Chronic postsurgical pain: current evidence for prevention and management
| Autor: | Pramote Euasobhon, Parineeta Thapa |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Chronic pain Review Article Neuropathic pain Transcutaneous electrical nerve stimulation law.invention Postoperative pain 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law medicine Ketamine Intensive care medicine Physical therapy modalities business.industry Incidence Prevention Perioperative medicine.disease Pain management Neuromodulation (medicine) Cognitive behavioral therapy Anesthesiology and Pain Medicine Therapeutic methods Operative surgical procedure Intractable pain Drug therapy business 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | The Korean Journal of Pain |
| ISSN: | 2093-0569 2005-9159 |
| DOI: | 10.3344/kjp.2018.31.3.155 |
| Popis: | Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients. |
| Databáze: | OpenAIRE |
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