This document discusses managing pain after surgery. It notes that persistent postsurgical pain is often overlooked and can be prevented. A multimodal approach using combinations of analgesics like opioids, NSAIDs, and nerve blocks can improve pain relief while reducing side effects from individual drugs. Identifying patients at risk of chronic pain and using multimodal acute pain management may decrease the risk of acute pain becoming persistent after surgery.
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).
postoperative pain assessment and managementpropofol2012
This document provides an overview of acute postoperative pain assessment and management. It defines pain and discusses pain assessment tools and the pathophysiology of pain. It outlines the objectives of treating pain, barriers to effective pain management, and complications of unrelieved pain. Different analgesic drugs are described including opioids, paracetamol, NSAIDs, and NMDA receptor antagonists. Methods of drug administration and non-pharmacological pain management methods are also summarized. Assessment of pain in critical care settings is discussed.
1) The document discusses the history and modern understanding of pain physiology and management of postoperative pain. It describes how pain was originally thought to be outside the body but is now understood as a physical sensation processed in the nervous system.
2) Postoperative pain has acute causes from incisions and procedures as well as referred pain, and poorly managed pain can impair recovery. A multimodal approach using combinations of analgesics like paracetamol, NSAIDs, and opioids along with local anesthetics and nerve blocks is recommended.
3) Patient-controlled analgesia allows patients to self-administer opioids within safe limits and provides effective pain relief. Preemptive analgesia aims to prevent central sensitization by treating pain before and
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
The document discusses the use of anti-inflammatory drugs for postoperative pain management. It provides conclusions from several studies on nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. The studies found that NSAIDs and COX-2 inhibitors provided effective postoperative pain relief when used as part of a multimodal analgesic regimen. Specifically, dexamethasone, ketorolac, parecoxib, celecoxib, and rofecoxib reduced postoperative pain and opioid consumption with few side effects when administered before or after surgery. The document concludes that anti-inflammatory drugs are a valuable adjuvant for multimodal postoperative pain management.
A 32-year-old pregnant woman at 29 weeks gestation presents to the ER with sudden onset of severe right flank pain radiating to her back and groin, associated with nausea and increased urination.
On examination, her vital signs are stable. The fetal heart sound is normal and there is no vaginal bleeding. Preliminary tests have been ordered.
The document discusses evaluating and treating pain using analgesics like paracetamol, NSAIDs, opioids, and adjuvants depending on the intensity of pain. Regional anesthesia techniques are also described.
For this pregnant patient, the document recommends treating her pain with paracetamol, NSAIDs initially given her gestational age and pain description. Close monitoring
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).
postoperative pain assessment and managementpropofol2012
This document provides an overview of acute postoperative pain assessment and management. It defines pain and discusses pain assessment tools and the pathophysiology of pain. It outlines the objectives of treating pain, barriers to effective pain management, and complications of unrelieved pain. Different analgesic drugs are described including opioids, paracetamol, NSAIDs, and NMDA receptor antagonists. Methods of drug administration and non-pharmacological pain management methods are also summarized. Assessment of pain in critical care settings is discussed.
1) The document discusses the history and modern understanding of pain physiology and management of postoperative pain. It describes how pain was originally thought to be outside the body but is now understood as a physical sensation processed in the nervous system.
2) Postoperative pain has acute causes from incisions and procedures as well as referred pain, and poorly managed pain can impair recovery. A multimodal approach using combinations of analgesics like paracetamol, NSAIDs, and opioids along with local anesthetics and nerve blocks is recommended.
3) Patient-controlled analgesia allows patients to self-administer opioids within safe limits and provides effective pain relief. Preemptive analgesia aims to prevent central sensitization by treating pain before and
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
The document discusses the use of anti-inflammatory drugs for postoperative pain management. It provides conclusions from several studies on nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors. The studies found that NSAIDs and COX-2 inhibitors provided effective postoperative pain relief when used as part of a multimodal analgesic regimen. Specifically, dexamethasone, ketorolac, parecoxib, celecoxib, and rofecoxib reduced postoperative pain and opioid consumption with few side effects when administered before or after surgery. The document concludes that anti-inflammatory drugs are a valuable adjuvant for multimodal postoperative pain management.
A 32-year-old pregnant woman at 29 weeks gestation presents to the ER with sudden onset of severe right flank pain radiating to her back and groin, associated with nausea and increased urination.
On examination, her vital signs are stable. The fetal heart sound is normal and there is no vaginal bleeding. Preliminary tests have been ordered.
The document discusses evaluating and treating pain using analgesics like paracetamol, NSAIDs, opioids, and adjuvants depending on the intensity of pain. Regional anesthesia techniques are also described.
For this pregnant patient, the document recommends treating her pain with paracetamol, NSAIDs initially given her gestational age and pain description. Close monitoring
This document discusses acute pain management and preemptive analgesia. It defines pain and outlines the physiological responses to pain, including effects on the cardiovascular, respiratory, gastrointestinal, neuroendocrine, musculoskeletal and central nervous systems. It discusses different types of acute pain and factors that influence perioperative pain. The principles and rationale of multimodal analgesia and preemptive analgesia are explained. Various analgesic drugs and techniques are described, including opioids, non-opioids, regional anesthesia techniques, patient-controlled analgesia, and their applications in acute pain management.
This document discusses pain therapy and postoperative pain management. It defines pain and describes different types of pain like acute, chronic, and neuropathic pain. The goals of postoperative pain management are to reduce pain, improve quality of life, reduce morbidity, facilitate rapid recovery, and allow for early hospital discharge. Effective pain management can decrease complications, chronic pain, hospital stay, and costs while increasing patient satisfaction. Pain should be assessed using scales like VAS, VNR, and categorical scales. Both pharmacological treatments like acetaminophen, NSAIDs, opioids, and alpha-2 agonists as well as procedural approaches like regional anesthesia and local infiltration are discussed. Factors that influence analgesic requirements and safety information are also summarized.
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
Management of acute postoperative pain rcacareyesmd
The document discusses pain assessment and management. It defines pain and describes different types of acute pain. Pain is the fifth vital sign and should be properly assessed. Several self-report scales are presented to assess pain intensity. Preemptive analgesia aims to prevent pain sensitization by providing analgesia before a painful stimulus occurs. Multimodal analgesia using opioids, NSAIDs, and acetaminophen can provide effective pain relief while reducing opioid requirements and side effects. Patient-controlled analgesia safely allows patients to self-administer opioids. Special populations like neonates and the elderly require modified dosing approaches.
This document discusses pain management and common misconceptions about pain. It defines pain and describes pain assessment and different types of pain. Non-pharmacological and pharmacological pain management methods are outlined, including the WHO analgesic ladder and use of opioid and non-opioid medications. Side effects of pain medications are also summarized. Assessment tools for pain are listed along with why standardized scales are important for evaluating pain.
Lemessa Jira pain managment in surgical patient pptLemessa jira
This document outlines principles of pain management in surgical patients. It discusses the pathophysiology of pain, categories of pain including nociceptive, neuropathic and mixed pain. It describes tools for assessing pain such as word description, intensity scales, location, duration and aggravating/alleviating factors. Pharmacological management of surgical pain is discussed including the WHO analgesic ladder and non-opioid analgesics, opioid analgesics, local anesthetics and adjuvant drugs. Non-pharmacological approaches are also mentioned. Post-operative pain management is described depending on the extent of surgical trauma.
This document discusses key concepts in post-operative pain management. It defines types of pain and outlines consequences of poorly managed acute post-operative pain such as increased risk of chronic pain, medical complications, and decreased patient satisfaction. The document reviews various analgesic agents including acetaminophen, NSAIDs, opioids, local anesthetics, and the benefits of a multimodal approach. Regional anesthesia techniques like peripheral nerve blocks and epidural analgesia are presented as effective options for post-operative pain control.
Postoperative pain management is an essential component of surgical patient care. About 75% of surgical patients experience pain after a procedure. Effective pain control allows for early mobilization, reduced complications, and faster recovery. Postoperative pain arises from tissue damage during surgery and the subsequent inflammatory response. Both pharmacological and non-pharmacological methods can be used to treat postoperative pain, including opioids, NSAIDs, local anesthetics, and physical therapy. Proper assessment and an individualized treatment plan that utilizes a stepwise multimodal approach can provide pain relief and optimize patient outcomes.
Postoperative pain is harmful and leads to both acute and chronic negative effects if poorly controlled. A multimodal approach to pain management is recommended, utilizing both pharmacological and non-pharmacological techniques. This includes the use of opioids, non-opioid analgesics like NSAIDs and gabapentinoids, and regional analgesic techniques such as epidurals, peripheral nerve blocks, and trigger point injections to provide superior pain relief with fewer side effects than systemic opioids alone. The goal is to control pain and facilitate early recovery after surgery.
This document provides an overview of novel trends in pain management, including new drug targets, concepts, and medications. It begins with classifications of pain and theories of pain transmission and modulation. Traditional and novel drug targets for pain are discussed, including opioids, NSAIDs, cannabinoids, and ion channel modulators. Multimodal analgesia and targeted drug delivery are presented as novel concepts. Recently approved pain medications from 2010-2016 are also summarized.
This document provides information on pain management for internal medicine housestaff. It begins with definitions of pain from the International Association for the Study of Pain. It then covers the basic approach to pain management, including assessing the etiology, classifying pain types, clinically assessing pain, and treating pain. It discusses treating cancer pain specifically and provides guidelines on the WHO analgesic ladder for treating mild, moderate, and severe pain. It also covers adjuvant analgesics, opioid selection, routes of administration, and equianalgesic dosing of common opioids like morphine, oxycodone, fentanyl, hydromorphone, and methadone.
This document discusses pain management strategies for various types of pain. It provides an overview of acute and chronic pain, as well as specific types of pain like kidney stone pain, stent pain, and post-procedure pain. The document outlines an interdisciplinary approach to pain management using both drug and non-drug interventions. It emphasizes the importance of comprehensive pain assessment, treatment, and education of patients. Key goals are reducing acute pain, enhancing patient comfort, and preventing severe or long-term chronic pain.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
The document discusses neuropathic pain, defining it and differentiating it from other types of pain. It provides statistics on the prevalence of acute and chronic pain. Neuropathic pain is very common, affects 1 in 7 people in the UK, and has both acute and chronic time courses. It has a massive socioeconomic impact. Treatment involves multiple modalities including pharmacological, physical, and psychological approaches.
Acute pain management involves classifying pain and identifying its underlying cause. Treatment options include nonopioid medications like acetaminophen and NSAIDs, opioids, and adjuvant analgesics. Opioids are effective for moderate to severe acute pain but can cause adverse effects like respiratory depression, nausea, and constipation. Adjuvant analgesics like gabapentin, pregabalin, and ketamine may enhance opioid analgesia and reduce opioid requirements and side effects. Close monitoring is important when using opioids to manage acute pain.
This document discusses acute perioperative pain management. It defines pain and its classification, and explains why treating pain is important for patient outcomes and recovery. It covers pain assessment methods, non-pharmacological and pharmacological treatment options including the WHO analgesic ladder and multimodal analgesia. Specific pain medications like acetaminophen, NSAIDs, opioids, gabapentin and regional anesthesia techniques are described. Management of side effects and opioid overdose is also summarized.
This document discusses pain, including definitions, types of pain, assessment, and treatment options. It defines pain and differentiates between acute and chronic pain. It classifies pain as somatic, visceral, or neuropathic based on pathophysiologic mechanisms. Assessment involves self-report scales as well as behavioral and physiologic measures. Treatment options depend on the type of pain and include opioids, NSAIDs, and adjuvant analgesics.
Preventing pain from becoming chronic short1Painspecialist
1. Preventing acute pain from transitioning to chronic pain requires early intervention, as chronic pain is defined as persisting over 3 months and is associated with physiological and psychological changes.
2. Chronic pain poses therapeutic challenges and carries a large economic burden in terms of healthcare costs, lost productivity, and reduced quality of life.
3. Certain surgeries and medical conditions are associated with higher risks of developing chronic postsurgical pain, emphasizing the need for optimal acute pain management after such procedures.
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!
This document discusses acute pain management and preemptive analgesia. It defines pain and outlines the physiological responses to pain, including effects on the cardiovascular, respiratory, gastrointestinal, neuroendocrine, musculoskeletal and central nervous systems. It discusses different types of acute pain and factors that influence perioperative pain. The principles and rationale of multimodal analgesia and preemptive analgesia are explained. Various analgesic drugs and techniques are described, including opioids, non-opioids, regional anesthesia techniques, patient-controlled analgesia, and their applications in acute pain management.
This document discusses pain therapy and postoperative pain management. It defines pain and describes different types of pain like acute, chronic, and neuropathic pain. The goals of postoperative pain management are to reduce pain, improve quality of life, reduce morbidity, facilitate rapid recovery, and allow for early hospital discharge. Effective pain management can decrease complications, chronic pain, hospital stay, and costs while increasing patient satisfaction. Pain should be assessed using scales like VAS, VNR, and categorical scales. Both pharmacological treatments like acetaminophen, NSAIDs, opioids, and alpha-2 agonists as well as procedural approaches like regional anesthesia and local infiltration are discussed. Factors that influence analgesic requirements and safety information are also summarized.
This document discusses acute pain management in the emergency department. It begins with an introduction noting that pain is the most common presenting symptom in emergency departments, with over 60% of patients experiencing pain. It then focuses on defining acute pain and providing an overview of the pathophysiology of acute pain. The document also discusses common barriers to pain management in emergency settings, dos and don'ts of pain treatment, and strategies to improve pain management in the emergency department. It provides recommendations from international health organizations on patients' right to pain relief.
Management of acute postoperative pain rcacareyesmd
The document discusses pain assessment and management. It defines pain and describes different types of acute pain. Pain is the fifth vital sign and should be properly assessed. Several self-report scales are presented to assess pain intensity. Preemptive analgesia aims to prevent pain sensitization by providing analgesia before a painful stimulus occurs. Multimodal analgesia using opioids, NSAIDs, and acetaminophen can provide effective pain relief while reducing opioid requirements and side effects. Patient-controlled analgesia safely allows patients to self-administer opioids. Special populations like neonates and the elderly require modified dosing approaches.
This document discusses pain management and common misconceptions about pain. It defines pain and describes pain assessment and different types of pain. Non-pharmacological and pharmacological pain management methods are outlined, including the WHO analgesic ladder and use of opioid and non-opioid medications. Side effects of pain medications are also summarized. Assessment tools for pain are listed along with why standardized scales are important for evaluating pain.
Lemessa Jira pain managment in surgical patient pptLemessa jira
This document outlines principles of pain management in surgical patients. It discusses the pathophysiology of pain, categories of pain including nociceptive, neuropathic and mixed pain. It describes tools for assessing pain such as word description, intensity scales, location, duration and aggravating/alleviating factors. Pharmacological management of surgical pain is discussed including the WHO analgesic ladder and non-opioid analgesics, opioid analgesics, local anesthetics and adjuvant drugs. Non-pharmacological approaches are also mentioned. Post-operative pain management is described depending on the extent of surgical trauma.
This document discusses key concepts in post-operative pain management. It defines types of pain and outlines consequences of poorly managed acute post-operative pain such as increased risk of chronic pain, medical complications, and decreased patient satisfaction. The document reviews various analgesic agents including acetaminophen, NSAIDs, opioids, local anesthetics, and the benefits of a multimodal approach. Regional anesthesia techniques like peripheral nerve blocks and epidural analgesia are presented as effective options for post-operative pain control.
Postoperative pain management is an essential component of surgical patient care. About 75% of surgical patients experience pain after a procedure. Effective pain control allows for early mobilization, reduced complications, and faster recovery. Postoperative pain arises from tissue damage during surgery and the subsequent inflammatory response. Both pharmacological and non-pharmacological methods can be used to treat postoperative pain, including opioids, NSAIDs, local anesthetics, and physical therapy. Proper assessment and an individualized treatment plan that utilizes a stepwise multimodal approach can provide pain relief and optimize patient outcomes.
Postoperative pain is harmful and leads to both acute and chronic negative effects if poorly controlled. A multimodal approach to pain management is recommended, utilizing both pharmacological and non-pharmacological techniques. This includes the use of opioids, non-opioid analgesics like NSAIDs and gabapentinoids, and regional analgesic techniques such as epidurals, peripheral nerve blocks, and trigger point injections to provide superior pain relief with fewer side effects than systemic opioids alone. The goal is to control pain and facilitate early recovery after surgery.
This document provides an overview of novel trends in pain management, including new drug targets, concepts, and medications. It begins with classifications of pain and theories of pain transmission and modulation. Traditional and novel drug targets for pain are discussed, including opioids, NSAIDs, cannabinoids, and ion channel modulators. Multimodal analgesia and targeted drug delivery are presented as novel concepts. Recently approved pain medications from 2010-2016 are also summarized.
This document provides information on pain management for internal medicine housestaff. It begins with definitions of pain from the International Association for the Study of Pain. It then covers the basic approach to pain management, including assessing the etiology, classifying pain types, clinically assessing pain, and treating pain. It discusses treating cancer pain specifically and provides guidelines on the WHO analgesic ladder for treating mild, moderate, and severe pain. It also covers adjuvant analgesics, opioid selection, routes of administration, and equianalgesic dosing of common opioids like morphine, oxycodone, fentanyl, hydromorphone, and methadone.
This document discusses pain management strategies for various types of pain. It provides an overview of acute and chronic pain, as well as specific types of pain like kidney stone pain, stent pain, and post-procedure pain. The document outlines an interdisciplinary approach to pain management using both drug and non-drug interventions. It emphasizes the importance of comprehensive pain assessment, treatment, and education of patients. Key goals are reducing acute pain, enhancing patient comfort, and preventing severe or long-term chronic pain.
The document discusses pain management standards established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001. These standards require facilities to properly assess, treat, and manage patient pain. It also discusses the differences between PRN ("as-needed") medication, where patients receive pain medication as requested, versus around-the-clock (ATC) scheduled dosing. Previous studies have found that ATC dosing results in better pain relief and fewer barriers to patients receiving adequate pain treatment compared to PRN dosing. This quality improvement study similarly found that ATC dosing was associated with lower reported pain levels without increasing adverse events.
This document provides information on multimodal regiments for acute pain management. It discusses the goals of multimodal analgesia including reducing opioid use through additive or synergistic effects. Key points:
- Multimodal analgesia involves using two or more analgesics with different mechanisms to better treat multiple pain sources and reduce side effects.
- Postoperative pain involves peripheral and central sensitization, so multimodal regiments target both levels.
- Common regiments discussed include paracetamol, NSAIDs, COXIBs, ketamine, gabapentinoids, clonidine and opioids. Low dose ketamine and gabapentinoids are highlighted for their anti-hyperalgesic effects.
- Combining
The document provides an overview of pain management, defining pain, classifying different types of pain, discussing pain physiology and assessment tools, and outlining approaches for managing both acute and chronic pain, including non-pharmacological and pharmacological options following the WHO analgesic ladder. It emphasizes the importance of regular pain assessment and treatment according to the R-A-T framework of recognizing pain, assessing its cause and severity, and then treating it appropriately.
The document discusses neuropathic pain, defining it and differentiating it from other types of pain. It provides statistics on the prevalence of acute and chronic pain. Neuropathic pain is very common, affects 1 in 7 people in the UK, and has both acute and chronic time courses. It has a massive socioeconomic impact. Treatment involves multiple modalities including pharmacological, physical, and psychological approaches.
Acute pain management involves classifying pain and identifying its underlying cause. Treatment options include nonopioid medications like acetaminophen and NSAIDs, opioids, and adjuvant analgesics. Opioids are effective for moderate to severe acute pain but can cause adverse effects like respiratory depression, nausea, and constipation. Adjuvant analgesics like gabapentin, pregabalin, and ketamine may enhance opioid analgesia and reduce opioid requirements and side effects. Close monitoring is important when using opioids to manage acute pain.
This document discusses acute perioperative pain management. It defines pain and its classification, and explains why treating pain is important for patient outcomes and recovery. It covers pain assessment methods, non-pharmacological and pharmacological treatment options including the WHO analgesic ladder and multimodal analgesia. Specific pain medications like acetaminophen, NSAIDs, opioids, gabapentin and regional anesthesia techniques are described. Management of side effects and opioid overdose is also summarized.
This document discusses pain, including definitions, types of pain, assessment, and treatment options. It defines pain and differentiates between acute and chronic pain. It classifies pain as somatic, visceral, or neuropathic based on pathophysiologic mechanisms. Assessment involves self-report scales as well as behavioral and physiologic measures. Treatment options depend on the type of pain and include opioids, NSAIDs, and adjuvant analgesics.
Preventing pain from becoming chronic short1Painspecialist
1. Preventing acute pain from transitioning to chronic pain requires early intervention, as chronic pain is defined as persisting over 3 months and is associated with physiological and psychological changes.
2. Chronic pain poses therapeutic challenges and carries a large economic burden in terms of healthcare costs, lost productivity, and reduced quality of life.
3. Certain surgeries and medical conditions are associated with higher risks of developing chronic postsurgical pain, emphasizing the need for optimal acute pain management after such procedures.
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!
Option of interventional pain therapy in multimodal treatment of chronic cancer and non-cancer pain
Established role when pharmacotherapy or surgery not suitable
Indications well accepted
Evidence for efficacy moderate to strong
Gabapentin reduced acute pain after mastectomy and decreased the incidence of chronic pain in two studies. A single dose of gabapentin was ineffective for reducing thoracotomy pain when an epidural was also used. Regional anesthesia and intravenous lidocaine reduced chronic pain incidence after mastectomy or thoracotomy in several studies. Ketamine and intercostal cryoanalgesia did not reduce chronic pain. Total intravenous anesthesia may reduce post-thoracotomy pain in one study.
Inguinodynia by Prof. Ajay Khanna, IMS, BHU, Varanasi, India Divya Khanna
Chronic groin pain, known as inguinodynia, occurs in approximately 11% of patients after hernia surgery, with 1/3 of cases being severe enough to interfere with daily activities. This rate of chronic pain is more common than hernia recurrence. Prevention through careful identification and handling of nerves during surgery is important. For select patients who do not find relief through medications, surgical neurectomy combined with mesh removal provides relief from pain in 80-95% of cases. Proper patient selection and surgical technique are needed to minimize the risk of chronic pain after hernia repair.
Pain management and accelerated rehabilitation for total hip and knee arthrop...FUAD HAZIME
This article discusses improved pain management techniques and accelerated rehabilitation programs for total hip and knee arthroplasty. The key aspects of the discussed program include:
1. Regional anesthesia using spinal anesthesia supplemented with perioperative nerve blocks and local periarticular injections for multimodal pain control.
2. Preemptive analgesia beginning preoperatively to control pain from onset and minimize narcotic use postoperatively.
3. Accelerated rehabilitation programs enabled by adequate pain control, allowing some patients to begin rehabilitation on the day of surgery to reduce length of stay.
4. Ongoing research into longer-acting local injectable agents and improved periarticular injection cocktails for superior pain management.
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.
Fisiol e anat ponv.PONV anatomy and physiology,risk of Claudio Melloni
This document discusses risk factors for postoperative nausea and vomiting (PONV) from several studies. It identifies non-anesthetic factors like female gender, history of motion sickness or PONV, and anesthetic factors like use of volatile anesthetics, nitrous oxide, and opioids as increasing PONV risk. Surgical factors like longer duration and types of surgery also impact risk. A key study developed a PONV prediction model using logistic regression to calculate individual patient risks based on their characteristics and procedure. Understanding risk factors can help optimize PONV prevention and management.
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
This document discusses interventional pain management (IPM) as a specialty focused on diagnosing and treating pain through minimally invasive procedures. It provides an overview of common IPM procedures like diagnostic nerve blocks, radiofrequency ablation, vertebroplasty, and percutaneous discectomy. The document also presents four case studies where IPM procedures like epidurolysis, percutaneous discectomy, vertebroplasty, and radiofrequency rhizotomy successfully treated chronic pain when other options had failed. It concludes that contrary to common beliefs, over 85% of spinal pain causes can be accurately diagnosed through IPM procedures and that IPM can provide long-term relief when pharmacologic treatments and surgery are not suitable options.
- The document discusses the opioid crisis and its impact on perioperative care. It notes that acute pain after surgery remains undertreated for many patients, and severe acute pain can lead to chronic postsurgical pain.
- It recommends ways to help address this, including screening high-risk patients, using multimodal analgesia with regional anesthesia when possible, standardized opioid prescribing, and transitional pain programs to support patients after surgery.
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.
Positioning patients during spinal surgery can potentially cause neurological complications such as quadriplegia if excessive rotation, extension or flexion is applied to the head and neck, with older patients and those with cervical spondylosis being at higher risk; prevention techniques include awake positioning in neutral alignment, awake intubation, and neuromonitoring. Positioning may also potentially lead to peripheral nerve palsies, eye complications, or excessive bleeding if not done carefully.
Pain management after joint replacement surgeryPranav Bansal
The document discusses key concepts in pain management following hip and knee arthroplasty. It defines pain and discusses what patients want after surgery like mobility and pain management. It outlines the benefits of a multimodal approach using techniques like neuraxial blocks, peripheral nerve blocks, and local infiltration to provide good pain relief with fewer side effects than opioids alone. This multimodal, balanced approach can lead to early mobilization, recovery and discharge from the hospital.
This document outlines the design of an enhanced recovery pathway for hip fracture patients. It reviews evidence that preoperative peripheral nerve blocks provide better pain control and reduce complications. Neuraxial anesthesia like spinal anesthesia is shown to be superior to general anesthesia for hip fractures based on reduced mortality, length of stay, and complications. The pathway emphasizes multimodal analgesia, delirium prevention strategies, and multidisciplinary post-operative care to optimize outcomes for hip fracture patients.
This document discusses pain management in oncology. It begins by outlining the objectives of understanding cancer pain management principles, categorizing pain, optimizing analgesia, using adjuvant analgesics, and recognizing when interventional therapies could help. It then provides background on cancer prevalence in Ghana and the high rates of pain in cancer patients. The rest of the document details approaches to assessing and treating cancer pain, including pharmacological and non-pharmacological options. It emphasizes a stepwise approach using the WHO analgesic ladder and treating the specific cause and type of cancer pain.
The study prospectively analyzed data from over 17,000 ambulatory surgery patients to identify predictors of postoperative nausea and vomiting (PONV). Independent predictors included younger age, female sex, nonsmoking status, previous PONV, general anesthesia, longer duration of anesthesia, and certain types of surgery like plastic surgery. Patients who experienced PONV had longer recovery times. A validated mathematical model was developed to predict PONV risk based on these factors to help determine which patients need preventative antiemetics.
1. Managing Pain After
Surgery
Dr Yeo Sow Nam
Director, The Pain Specialist,
Mount Elizabeth Hospital &
Founder and Past Director, Pain
Management and Acupuncture
Services, Singapore General Hospital
MBBS (Singapore)
MMED (Anesthesiology, S’pore)
FANZCA (Anesthesiology, Aust/NZ)
FFPMANZCA (Pain Medicine,
Aust/NZ)
FAMS, Registered Acupuncturist
2. Sites and mechanisms responsible
for acute & chronic postsurgical pain
Kehlet H, et al. Lancet 2006;367:1618-1625.
1. Denervated Schwann cells and infiltrating macrophages distal tp nerve injury produce local and systemic chemicals that drive
pain signalling; 2. Neuroma at site of injury is source of ectopic spontaneous excitability; 3. Changes in gene expression in dorsal
root ganglion; 4. Central sensitization at dorsal horn; 5. Modulation of pain transmission at brainstem; 6. Contributions from limbic
system and hypothalamus; 7. Sensation of pain generated in cortex; 8. Genomic DNA predisposes (or not) to chronic pain
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3. Postoperative pain vs persistent
postsurgical pain
Patient 1- PoP
Severity of Pain
Patient 2- PoP + PPP
Surgery
Time
Acute- PoP Chronic- PPP
Persistent Postsurgical Pain (PPP) Postoperative Pain (PoP)
• Pain that persists beyond the usual course of • Pain resulting from the inflammation associated
healing and is neuropathic in nature with surgical intervention
• Pain is irresolvable and becomes chronic • Pain is resolvable and acute
through irreversible changes to the pain pathway • All surgical interventions result in the
• Incidence of PPP depends on surgery, intensity development of PoP
of PoP, and genetic factors
3
4. Risk factors for development of
persistent postsurgical pain1,2
1. Genetic susceptibility
2. Moderate to severe preoperative pain
3. Psychosocial factors
4. Age and sex
5. Poor surgical technique
6. Poorly controlled postoperative pain
1. Kehlet H, et al. Lancet 2006;367:1618-1625;
2. Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
4
5. Persistent postsurgical pain:
Manifestation of neuropathic pain
• Postsurgical chronic pain is the consequence
of either ongoing inflammation or, much
more commonly, a manifestation of
neuropathic pain resulting from surgical
injury to major peripheral nerves
– If nerves are injured during surgery, a
neuropathic component of the pain might develop
immediately and then persist in the absence of
any peripheral noxious stimulus or ongoing
peripheral inflammation. This pain, once
established, is likely to be resistant to COX-2
inhibitors.
Kehlet H, et al. Lancet 2006;367:1618-1625.
5
6. Persistent postsurgical pain:
Persistently overlooked
• Development of chronic postsurgical pain
may be the most overlooked negative sequel
of elective operations
– In the UK, surgery is the second most common
reason patients give for having developed chronic
neuropathic pain
• Patients who present for surgery are often
not told of this risk, and the surgeons and
anaesthesiologists caring for them may not
be aware of the prevalence of the problem
Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
6
7. Estimated incidence of chronic
postsurgical pain1,2
Estimated incidence Estimated incidence of Estimated US
of chronic severe (disabling) pain surgical volumes
postsurgical pain (1000s)
Inguinal hernia repair 10% 2–4% 600
Lower limb 30–50% 5–10% 160
amputation
Breast surgery 20–30% 5–10% 480
(lumpectomy or
mastectomy)
Thoracotomy 30–40% 10% 200
Total knee 12% 2–4% 550
arthroplasty
Coronary artery 30–50% 5–10% 598
bypass surgery
Caesarean section 10% 4% 220
1. Kehlet H, et al. Lancet 2006;367:1618-1625;
2. Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
7
8. Sub-optimal pain management
can have economic consequences
Re-admissions following day-care surgery
Other • Mean charges for
Surgical
17%
21% patients re-admitted
due to pain were
ADE $1,869 4,553 per
3% visit*
Medical
14% • 38% of patients re-
admitted for pain had
undergone
Bleeding
orthopaedic
Pain procedures
4%
38% N/V
3%
*Mean inpatient re-admissions for pain $13,902 11,732 per visit
ADE, adverse drug event
N/V, nausea/vomiting Coley et al. J Clin Anesth 2002;14:349.
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9. Persistent postsurgical pain:
Potential for prevention
• Avoidance of intraoperative nerve injury
– Careful dissection
– Reduction of inflammatory responses
– Use of minimally invasive surgical techniques
• Pre-emptive and aggressive multimodal
analgesia
– Afferent blockade, COX-2 inhibitors and opiates
to alleviate inflammatory pain
– Anti-neuropathic pain agents to prevent
neuropathic pain
Kehlet H, et al. Lancet 2006;367:1618-1625.
9
10. Multimodal analgesia: Rationale
• Although opioid-based patient-controlled analgesia
(PCA) is widely used as an effective method to control
postoperative pain, it is associated with a high
incidence of side effects, such as nausea, vomiting and
respiratory depression1,2
• In recent years, a multimodal approach based on the
combination of opioids and other adjuvant drugs (eg,
nonsteroidal anti-inflammatory drugs, ketamine, local
anesthetics and α2δ ligands) has been extensively
attempted to decrease opioid-related adverse effects1,3
1. Kim JC, et al. Spine 2011;36:428-433;
2. Grass JA, et al. Anesthesiology 1993;78:642-648;
3. White PF. Curr Opin Investig Drugs 2008;9:76-82.
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11. Multimodal analgesia
• Current state of the art in the management
of acute surgical pain
• Strategy utilizing two or more modalities from
the acute pain armamentarium to enhance
analgesia and/or minimize risk of side effects
• For multimodal analgesia to be maximized,
the modes of analgesia should be procedure-
and patient-specific
Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
11
12. Benefits of multimodal analgesia
Opioid • Decreased doses of each
analgesic
Potentiation • Improved anti-nociception
due to synergistic/additive
effects
Paracetamol
NSAIDs/coxibs
Α2δ ligands
• Decreased severity of side
Ketamine effects of each drug
Nerve blocks
Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758;
Kehlet H, Dahl JB. Anesth Analg 1993;77:1048-1056;
Playford RJ, et al. Digestion 1991;49:198-203.
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13. Pain sensitization by injury:
Hyperalgesia and allodynia
HYPERALGESIA Sensitized
pain response
10
Pain intensity Normal
8 for stimulus X: pain response
Sensitized
Pain intensity
pain response
6 Injury
Pain intensity
4 for stimulus X:
Normal
pain response
2
0
X
ALLODYNIA
Stimulus intensity
13
15. Prevention of persistent
postsurgical pain
Chronic postsurgical pain is a problem worldwide,
but it is often overlooked or minimized. Several
million patients each year may develop chronic
pain due to nerve injury sustained during surgery.
Identifying these patients and modeling a
multimodal acute pain management plan to
decrease the conversion of acute to chronic pain is
an important therapeutic goal.
Durkin B, et al. Expert Opin Pharmacother 2010;11:2751-2758.
15
16. Summary
• Postsurgical chronic pain is a problem worldwide, but it is
often overlooked or minimized
• Postsurgical chronic pain is the consequence of either
ongoing inflammation or, much more commonly, a
manifestation of neuropathic pain resulting from surgical
injury to major peripheral nerves
• Identifying these patients and modeling a multimodal acute
pain management plan to decrease the conversion of acute
to chronic pain is an important therapeutic goal
• Postsurgical chronic pain can be prevented by various ways
• Recently, a multimodal approach has been extensively
attempted to decrease opioid-related adverse effects
16