Preemptive Analgesia: Does it Prevent Chronic Pain?

Size: px
Start display at page:

Download "Preemptive Analgesia: Does it Prevent Chronic Pain?"

Transcription

1 Preemptive Analgesia: Does it Prevent Chronic Pain? Prof. Dr. Maged El-Ansary Al Azhar Univ. Al Azhar university, Cairo, Egypt 1. President of Egyptian Society for Regional Anesthesia & Pain Medicine 2.President of African Association for the Study of Pain, AASP 3. Former Council Member of International Association for the Study of Pain, IASP 4. Secretary General of Arab Union for Pain Management, AUPM

2 History Crile GW first described a possible relationship between intraoperative tissue damage and an intensification of acute pain and longterm postoperative pain, which is now referred to as central sensitization Clifford Woolf The evidence for a central component of post-injury pain hypersensitivity in experimental studies. Wall P Proposed the concept of pre-emptive preoperative analgesia 1. Crile GW. Austin A Man An Adaptive Mechanism. New York, NY, USA: The Macmillan Company; Wall PD. The prevention of postoperative pain. Pain. 1988;33: Woolf CJ. Evidence for a central component of post-injury pain hypersensitivity. Nature 1983;306:686 8

3 Introduction Pain is complex body reaction It is personal and individualized Patients undergoing a surgical procedure are predisposed to pain postoperative Pain due to: to noxious stimuli experience. 1. Pre-existing pain (acute and chronic) 2. Psychological fear of recurring additional pain 3. Neurovascular tissue damage from a prior operation 4. As well as the extent of the surgery can all contribute to major postoperative discomfort

4 Why To Relief Post Operative Pain? 5 Prof. M. El-ansary, Al-Azhar University Friday, October 09, 2015

5 6 Prof. M. El-ansary, Al-Azhar University Friday, October 09, 2015

6 Pain & Stress Pain Stress Response Infection 7 Prof. M. El-ansary, Al-Azhar University Friday, October 09, 2015

7 Pain & Stress Mechanisms of Stress Response Afferent Neural Stimuli Minor CNS ( Pain) Major CNS + Other Factors 1. Local Tissue Factors 2. Modifying Factors 8 Prof. M. El-ansary, Al-Azhar University Friday, October 09, 2015

8 Pain & Stress Stress Response Acute (Shock) Very Short (hrs) Hyperdynamic (Flow) Catabolic Hormones Anabolic Hormones Long (day- week) 9 Prof. M. El-ansary, Al-Azhar University Friday, October 09, 2015

9 Release of : Stress response to pain insulin, cortisol, catecholamine, and other hormons Resp. Dep Hypercoagulabilty Muscles pneumonia thrombosis or embolism spasm or atrophy urinary bladder urinary retention. High sympathetic tone Sleep deprivation ischemic H. D anxiety and depression. Dunwoody CJ, Krenzischek DA, Pasero C, Rathmell JP, Polomano RC. Assessment, physiological monitoring, and consequences of inadequately treated acute pain. Pain Manag Nurs. 2008;9:S11 S21.

10 Pre-emptive analgesia, Jørgen B. Dahl and Steen Møiniche, Department of Anaesthesiology, Glostrup University Hospital, Glostrup, Denmark, Correspondence to: Jørgen B. Dahl, Department of Anaesthesiology, Glostrup University Hospital Ndr. Ringvej, DK-2600 Glostrup, Denmark, Accepted November 3, 2004

11 Physiology of pain: Pain processing in the brain Cerebral cortex Thalamus Limbic system Hypothalamus Medulla oblongata Reticular formation Spinal cord

12 Physiology Touch pain Pain Nerve C-fibre A-ß-fibre

13 Physiology Peripheral nerve pathways do not react like telephone wires!

14 Pathophysiology Nerve pathways are not one-way streets! CGRP, COX2 Na-channel BK1-R

15 Pathophysiology peripheral and central mechanisms Massive AP influx on a spinal level Release of TNF, IL-1 NGF Intracellular molecular change Number of receptors (AMPA, NMDA, NK1) Antero- and retrograde axonal transport Expression of bradykinin receptors Neuropeptides Local effect: Na channels Cytokine Induction of COX-2 Central sensitisation Peripheral sensitisation

16 Pathophysiology - chronic neuropathy Central sensitisation: Touch pain Pain C-fibre A-ß-fibre WDR neurone

17 Pathogenesis of post-herpetic pain C-fibre degeneration: touch pain Pain C-fibre degeneration A-ß-fibre Sprouting

18 Pathogenesis of sympathetic pain Sympathetic nociceptive coupling Sympathetic fibre Noradrenaline NA NA NA C- Faser NA Ramer et al., 1998

19 Chronic postsurgical pain Chronic postsurgical pain (CPSP) 3 6 months It disrupts their quality of life 10-50%. CPSP due to: inflammatory processes initiation of neuropathic pain from peripheral nerve damage Several risk factors : psychosocial factors, sex, age, level of pre-existing pain. genetic predisposition Multimodal analgesia : use of surgical techniques that avoid nerve damage are beneficial for preventing long-term postsurgical pain Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:

20 Preventive Analgesia (aims and methods) To block perioperative pain To block neurochemical cascade chronic pain By blockade (NMDA-Rs) By arresting glial cells reaction By preventing the phenotypic interneurons to become pronociceptive. Katz J, McCartney CJL. Current status of preemptive analgesia.curr Opin Anaesthesiol 2002;15:435 41

21 Sources of perioperative pain Peripheral sensitization afferent input arising from nerve injury cut of primary afferents (e.g., retraction) Postoperative inflammation (hours weeks) Central sensitization hyperexcitability and ectopic activity in DRG hyperexcitability and ectopic activity in DHN

22 Factors and phases of perioperative pain Preoperative Genetic predisposition, Psychological vulnerability, Non-genetic environnemental variables (expectations, cultural, dietary, and more), preoperative noxious inputs, and pain Intraoperative Cutting, retraction, manipulation, chemical irritation by sterilizing substances and stress response Postoperative regenerating wounded structures fibrosis Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother : 7230, 2009

23 Left untreated, acute pain can lead to: 1. Emotional and psychological distress 2. Potential to develop chronic pain state 3. which is much more difficult to manage

24 The plan for preventive analgesia Taking a thorough patient history, Including: 1. Factors such as prior responses to pain, 2. Past contact with analgesics, 3. Current medications, 4. Fears or concerns regarding future pain, 5. Any additional relevant information.

25 Preventive (perioperative) analgesia Time of analgesia Before, during and post-operatively Type of analgesia (multimodal) Systemic IV NSAIDs (anti Cox 1,2) & opioids NMDA receptors antagonists ketamine Anti convulsants pregabalin Local analgesics Wound infiltration Peripheral N. block Extended epidural or intrathecal analgesia Pre, intra, and post operatively Adjuvants (opioids and/or ά2 agonists ) G. anesthesia no block of stress response Lavand homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology 2005;103:813 20

26 Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 41-96:725; 2002 Is There a Link Between Acute Pain and Chronic Pain?

27 Transition from acute to chronic pain N.injury cascade of reactions leading to the transition from acute to chronic pain destruction of In the DHNs glial cells antinociceptive inhibitory Ns activation GABAergic interneurons in the dorsal horn from being normally: antinociceptive pronociceptive interneurons. Coull JA, Beggs S, Boudreau D, Boivin D, Tsuda M, Inoue K, Gravel C, Salter MW, De Koninck Y. BDNF from microglia, causes the shift in neuronal anion gradient underlying neuropathic pain. Nature 2005;438:

28 Take home messages 1. Pre-emptive analgesia provides better analgesia postoperatively if applied before incision or surgery. 2. Multimodal analgesia means the use of lower doses of any one medication to be used in combination with less side effects. 3. Preventive analgesia could be used before, during or after incision and surgery. 4. Duration of treatment and effective analgesic regimens are important factors in the administration of preventive analgesia. 5. Preventive analgesia is more effective than peemptive analgesia to prevent chronic pain

Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation

Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Anaesthesia and Pain Management for Endo Exo Femoral Prosthesis (EEFP) Bridging the Gap from Surgery to Rehabilitation Dr Ajay Kumar Senior Lecturer Macquarie and Melbourne University Introduction Amputee

More information

From preemptive to preventive analgesia Esther M. Pogatzki-Zahn and Peter K. Zahn

From preemptive to preventive analgesia Esther M. Pogatzki-Zahn and Peter K. Zahn From preemptive to preventive analgesia Esther M. Pogatzki-Zahn and Peter K. Zahn Purpose of review Much effort has been taken to prove that a treatment initiated before surgery is more effective in reducing

More information

Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain

Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain Pre-op Interventions to Mitigate Post-op Acute and Chronic Pain H A R S H A S H A N T H A N N A. M D, M S C A S S O C I A T E P R O F E S S O R D E P A R T M E N T O F A N E S T H E S I A C H R O N I C

More information

Transitions from Acute to Chronic Pain

Transitions from Acute to Chronic Pain Transitions from Acute to Chronic Pain Chronic Post-surgical Pain An Important yet largely unrecognized clinical problem! 1,2 Defined as pain and pain disability persisting more than 3 months after surgery

More information

Neurobiology of Pain Adjuvant analgesia

Neurobiology of Pain Adjuvant analgesia Neurobiology of Pain Adjuvant analgesia Jason Brooks Consultant Anaesthesia and Pain Management BCH March 2017 The Brief A broad overview of the abnormal and normal anatomy and physiology of pain pathways

More information

Objectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE

Objectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation

More information

Chronic pain after surgery: pathophysiology, risk factors and prevention

Chronic pain after surgery: pathophysiology, risk factors and prevention Review 1 Centre for Anaesthesia, University College London Hospital, London, UK 2 Pain Management Centre, National Hospital for Neurology and Neurosurgery, London, UK Correspondence to Dr Danielle Reddi,

More information

Spinal Cord Injury Pain. Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018

Spinal Cord Injury Pain. Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018 Spinal Cord Injury Pain Michael Massey, DO CentraCare Health St Cloud, MN 11/07/2018 Objectives At the conclusion of this session, participants should be able to: 1. Understand the difference between nociceptive

More information

Pain Mechanisms. Prof Michael G Irwin MD, FRCA, FANZCA FHKAM Head Department of Anaesthesiology University of Hong Kong. The Somatosensory System

Pain Mechanisms. Prof Michael G Irwin MD, FRCA, FANZCA FHKAM Head Department of Anaesthesiology University of Hong Kong. The Somatosensory System ain Mechanisms rof Michael G Irwin MD, FRCA, FANZCA FHKAM Head Department of Anaesthesiology University of Hong Kong The Somatosensory System Frontal cortex Descending pathway eriaqueductal gray matter

More information

Chapter 16. Sense of Pain

Chapter 16. Sense of Pain Chapter 16 Sense of Pain Pain Discomfort caused by tissue injury or noxious stimulation, and typically leading to evasive action important /// helps to protect us lost of pain in diabetes mellitus = diabetic

More information

Pain and endometriosis: How to optimize the medical management?

Pain and endometriosis: How to optimize the medical management? Pre-congress course Endometriosis sand pelvic pain 1st Society for endometriosis and uterine Disorders Meeting Paris, 7-9 May 2015 Pain and endometriosis: How to optimize the medical management? J. FAIDHERBE

More information

Pain Pathways. Dr Sameer Gupta Consultant in Anaesthesia and Pain Management, NGH

Pain Pathways. Dr Sameer Gupta Consultant in Anaesthesia and Pain Management, NGH Pain Pathways Dr Sameer Gupta Consultant in Anaesthesia and Pain Management, NGH Objective To give you a simplistic and basic concepts of pain pathways to help understand the complex issue of pain Pain

More information

Continuous Wound Infusion and Postoperative Pain Current status?

Continuous Wound Infusion and Postoperative Pain Current status? Continuous Wound Infusion and Postoperative Pain Current status? Pr Patricia Lavand homme Department of Anesthesiology St Luc Hospital University Catholic of Louvain Medical School Brussels, Belgium Severe

More information

Pathophysiology of Pain. Ramon Go MD Assistant Professor Anesthesiology and Pain medicine NYP-CUMC

Pathophysiology of Pain. Ramon Go MD Assistant Professor Anesthesiology and Pain medicine NYP-CUMC Pathophysiology of Pain Ramon Go MD Assistant Professor Anesthesiology and Pain medicine NYP-CUMC Learning Objectives Anatomic pathway of nociception Discuss the multiple target sites of pharmacological

More information

When Acute Pain Becomes Chronic

When Acute Pain Becomes Chronic When Acute Pain Becomes Chronic John F. Peppin, DO, FACP Disclosures Ferring Pharmaceuticals: Consultant and Speaker One Source Regulatory: Consultant Your Encore: Consultant Janssen Pharmaceuticals: Consultant

More information

Persistent post surgical pain. Jim Olson Waitemata DHB Auckland

Persistent post surgical pain. Jim Olson Waitemata DHB Auckland Persistent post surgical pain Jim Olson Waitemata DHB Auckland Declaration Within the last five years I have accepted hospitality from the pharmaceutical industry, received honoraria from Mundipharma NZ

More information

Pharmacology of Pain Transmission and Modulation

Pharmacology of Pain Transmission and Modulation Pharmacology of Pain Transmission and Modulation 2 Jürg Schliessbach and Konrad Maurer Nociceptive Nerve Fibers Pain is transmitted to the central nervous system via thinly myelinated Aδ and unmyelinated

More information

What do we want for pain medications?

What do we want for pain medications? New Trends in Pain Pharmacotherapy Dr. Chi Wai Cheung MBBS(HK), FHKCA, FHKAM(Anaesthesiology), Dip Pain Mgt(HKCA) Clinical Assistant Professor Department of Anaesthesiology The University of Hong Kong

More information

Pathophysiology of Pain

Pathophysiology of Pain Pathophysiology of Pain Wound Inflammatory response Chemical mediators Activity in Pain Path PAIN http://neuroscience.uth.tmc.edu/s2/chapter08.html Chris Cohan, Ph.D. Dept. of Pathology/Anat Sci University

More information

Transition from Acute to Chronic Pain after Surgery. Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium

Transition from Acute to Chronic Pain after Surgery. Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium Transition from Acute to Chronic Pain after Surgery Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare Some disclosures Pain is multi-faceted

More information

Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007

Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007 Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress REDUCING THE PAIN FACTOR AN UPDATE ON PERI-OPERATIVE ANALGESIA Sandra Forysth, BVSc DipACVA Institute of Veterinary,

More information

Introduction to some interesting research questions: Molecular biology of the primary afferent nociceptor

Introduction to some interesting research questions: Molecular biology of the primary afferent nociceptor Introduction to some interesting research questions: Molecular biology of the primary afferent nociceptor NOCICEPTORS ARE NOT IDENTICAL PEPTIDE SubP/CGRP Trk A NON-PEPTIDE IB4 P2X 3 c-ret Snider and McMahon

More information

PAIN MANAGEMENT. It is important to know as much about the man who has pain as it is to know about pain the man has Quote by Macnab et al

PAIN MANAGEMENT. It is important to know as much about the man who has pain as it is to know about pain the man has Quote by Macnab et al PAIN MANAGEMENT It is important to know as much about the man who has pain as it is to know about pain the man has Quote by Macnab et al DEFINATION OF PAIN International Association for the study of pain

More information

Transition from acute to chronic pain

Transition from acute to chronic pain A Feizerfan FRCA G Sheh BHB MBChB FAFRM(RACP) FFPMANZCA Matrix reference 3E00 Key points Physiology of pain involves activation and complex interactions of autonomic, peripheral and central nervous systems,

More information

PAIN. Physiology of pain relating to pain management

PAIN. Physiology of pain relating to pain management PAIN Physiology of pain relating to pain management What is pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage. (Melzac and Wall) The generation of pain

More information

The Role of Ketamine in the Management of Complex Acute Pain

The Role of Ketamine in the Management of Complex Acute Pain The Role of Ketamine in the Management of Complex Acute Pain Dr James Bennett Consultant Anaesthetist Consultant Lead for Inpatient Pain Service East Sussex Healthcare NHS Trust STAPG Committee Member

More information

PAIN MANAGEMENT in the CANINE PATIENT

PAIN MANAGEMENT in the CANINE PATIENT PAIN MANAGEMENT in the CANINE PATIENT Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT Part 1: Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT 1 Pain is the most common reason

More information

The Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study

The Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study PAIN MEDICINE Volume 10 Number 1 2009 The Effect of Preemptive Analgesia in Postoperative Pain Relief A Prospective Double-Blind Randomized Study Seetharaman Hariharan, MD, Harley Moseley, FFARCS, Areti

More information

POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS

POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS POST OPERATIVE PAIN MANAGEMENT: PAIN AND COMPLICATIONS November 9, 2018 Aimee LaMere, CNP Molly McNaughton, CNP Leslie Weide, MSW, LICSW, ACM Disclosures: Conflict of interest statement: We certify that,

More information

Receptors and Neurotransmitters: It Sounds Greek to Me. Agenda. What We Know About Pain 9/7/2012

Receptors and Neurotransmitters: It Sounds Greek to Me. Agenda. What We Know About Pain 9/7/2012 Receptors and Neurotransmitters: It Sounds Greek to Me Cathy Carlson, PhD, RN Northern Illinois University Agenda We will be going through this lecture on basic pain physiology using analogies, mnemonics,

More information

Acute Pain NETP: SEPTEMBER 2013 COHORT

Acute Pain NETP: SEPTEMBER 2013 COHORT Acute Pain NETP: SEPTEMBER 2013 COHORT Pain & Suffering an unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage International

More information

Neuropathic Pain in Palliative Care

Neuropathic Pain in Palliative Care Neuropathic Pain in Palliative Care Neuropathic Pain in Advanced Cancer Affects 40% of patients Multiple concurrent pains are common Often complex pathophysiology with mixed components Nocioceptive Neuropathic

More information

Historical Understandings of Pain

Historical Understandings of Pain Gain-Control Theory: A Guide for Pain Relief Nursing: Paul Arnstein, RN, PhD, Director: MGH Cares About Pain Relief 9/24/10 ASPMN 20 th Annual Conference Historical Understandings of Pain Pain is mystical

More information

Acute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance

Acute Pain Management in the Opioid Tolerant Patient. Objectives. Opioids. The participant will be able to define opioid tolerance Acute Pain Management in the Opioid Tolerant Patient Kathleen M. Colfer, MSN, RN-BC Clinical Nurse Specialist Acute Pain Management Service Department of Anesthesiology Thomas Jefferson University Hospital

More information

POST-OP MULTIMODAL PAIN MANAGEMENT. Maripat Welz-Bosna Reading Hospital Medical Center Department of Medicine Hospitalist Services/Pain Management

POST-OP MULTIMODAL PAIN MANAGEMENT. Maripat Welz-Bosna Reading Hospital Medical Center Department of Medicine Hospitalist Services/Pain Management POST-OP MULTIMODAL PAIN MANAGEMENT Maripat Welz-Bosna Reading Hospital Medical Center Department of Medicine Hospitalist Services/Pain Management Objectives Understand the basic neurobiology of the pain

More information

Somatosensory Physiology (Pain And Temperature) Richard M. Costanzo, Ph.D.

Somatosensory Physiology (Pain And Temperature) Richard M. Costanzo, Ph.D. Somatosensory Physiology (Pain And Temperature) Richard M. Costanzo, Ph.D. OBJECTIVES After studying the material of this lecture the student should be familiar with: 1. The relationship between nociception

More information

Seizure: the clinical manifestation of an abnormal and excessive excitation and synchronization of a population of cortical

Seizure: the clinical manifestation of an abnormal and excessive excitation and synchronization of a population of cortical Are There Sharing Mechanisms of Epilepsy, Migraine and Neuropathic Pain? Chin-Wei Huang, MD, PhD Department of Neurology, NCKUH Basic mechanisms underlying seizures and epilepsy Seizure: the clinical manifestation

More information

Pre-Emptive Analgesia for Reduction of Postoperative Pain

Pre-Emptive Analgesia for Reduction of Postoperative Pain REDUCTION THE IRAQI POSTGRADUATE OF POSTOPERATIVE MEDICAL JOURNAL PAIN Pre-Emptive Analgesia for Reduction of Postoperative Pain Ali Abdul Hammed, Khulood Salih Al-Ani ABSTRACT: BACKGROUND: Pre-emptive

More information

Special Issue on Pain and Itch

Special Issue on Pain and Itch Special Issue on Pain and Itch Title: Recent Progress in Understanding the Mechanisms of Pain and Itch Guest Editor of the Special Issue: Ru-Rong Ji, PhD Chronic pain is a major health problem world-wide.

More information

Preventive analgesia Jørgen B. Dahl a and Henrik Kehlet b

Preventive analgesia Jørgen B. Dahl a and Henrik Kehlet b Preventive analgesia Jørgen B. Dahl a and Henrik Kehlet b a Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet and Copenhagen University and b Section for Surgical Pathophysiology

More information

Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS. Pain Management in the Elite Athlete: The 2017 IOC Consensus Statement

Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS. Pain Management in the Elite Athlete: The 2017 IOC Consensus Statement Prof Wayne Derman MBChB,BSc (Med)(Hons) PhD, FFIMS Pain Management in the Elite Athlete: The 2017 IOC Consensus Statement 2 as 20 Experts published and leaders in their respective field 12 month lead in

More information

Pain Society of the Carolinas 2015: Nerve Injury and Neuropathy

Pain Society of the Carolinas 2015: Nerve Injury and Neuropathy Google Images Pain Society of the Carolinas 2015: Nerve Injury and Neuropathy Thomas Buchheit, MD Associate Professor Director of Pain Medicine Department of Anesthesiology Duke University Medical Center

More information

Pre-emptive analgesia

Pre-emptive analgesia Pre-emptive analgesia Published online December 13, 2004 Jørgen B. Dahl and Steen Møiniche Department of Anaesthesiology, Glostrup University Hospital, Glostrup, Denmark The concept Accepted: November

More information

Perioperative Pain Management

Perioperative Pain Management Perioperative Pain Management Overview and Update As defined by the Anesthesiologist's Task Force on Acute Pain Management are from the practice guidelines from the American Society of Anesthesiologists

More information

When Acute Pain Becomes Chronic. Michael R. Clark, MD, MPH, MBA

When Acute Pain Becomes Chronic. Michael R. Clark, MD, MPH, MBA When Acute Pain Becomes Chronic Michael R. Clark, MD, MPH, MBA Disclosures Nothing to Disclose Learning Objectives Describe the phenomenon of the transition from acute to chronic pain Review risk factors

More information

Learning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16

Learning Objectives. Perioperative goals. Acute Pain in the Chronic Pain Patient for Ambulatory Surgery 9/8/16 Acute Pain in the Chronic Pain Patient for Ambulatory Surgery Danielle Ludwin, MD Associate Professor of Anesthesiology Division of Regional and Orthopedic Anesthesia Columbia University Medical Center

More information

EPIDURAL ANALGESIA IN CARDIOTHORACIC SURGERY:

EPIDURAL ANALGESIA IN CARDIOTHORACIC SURGERY: EPIDURAL ANALGESIA IN CARDIOTHORACIC SURGERY: Does it prevent chronic postoperative pain? Eleni Moka Anaesthesiologist Creta InterClinic Hospital Heraklion Crete Greece In official cooperation with University

More information

EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1

EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June RC1 PREVENTING PAIN IN NEUROSURGICAL PATIENTS EUROANESTHESIA 2008 Copenhagen, Denmark, 31 May - 3 June 2008 07RC1 SABINE HIMMELSEHER, EBERHARD F. KOCHS Department of Anaesthesiology Technical University Munich

More information

The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery

The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery (Acta Anaesth. Belg., 2006, 57, 373-379) The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery P. LAVAND HOMME

More information

NMDA-Receptor Antagonists and Opioid Receptor Interactions as Related to Analgesia and Tolerance

NMDA-Receptor Antagonists and Opioid Receptor Interactions as Related to Analgesia and Tolerance Vol. 19 No. 1(Suppl.) January 2000 Journal of Pain and Symptom Management S7 Proceedings Supplement NDMA-Receptor Antagonists: Evolving Role in Analgesia NMDA-Receptor Antagonists and Opioid Receptor Interactions

More information

The anatomy and physiology of pain

The anatomy and physiology of pain The anatomy and physiology of pain Charlotte E Steeds Abstract Pain is an unpleasant experience that results from both physical and psychological responses to injury. A complex set of pathways transmits

More information

CHAPTER 4 PAIN AND ITS MANAGEMENT

CHAPTER 4 PAIN AND ITS MANAGEMENT CHAPTER 4 PAIN AND ITS MANAGEMENT Pain Definition: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Types of Pain

More information

Objectives PAIN PATHWAYS PAIN PATHWAYS PAIN PATHWAYS

Objectives PAIN PATHWAYS PAIN PATHWAYS PAIN PATHWAYS Objectives NURSE ANESTHESIOLOGY PROGRAM FLORIDA INTERNATIONAL UNIVERSITY LINDA WUNDER, CRNA MSN 1. Recognize the pain pathways from peripheral stimulus to supraspinal processing. 2. Understand the differences

More information

Chronic pain: We should not underestimate the contribution of neural plasticity. *Gwyn N Lewis 1, David A Rice 1,2

Chronic pain: We should not underestimate the contribution of neural plasticity. *Gwyn N Lewis 1, David A Rice 1,2 Chronic pain: We should not underestimate the contribution of neural plasticity *Gwyn N Lewis 1, David A Rice 1,2 1 Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand 2

More information

How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium

How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium How to manage severe postoperative pain? Pr Patricia Lavand homme Anesthesiology Dpt & Acute Pain Service Brussels, Belgium No conflict of interest to declare. Does severe acute postoperative pain still

More information

San Francisco Chronicle, June 2001

San Francisco Chronicle, June 2001 PAIN San Francisco Chronicle, June 2001 CONGENITAL INSENSITIVITY TO PAIN PAIN IS A SUBJECTIVE EXPERIENCE: It is not a stimulus MAJOR FEATURES OF THE PAIN EXPERIENCE: Sensory discriminative Affective (emotional)

More information

Department of Anesthesiology, Shimane University Faculty of Medicine, Izumo, , Japan

Department of Anesthesiology, Shimane University Faculty of Medicine, Izumo, , Japan Shimane J. Med. Sci., Vol.34 pp.93-97, 2018 The Incidence of Chronic Postsurgical Pain After Inguinal Hernia Surgery: Association with the Acute Postsurgical Pain: A Preliminary Study Based on Questionnaires

More information

Chronic pain after childbirth. Petter Kainu Split

Chronic pain after childbirth. Petter Kainu Split Chronic pain after childbirth Petter Kainu Split 9.5.13 Backround: 128 milj. births per year world wide 18.5 milj. caesarean sections (WHO 2008) 234 milj. surgical operations per year (WHO 2004) Chronic

More information

Analgesia for Small Animals Pharmacology & Clinical Practice. Jill Maddison The Royal Veterinary College Hawkshead Lane, North Mymms, AL9 7TA, UK

Analgesia for Small Animals Pharmacology & Clinical Practice. Jill Maddison The Royal Veterinary College Hawkshead Lane, North Mymms, AL9 7TA, UK Analgesia for Small Animals Pharmacology & Clinical Practice Jill Maddison The Royal Veterinary College Hawkshead Lane, North Mymms, AL9 7TA, UK Colin Dunlop Advanced Anaesthesia Specialists Unit 13, 46-48

More information

Cancer-induced bone pain

Cancer-induced bone pain Cancer-induced bone pain Common Prevalent in particular cancers: breast (73%), prostate (68%), thyroid (42%), lung (36%), renal (35%), colon (5%) Correlates with an increased morbidity Reduced performance

More information

SYLLABUS SPRING 2011 COURSE: NSC NEUROBIOLOGY OF PAIN

SYLLABUS SPRING 2011 COURSE: NSC NEUROBIOLOGY OF PAIN SYLLABUS NSC 4358 NEUROBIOLOGY OF PAIN SPRING 2011 1 SYLLABUS SPRING 2011 COURSE: NSC 4358 001 NEUROBIOLOGY OF PAIN Instructor: Aage R. Møller PhD E-mail: AMOLLER@UTDALLAS.EDU Class schedule: Main Campus:

More information

211MDS Pain theories

211MDS Pain theories 211MDS Pain theories Definition In 1986, the International Association for the Study of Pain (IASP) defined pain as a sensory and emotional experience associated with real or potential injuries, or described

More information

CRPS for all of us. MC Chu Anaesthesia and Intensive Care, PWH. 7th November 2007

CRPS for all of us. MC Chu Anaesthesia and Intensive Care, PWH. 7th November 2007 CRPS for all of us MC Chu Anaesthesia and Intensive Care, PWH 7th November 2007 Agenda What is CRPS Physiotherapy for CRPS Other interventions for CRPS Optimizing outcome Before CRPS Reflex sympathetic

More information

Prevention of chronic post-surgical pain. Is it possible?

Prevention of chronic post-surgical pain. Is it possible? Prevention of chronic post-surgical pain. Is it possible? Dr Jane Quinlan Consultant in anaesthesia and acute pain management Oxford University Hospitals Trust South Thames Acute Pain Group 18 th Annual

More information

Multimodal analgesic therapy has gained widespread

Multimodal analgesic therapy has gained widespread TOPICAL REVIEW Analgesia for Anesthetized Patients Kip A. Lemke, DVM, MSc, Dipl. ACVA, and Catherine M. Creighton, DVM Many perioperative pain management protocols for cats and dogs are overly complex,

More information

PAIN IS A SUBJECTIVE EXPERIENCE: It is not a stimulus. MAJOR FEATURES OF THE PAIN EXPERIENCE: Sensory discriminative Affective (emotional) Cognitive

PAIN IS A SUBJECTIVE EXPERIENCE: It is not a stimulus. MAJOR FEATURES OF THE PAIN EXPERIENCE: Sensory discriminative Affective (emotional) Cognitive PAIN PAIN IS A SUBJECTIVE EXPERIENCE: It is not a stimulus MAJOR FEATURES OF THE PAIN EXPERIENCE: Sensory discriminative Affective (emotional) Cognitive MEASUREMENT OF PAIN: A BIG PROBLEM Worst pain ever

More information

GUIDELINES ON PAIN MANAGEMENT IN UROLOGY

GUIDELINES ON PAIN MANAGEMENT IN UROLOGY GUIDELINES ON PAIN MANAGEMENT IN UROLOGY F. Francesca (chairman), P. Bader, D. Echtle, F. Giunta, J. Williams Eur Urol 2003; 44(4):383-389 Introduction Pain is defined as an unpleasant sensory and emotional

More information

SEEING KETAMINE IN A NEW LIGHT

SEEING KETAMINE IN A NEW LIGHT SEEING KETAMINE IN A NEW LIGHT BobbieJean Sweitzer, M.D., FACP Professor of Anesthesiology Director of Perioperative Medicine Northwestern University Bobbie.Sweitzer@northwestern.edu LEARNING OBJECTIVES

More information

Pain and impulse conduction

Pain and impulse conduction 1 Pain and impulse conduction L.H.D.J. Booij According to the World Health Organisation pain is defined as an unpleasant sensation that occurs from imminent tissue damage. From a physiological perspective,

More information

When does acute pain become chronic?

When does acute pain become chronic? British Journal of Anaesthesia 105 (S1): i69 i85 (2010) doi:10.1093/bja/aeq323 PAIN When does acute pain become chronic? C. Voscopoulos and M. Lema* Department of Anesthesiology, Critical Care, and Pain

More information

What it Takes to be a Pain

What it Takes to be a Pain What it Takes to be a Pain Pain Pathways and the Neurophysiology of pain Dennis S. Pacl, MD, FACP, FAChPM Austin Palliative Care/ Hospice Austin A Definition of Pain complex constellation of unpleasant

More information

PAIN MANAGEMENT IN UROLOGY

PAIN MANAGEMENT IN UROLOGY 24 PAIN MANAGEMENT IN UROLOGY F. Francesca (chairman), P. Bader, D. Echtle, F. Giunta, J. Williams Eur Urol 2003; 44(4):383-389 Introduction Pain is defined as an unpleasant sensory and emotional experience

More information

Inpatient Management of Trauma Related Pain

Inpatient Management of Trauma Related Pain Inpatient Management of Trauma Related Pain STOMP Summit September 9, 2016 Ann O Rourke, MD, MPH University of Wisconsin Department of Surgery 1 Our patient Small SDH Intubated Hemopneumothorax with multiple

More information

Chapter 8. The Nervous System

Chapter 8. The Nervous System Chapter 8 The Nervous System The Nervous System Consists of the Central and Peripheral Nervous Systems Principle Parts of Nervous System Central Nervous System (CNS) Components: brain and spinal cord

More information

Perioperative pathophysiology and the objectives behind Enhanced Recovery Care

Perioperative pathophysiology and the objectives behind Enhanced Recovery Care Perioperative pathophysiology and the objectives behind Enhanced Recovery Care Francesco Carli, MD, MPhil McGill University Montreal, Canada franco.carli@mcgill.ca 60 patients (74 yo) Open colon resection

More information

Brian Kahan, D.O. FAAPMR, DABPM, DAOCRM, FIPP Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite 150 Annapolis, MD

Brian Kahan, D.O. FAAPMR, DABPM, DAOCRM, FIPP Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite 150 Annapolis, MD Brian Kahan, D.O. FAAPMR, DABPM, DAOCRM, FIPP Center for Pain Medicine and Physiatric Rehabilitation 2002 Medical Parkway Suite 150 Annapolis, MD 1630 Main Street Suite 215 Chester, MD 410-571-9000 www.4-no-pain.com

More information

The perception of pain is a complex process,

The perception of pain is a complex process, SPECIAL TOPIC Pathophysiology of Pain: A Practical Primer Adeline Fong, MRCP, MRCA, FANZCA Stephan A. Schug, MD, FANZCA, FFPMANZCA Perth, Australia Summary: The experience of pain is a subjective one and

More information

DOCTORAL DISSERTATION

DOCTORAL DISSERTATION UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORAL DISSERTATION - Summary - METHODS OF ANALGESIA AND SEDATION IN THE POSTOPERATIVE PERIOD PhD SUPERVISER: PH. D. PROFESSOR : VALENTIN C#RLIG

More information

1 The Physiology of Pain

1 The Physiology of Pain 1 The Physiology of Pain Rohit Juneja and Siân Jaggar Introduction Definitions Key Messages Pain is still underdiagnosed and undertreated. Pain is a subjective experience and may even be present in the

More information

PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE?

PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE? PERIOPERATIVE PAIN MANAGEMENT: WHAT S UP WITH METHADONE? Sandra Z Perkowski, VMD, PhD, DACVAA University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA Pre-emptive and multimodal use

More information

Pre-emptive analgesia in pancreatic surgery hypersensitivity and the incidence of hyperalgesia, many clinical and experimental studies have been perfo

Pre-emptive analgesia in pancreatic surgery hypersensitivity and the incidence of hyperalgesia, many clinical and experimental studies have been perfo British Journal of Anaesthesia 100 (1): 36 41 (2008) doi:10.1093/bja/aem338 Advance Access publication November 27, 2007 CLINICAL PRACTICE Pre-incisional epidural ropivacaine, sufentanil, clonidine, and

More information

What is Pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective

What is Pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective Pain & Acupuncture What is Pain? An unpleasant sensory and emotional experience associated with actual or potential tissue damage. NOCICEPTION( the neural processes of encoding and processing noxious stimuli.)

More information

The nervous system regulates most body systems using direct connections called nerves. It enables you to sense and respond to stimuli

The nervous system regulates most body systems using direct connections called nerves. It enables you to sense and respond to stimuli The nervous system regulates most body systems using direct connections called nerves. It enables you to sense and respond to stimuli The basic function of nervous system are: Receive sensory input internal

More information

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus

More information

Is mindfulness meditation an appropriate therapy in patients presenting with chronic pain?

Is mindfulness meditation an appropriate therapy in patients presenting with chronic pain? Is mindfulness meditation an appropriate therapy in patients presenting with chronic pain? Background Chronic pain affects between one-third and one-half of the UK adult 10.4% to 14.3% of cases being moderate-severely

More information

SOMATOSENSORY SYSTEMS AND PAIN

SOMATOSENSORY SYSTEMS AND PAIN SOMATOSENSORY SYSTEMS AND PAIN A 21 year old man presented with a stab wound of the right side of the neck (Panel A). Neurological examination revealed right hemiplegia and complete right-sided loss of

More information

MANAGING CHRONIC PAIN

MANAGING CHRONIC PAIN George Hardas MANAGING CHRONIC PAIN The guide to understanding chronic pain and how to manage it. George Hardas MMed (UNSW) MScMed (Syd) MChiro (Macq) BSc (Syd) Grad Cert Pain Management (Syd) Cognitive

More information

Human Nervous System

Human Nervous System Human Nervous System A network of interconnected parts that controls behavior & connects us to the world Central Nervous System consists of the brain and spinal cord Peripheral Nervous System consists

More information

Original Article Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal surgeries: a comparative study

Original Article Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal surgeries: a comparative study Available online at www.jsan.org.np Journal of Society of Anesthesiologists of Nepal Original Article Pre-incisional epidural magnesium provides pre-emptive and postoperative analgesia in lower abdominal

More information

AANA Journal Course 2

AANA Journal Course 2 AANA Journal Course 2 Update for Nurse Anesthetists Preemptive analgesia applied to postoperative pain management Dede A. Farris, CRNA, MSNA Birmingham, Alabama Michael A. Fiedler, CRNA, MS Memphis, Tennessee

More information

Nervous System - PNS and CNS. Bio 105

Nervous System - PNS and CNS. Bio 105 Nervous System - PNS and CNS Bio 105 Outline I. Central Nervous System vs Peripheral Nervous System II. Peripheral Nervous System A. Autonomic Nervous Systems B. Somatic Nervous Systems III. Autonomic

More information

Motor Control, Pain, Somatic Dysfunction, Core Stability. Richard G. Schuster, DO Shawn Kerger, DO, FAOASM 19 September 2016 OMED 2016 Anaheim, CA

Motor Control, Pain, Somatic Dysfunction, Core Stability. Richard G. Schuster, DO Shawn Kerger, DO, FAOASM 19 September 2016 OMED 2016 Anaheim, CA Motor Control, Pain, Somatic Dysfunction, Core Stability Richard G. Schuster, DO Shawn Kerger, DO, FAOASM 19 September 2016 OMED 2016 Anaheim, CA How do we move? Decision to move (Executive or Cognitive

More information

Joint Session with ACOFP, AOASM and AAO: Motor Control, Pain, Somatic Dysfunction, Core Stability. Shawn R. Kerger, DO, FAOSM Richard G.

Joint Session with ACOFP, AOASM and AAO: Motor Control, Pain, Somatic Dysfunction, Core Stability. Shawn R. Kerger, DO, FAOSM Richard G. Joint Session with ACOFP, AOASM and AAO: Motor Control, Pain, Somatic Dysfunction, Core Stability Shawn R. Kerger, DO, FAOSM Richard G. Schuster, DO Motor Control, Pain, Somatic Dysfunction, Core Stability

More information

Practical Management Of Osteoporosis

Practical Management Of Osteoporosis Practical Management Of Osteoporosis CONFERENCE 2012 Education Centre, Bournemouth.19 November The following companies have given funding towards the cost of this meeting but have no input into the agenda

More information

Nervous System and Brain Review. Bio 3201

Nervous System and Brain Review. Bio 3201 Nervous System and Brain Review Bio 3201 Dont worry about: glial cells Oligodendrocytes Satelite cells etc Nervous System - Vital to maintaining homeostasis in organisms - Comprised of : brain, spinal

More information

3/15/17. Outline. Nervous System - PNS and CNS. Two Parts of the Nervous System

3/15/17. Outline. Nervous System - PNS and CNS. Two Parts of the Nervous System Nervous System - PNS and CNS Bio 105 Outline I. Central Nervous System vs Peripheral Nervous System II. Peripheral Nervous System A. Autonomic Nervous Systems B. Somatic Nervous Systems III. Autonomic

More information

Neurobiology of Pain

Neurobiology of Pain Neurobiology of Pain What the Ratologists have taught me!!!! Dr Diarmuid McCoy MB BCh BAO (NUI) FFARCSI FFPMANZCA FANZCA FFPMCAI Specialist Pain Medicine Physician The Geelong Hospital Barwon Health Pain

More information

Biomechanics of Pain: Dynamics of the Neuromatrix

Biomechanics of Pain: Dynamics of the Neuromatrix Biomechanics of Pain: Dynamics of the Neuromatrix Partap S. Khalsa, D.C., Ph.D. Department of Biomedical Engineering The Neuromatrix From: Melzack R (1999) Pain Suppl 6:S121-6. NIOSH STAR Symposium May

More information