Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review

Drugs ◽  
2018 ◽  
Vol 78 (3) ◽  
pp. 339-354 ◽  
Author(s):  
Arnaud Steyaert ◽  
Patricia Lavand’homme
Keyword(s):  
Narrative Review ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Prevention And Treatment

scholarly journals Transition from Acute to Chronic Pain: Evaluating Risk for Chronic Postsurgical Pain

2019 ◽  
Vol 5 (22;5) ◽  
pp. 479-488
Author(s):  
Jingping Wang
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Predictive Models ◽  
Narrative Review ◽  
Current Understanding ◽  
Anesthetic Techniques ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Pain Sensitization ◽  
Underlying Pathophysiology

Background: The pathophysiology of pain involves complex nervous system interactions after initial noxious stimuli. When stimuli persist, biochemical and structural changes occur in the nociceptive pathways of the central and peripheral nervous systems, leading to pain sensitization. Peripheral and central sensitization are key in the transition from acute to chronic pain. This development of chronic pain is particularly common following various surgical procedures, with many postsurgical patients experiencing persistent pain for significant periods. Chronic pain is a common and severe complication of surgery, and preventing its development is tantamount in improving patient outcomes. Objectives: To understand underlying pathophysiology of chronic postsurgical pain (CPSP) and the underlying risk factors predisposing the transition from acute to CPSP. To review our ability to identify patients at highest risk for the development CPSP. To identify evidence-based multimodal approaches that can aid in the prevention of CPSP. Study Design: Narrative review of peer-reviewed literature. Setting: Inpatient surgical centers. Methods: Medline and Cochrane databases were reviewed to identify publications relevant to CPSP pathophysiology, risk factors, predictive models, and prevention. Publications were selected based on author expertise to summarize our current understanding of CPSP. Results: This review presents our current understanding of CPSP in the following domains: underlying pathophysiology, predisposing risk factors, predictive models of CPSP, and preventative strategies. Each section provides a structured review of key evidence base to understand the complex topic of CPSP. Limitations: This narrative review is a nonsystematic review of relevant publications aimed at presenting succinct overview of CPSP. Conclusions: The incidence of CPSP can potentially be reduced through early identification of perioperative, genetic, physiologic, and psychologic factors. Models predicting the development of CPSP continue to improve and may help focus preventative efforts in patients at highest risk. There is a growing body of evidence supporting the use of multimodal analgesia and anesthetic techniques in the reducing rates of CPSP development. Key words: Acute pain, chronic postsurgical pain, pain sensitization, chronic pain prevention, regional anesthesia, pain adjuncts, neuraxial anesthesia, chronic pain risk factors

scholarly journals Modulation of Gut Microbiota for the Prevention and Treatment of COVID-19

2021 ◽  
Vol 10 (13) ◽  
pp. 2903
Author(s):  
Jiezhong Chen ◽  
Luis Vitetta
Keyword(s):  
Clinical Trials ◽  
Trace Elements ◽  
Gut Microbiota ◽  
Human Health ◽  
Intestinal Microbiota ◽  
Narrative Review ◽  
Bacterial Metabolites ◽  
Gut Dysbiosis ◽  
Prevention And Treatment

The gut microbiota is well known to exert multiple benefits on human health including protection from disease causing pathobiont microbes. It has been recognized that healthy intestinal microbiota is of great importance in the pathogenesis of COVID-19. Gut dysbiosis caused by various reasons is associated with severe COVID-19. Therefore, the modulation of gut microbiota and supplementation of commensal bacterial metabolites could reduce the severity of COVID-19. Many approaches have been studied to improve gut microbiota in COVID-19 including probiotics, bacterial metabolites, and prebiotics, as well as nutraceuticals and trace elements. So far, 19 clinical trials for testing the efficacy of probiotics and synbiotics in COVID-19 prevention and treatment are ongoing. In this narrative review, we summarize the effects of various approaches on the prevention and treatment of COVID-19 and discuss associated mechanisms.

The different mechanisms of peripheral and central TLR4 on chronic postsurgical pain in rats

2021 ◽  
Author(s):  
Xuemin Han ◽  
Jinping Shao ◽  
Xiuhua Ren ◽  
Yaru Li ◽  
Wenli Yu ◽  
...  
Keyword(s):  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nina Graf ◽  
Katharina Geißler ◽  
Winfried Meißner ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Postsurgical Pain ◽  
Average Pain Intensity ◽  
Chronic Postsurgical Pain ◽  
Average Pain ◽  
Patients At Risk ◽  
Perioperative Assessment ◽  
Numeric Rating

AbstractData on chronic postsurgical pain (CPSP) after otorhinolaryngological surgery are sparse. Adult in-patients treated in 2017 were included into the prospective PAIN OUT registry. Patients’ pain on the first postoperative day (D1), after six months (M6) and 12 months (M12) were evaluated. Determining factor for CPSP was an average pain intensity ≥ 3 (numeric rating scale 0–10) at M6. Risk factors associated with CPSP were evaluated by univariate and multivariate analyses. 10% of 191 included patients (60% male, median age: 52 years; maximal pain at D1: 3.5 ± 2.7), had CPSP. Average pain at M6 was 0.1 ± 0.5 for patients without CPSP and 4.2 ± 1.2 with CPSP. Average pain with CPSP still was 3.7 ± 1.1 at M12. Higher ASA status (Odds ratio [OR] = 4.052; 95% confidence interval [CI] = 1.453–11.189; p = 0.007), and higher minimal pain at D1 (OR = 1.721; CI = 1.189–2.492; p = 0.004) were independent predictors of CPSP at M6. Minimal pain at D1 (OR = 1.443; CI = 1.008–2.064; p = 0.045) and maximal pain at M6 (OR = 1.665; CI = 1.340–2.069; p < 0.001) were independent predictors for CPSP at M12. CPSP is an important issue after otorhinolaryngological surgery. Better instrument for perioperative assessment should be defined to identify patients at risk for CPSP.

The Associations Between Severity of Early Postoperative Pain, Chronic Postsurgical Pain and Plasma Concentration of Stable Nitric Oxide Products After Breast Surgery

2006 ◽  
Vol 103 (4) ◽  
pp. 995-1000 ◽  
Author(s):  
Gabriella Iohom ◽  
Hamza Abdalla ◽  
James O??Brien ◽  
Szilvia Szarvas ◽  
Vivienne Larney ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Plasma Concentration ◽  
Postoperative Pain ◽  
Breast Surgery ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain
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