pain and psychological factors
major predictorsmajor predictors
Prevention possible with high qualityPrevention possible with high quality
perioperative pain relief including LA techniques,perioperative pain relief including LA techniques,
NMDA antagonists and surgical approachNMDA antagonists and surgical approach
Future management possibilities include novelFuture management possibilities include novel
therapeutic, psychological andtherapeutic, psychological and
pharmacogenomic approachespharmacogenomic approaches
6.
7.
8. Incidence ofIncidence of
Chronic Post-Surgical PainChronic Post-Surgical Pain
Pain after surgery of primary concern toPain after surgery of primary concern to
patients (Apfelbaum et al 1999)patients (Apfelbaum et al 1999)
Acute postoperative pain remainsAcute postoperative pain remains
undertreatedundertreated
Incidence of severe acute pain a problemIncidence of severe acute pain a problem
Severe acute pain associated with CPSPSevere acute pain associated with CPSP
Definition: pain >2 months after surgeryDefinition: pain >2 months after surgery
11. 300 patients300 patients
2/3 had moderate-severe pain after2/3 had moderate-severe pain after
surgerysurgery
No change from 10 years earlierNo change from 10 years earlier
Gan TJ et al CMRO 2014
19. Systematic review. 281 studies assessedSystematic review. 281 studies assessed
investigating PSPS in 11 surgical typesinvestigating PSPS in 11 surgical types
Prevalence of NeuP determined using NeuPPrevalence of NeuP determined using NeuP
grading systemgrading system
Prevalence of NeuP high after thoracic andPrevalence of NeuP high after thoracic and
breast surgery (66/68%). 31% after groin herniabreast surgery (66/68%). 31% after groin hernia
repair and 6% after THA and TKArepair and 6% after THA and TKA
Prevalence of PneuP varies by type of surgeryPrevalence of PneuP varies by type of surgery
and probability of nerve injuryand probability of nerve injury
20. >200 patients with MSK trauma>200 patients with MSK trauma
Testing at baseline and 4 months after injuryTesting at baseline and 4 months after injury
Injury severity, pain, anxiety, depression andInjury severity, pain, anxiety, depression and
PTSDPTSD
21% moderate to severe pain at baseline and21% moderate to severe pain at baseline and
11% at 4 months11% at 4 months
High prevalence of neuropathic painHigh prevalence of neuropathic pain
Neuropathic pain poorly managed in-hospitalNeuropathic pain poorly managed in-hospital
22. Risk Factors for CPSP?Risk Factors for CPSP?
Preoperative: Pain, Repeat surgery,Preoperative: Pain, Repeat surgery,
Psychological factors, Female gender andPsychological factors, Female gender and
younger age, Genetic predispositionyounger age, Genetic predisposition
Intraoperative: Surgical approach andIntraoperative: Surgical approach and
risks of nerve injuryrisks of nerve injury
Postoperative: Acute Pain, Radiation Rx,Postoperative: Acute Pain, Radiation Rx,
Neurotoxic chemotherapy, Anxiety andNeurotoxic chemotherapy, Anxiety and
Depression, NeuroticismDepression, Neuroticism
McIntyre et al 2010
23. What can we do about theWhat can we do about the
problem?problem?
Regional anesthesia techniquesRegional anesthesia techniques
Systemic drug interventionsSystemic drug interventions
Modified surgical techniquesModified surgical techniques
Focus on postoperative pain controlFocus on postoperative pain control
24. Case: Patient with two TKA proceduresCase: Patient with two TKA procedures
26. 23 RCTs in total23 RCTs in total
Pooled 3 studies for epidural afterPooled 3 studies for epidural after
thoracotomy and 2 for PVB after breastthoracotomy and 2 for PVB after breast
surgerysurgery
Unable to pool data from other studies dueUnable to pool data from other studies due
to marked heterogeneityto marked heterogeneity
33. No long term benefit for:No long term benefit for:
– GabapentinGabapentin
– PregabalinPregabalin
– NSAIDSNSAIDS
– CorticosteroidsCorticosteroids
– MexilitineMexilitine
2013 Cochrane Collaboration
45. Preoperative painPreoperative pain
Pain catastrophizingPain catastrophizing
Mental healthMental health
Pain at other sitesPain at other sites
52. Genetics of PainGenetics of Pain
3 variants (haplotypes) of gene encoding3 variants (haplotypes) of gene encoding
COMT predicting low, moderate and highCOMT predicting low, moderate and high
sensitivity to painsensitivity to pain
Encompass 96% of humansEncompass 96% of humans
Low COMT levels predict high painLow COMT levels predict high pain
sensitivity and risk of developing TMDsensitivity and risk of developing TMD
Inhibition of COMT in rat model increasesInhibition of COMT in rat model increases
pain sensitivitypain sensitivity
Diatchenko L et al 2005
53. CPSP is likely 50% influenced by geneticCPSP is likely 50% influenced by genetic
determinantsdeterminants
Identifying genetic basis of CPSP couldIdentifying genetic basis of CPSP could
lead to significant improvement inlead to significant improvement in
treatmenttreatment
Prediction of CPSP, PharmacogenomicsPrediction of CPSP, Pharmacogenomics
Improved treatmentsImproved treatments
CJA 2015
54. Novel neuroactive agentsNovel neuroactive agents
Not analgesic per seNot analgesic per se
Prevent mechanism of transition to chronicPrevent mechanism of transition to chronic
painpain
rhBDNF, neuroprotective agents (e.g.rhBDNF, neuroprotective agents (e.g.
acetyl l-carnitine) and anti-oxidantsacetyl l-carnitine) and anti-oxidants
Early promising resultsEarly promising results
Bordet T et al Neurotherapeutics 2009
55. SummarySummary
CPSP common and varies by type of surgeryCPSP common and varies by type of surgery
Preoperative pain and psychological factorsPreoperative pain and psychological factors
major predictorsmajor predictors
Prevention possible with high qualityPrevention possible with high quality
perioperative pain relief including LA techniquesperioperative pain relief including LA techniques
and NMDA antagonists and surgical approachand NMDA antagonists and surgical approach
Future management possibilities include novelFuture management possibilities include novel
therapeutic, psychological andtherapeutic, psychological and
pharmacogenomic approachespharmacogenomic approaches
56. Good Acute Pain Control MajorGood Acute Pain Control Major
Concern for PatientsConcern for Patients
Apfelbaum et al A&A 2003
57. Acute pain controlAcute pain control
Use regional anesthesia where possibleUse regional anesthesia where possible
Use NSAIDS, paracetamol in multimodalUse NSAIDS, paracetamol in multimodal
regimenregimen
For higher risk cases use ketamine and/orFor higher risk cases use ketamine and/or
lidocaine infusion during surgerylidocaine infusion during surgery
Gabapentin/Pregabalin useful for acuteGabapentin/Pregabalin useful for acute
pain control and reduction of opioidpain control and reduction of opioid
consumptionconsumption
60. Transitional Pain ServiceTransitional Pain Service
Pre-operative review, acute postoperativePre-operative review, acute postoperative
and long-term follow upand long-term follow up
Patients identified early and referredPatients identified early and referred
Co-ordinated care by pain physicians,Co-ordinated care by pain physicians,
psychologists, physiotherapists andpsychologists, physiotherapists and
advanced practice nursesadvanced practice nurses
Bypasses long wait times for chronic painBypasses long wait times for chronic pain
clinicclinic
61. Risk of Developing PersistentRisk of Developing Persistent
Opioid Use after Major SurgeryOpioid Use after Major Surgery
Soneji N et al JAMA Surg 2016
62. Epidemiology better understoodEpidemiology better understood
Literature still hampered by varying definitionsLiterature still hampered by varying definitions
and types of painand types of pain
Shift in attitude occurring: transitional painShift in attitude occurring: transitional pain
programprogram
Better research developing from centres ofBetter research developing from centres of
excellenceexcellence