scholarly journals Pain mechanisms and management in corneal cross-linking: a review

2021 ◽  
Vol 6 (1) ◽  
pp. e000878
Author(s):  
Emilie Sophie van der Valk Bouman ◽  
Heather Pump ◽  
David Borsook ◽  
Boris Severinsky ◽  
Robert PL Wisse ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Clinical Care ◽  
Tear Film ◽  
Cross Linking ◽  
Common Procedure ◽  
Pain Mechanisms ◽  
Pain Outcomes ◽  
Pain Chronification ◽  
The Difference

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.

scholarly journals Big Data in Studying Acute Pain and Regional Anesthesia

2021 ◽  
Author(s):  
Lukas M. Müller-Wirtz ◽  
Thomas Volk
Keyword(s):  
Big Data ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Acute Pain ◽  
Management Strategies ◽  
Administrative Databases ◽  
Treatment Quality ◽  
Clinical Registries ◽  
Pain Outcomes ◽  
The Status

The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyzes have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, utilization of big data in acute pain and regional anesthesia research considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.

scholarly journals Big Data in Studying Acute Pain and Regional Anesthesia

2021 ◽  
Vol 10 (7) ◽  
pp. 1425
Author(s):  
Lukas M. Müller-Wirtz ◽  
Thomas Volk
Keyword(s):  
Big Data ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Acute Pain ◽  
Management Strategies ◽  
Administrative Databases ◽  
Treatment Quality ◽  
Clinical Registries ◽  
Pain Outcomes ◽  
The Status

The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyses have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, the utilization of big data in acute pain and regional anesthesia research has considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.

Key facts on moderate to severe acute pain combined treatment with tramadol and dexketoprofen at fixed doses

2020 ◽  
Vol 13 (3) ◽  
pp. 304-310
Author(s):  
Jarosław Woroń
Keyword(s):  
Quality Of Life ◽  
Treatment Adherence ◽  
Acute Pain ◽  
Pain Treatment ◽  
Combined Treatment ◽  
Physiological Changes ◽  
Physiological Mechanisms ◽  
Pain Mechanisms ◽  
Proven Efficacy

The development of pain is associated with numerous physiological mechanisms. Improper acute pain treatment significantly reduces the quality of life and leads to a number of physiological changes that adversely affect the general condition of the patient. In many cases, inadequate analgesic therapy results in the transition from acute to chronic pain. For this reason, it is extremely important to use drugs that synergistically affect various pain mechanisms. Combined preparations, including the combination of tramadol and dexketoprofen, are very effective. This combination has many advantages, including proven efficacy and tolerability, ensures better treatment adherence and is easy to administer.

scholarly journals FRI0412 DOES SEVERE ACUTE POSTOPERATIVE PAIN RESULT IN MORE LONG-TERM PAIN AFTER TOTAL HIP OR KNEE ARTHROPLASTY (THA OR TKA) FOR OSTEOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 805.2-805
Author(s):  
D. A. J. M. Latijnhouwers ◽  
C. H. Martini ◽  
R. G. H. H. Nelissen ◽  
H. M. J. Van der Linden ◽  
T. P. M. Vliet Vlieland ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Missing Values ◽  
Rating Scale ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Mixed Effect ◽  
Total Hip ◽  
Chronic Postsurgical Pain

Background:Chronic pain is a frequently reported unfavourable outcome of total hip and knee arthroplasties (THA/TKA) (7-23% and 10-34%, respectively) in osteoarthritis (OA) patients (1), which is difficult to treat as underlying mechanisms are not fully understood. Acute postoperative pain has been identified as risk factor for development of long-term pain in other surgical procedures, such as mastectomy and thoracotomy (2). However, the effect of acute postoperative pain on development of long-term pain in THA and TKA patients is unknown.Objectives:To investigate if acute pain following THA/TKA in OA patients is associated with long-term pain and if acute pain affects the course of pain up to 1-year postoperatively.Methods:From a longitudinal multicenter study, OA patients scheduled for primary THA or TKA were included. Acute pain scores, using Numeric Rating Scale (NRS), were routinely collected as part of standard care (≤72 hours after surgery). In case of ≥2 NRS scores the two highest scores were averaged (n=160), else the single score was taken. Pain was dichotomized into severe (NRS≥5) and mild (NRS<5). Pain was assessed preoperatively, at 3 (only THA), 6 and 12 months postoperatively using HOOS/KOOS subscale pain. Separate mixed-effect models for THA and TKA patients were used, with dichotomized acute pain as fixed-effect and long-term pain as outcome, while adjusting for confounders (age, sex, BMI, preoperative pain, mental component scale of the SF12 (MCS-12), and duration of the surgery and hospitalization). We included an interaction between time of measurement and acute postoperative pain to analyse whether effect modification was present. Missing values in preoperative pain and MCS-12 were imputed using multiple imputation methods.Results:81 THA and 87 TKA patients were included, of whom 32.1% and 56.3% reported severe acute pain. The results did not show an associated between severe acute pain and long term pain (THA: β=2.0, 95%-CI:-10.9-7.0; TKA: β=3.8, 95%-CI:-10.6-2.9). Furthermore, It seems that there is no effect present of difference in severity of acute pain and the course of pain over time (THA 6-months: β=6.4, 95%-CI:1.9-10.9 and 12-months: β=0.2, 95%-CI:-4.4-4.8; TKA 12-months: β=3.2, 95%-CI:-0.5-6.8).Conclusion:We did not find an association between acute pain and the development of long-term pain nor that severity of acute pain affects the course of postoperative pain in THA and TKA patients. The fact that THA and TKA patients often experience chronic preoperative pain might be a possible explanation for this finding. Nonetheless, future studies including additional measures of acute pain and pain sensitization in patients with chronic preoperative pain are necessary to draw stronger conclusions.References:[1]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open. 2012;2(1):e000435.[2]Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics. 2009;9(5):723-44.Acknowledgments:We would like to thank the study group that consists of: B.L. Kaptein, Leiden University Medical Center, Leiden; S.B.W Vehmeijer, Reinier de Graaf Hospital, Delft; R. Onstenk, Groene Hart Hospital, Gouda; S.H.M. Verdegaal, Alrijne Hospital, Leiderdorp; H.H. Kaptijn, LangeLand Hospital, Zoetermeer; W.C.M. Marijnissen, Albert Schweitzer Hospital, Dordrecht; P.J. Damen, Waterland Hospital, Hoorn; the NetherlandsDisclosure of Interests:None declared

scholarly journals Acute Pain Predictors of Remote Postoperative Pain Resolution After Hand Surgery

2021 ◽  
Author(s):  
Jennifer M. Hah ◽  
Chinwe A. Nwaneshiudu ◽  
Eric M. Cramer ◽  
Ian R. Carroll ◽  
Catherine M. Curtin
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Hand Surgery

scholarly journals Monopolar Diathermy Tonsillectomy Versus Dissection Method Tonsillectomy

KYAMC Journal ◽  
2019 ◽  
Vol 10 (1) ◽  
pp. 21-24
Author(s):  
Md Abdus Salam ◽  
Md Mahbub Alam ◽  
Rezwan Ahmed ◽  
Md Sultan Mahmud
Keyword(s):  
Postoperative Pain ◽  
Postoperative Bleeding ◽  
Throat Pain ◽  
Medical College ◽  
Advantages And Disadvantages ◽  
Case Surgery ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Dissection Method

Background: Tonsillectomy is one of the most common surgical procedures performed worldwide by otorhinolaryngologists for different indications. Tonsillectomy is often performed as day-case surgery, which increases the demands of a satisfactory postoperative pain control and a low risk of early postoperative bleeding. Objective: The aim of the study was to compare the Monopolar diathermy and Dissection methods of tonsillectomy and evaluate their advantages and disadvantages during surgery, convalescence. Materials and Methods: Two hundred children were recruited for this study during the period of five years from January, 2014 to December, 2018 at Otolaryngology department of Khwaja Yunus Ali Medical College and Hospital (KYAMCH). Subjects between the age of 5 and 25 years listed for tonsillectomy were included. Subjects were recommended not to have aspirin within the 2 weeks before surgery. Results: The mean duration of operation was found 10.6±0.4 minutes in group A and 17.0±0.7 minutes in group B. The difference was statistically significant (p<0.05) between two groups. At 1st day, 11(11.0%) patients had throat pain in group A and 23(23.0%) in group B. At 2nd day, 14(14.0%) patients had throat pain in group A and 25(25.0%) in group B. Which were statistically significant (p<0.05) between two groups. Conclusion: The monopolar diathermy tonsillectomy appears to cause less bleeding, postoperative pain and less time consuming in compare with the dissection tonsillectomy although patients experience slightly more pain than dissection Method. KYAMC Journal Vol. 10, No.-1, April 2019, Page 21-24

scholarly journals Pain therapy to reduce perioperative complications

2019 ◽  
Vol 4 (4) ◽  
pp. 158-166
Author(s):  
Stephan M. Freys ◽  
Esther Pogatzki-Zahn
Keyword(s):  
Postoperative Pain ◽  
Postoperative Complications ◽  
Adverse Events ◽  
Acute Pain ◽  
Surgical Procedure ◽  
Pain Therapy ◽  
Recovery Period ◽  
Acute Pain Therapy

AbstractThe incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

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