Dolor crónico postquirúrgico

Dolor crónico postquirúrgico Chronic post-surgical pain. Akkaya T, Ozkan D. Department of Anesthesiology and Pain Unit, Diskapi Yildirim Beyazit Research and Training Hospital, Ankara, Turkey. taylanakkaya@yahoo.com Agri. 2009 Jan;21(1):1-9. Abstract Chronic postsurgical pain (CPSP) has lately become a neglected phenomenon. However, in recent years, investigations of the possible risk factors (type of surgery, preoperative pain, acute postoperative pain, and psychological and genetic factors) have also gained as much importance as the clinical problem. CPSP is not only observed following major surgery, but also following minor surgical procedures, such as hernia and vasectomy. Definitive data regarding the incidence of CPSP have not been obtained yet, since it is difficult to develop standard methods to resolve this difficult and complicated clinical picture. Many different medications, such as gabapentin, ketamine, venlafaxine, lidocaine, tramadol, and steroids have been tested in addition to multimodal analgesic techniques for the management of CPSP. Hence, preventive analgesia is a broader application of preemptive analgesia that includes any preoperative analgesic regimen able to control the sensitivity induced by pain. http://www.journalagent.com/pubmed/linkout.asp?ISSN=1300-0012&PMID=19357994    Más allá del dolor informado por el paciente: las imágenes de RNM por perfusión demuestran una representación cerebral reproducible del dolor quirúrgico. Beyond patient reported pain: perfusion magnetic resonance imaging demonstrates reproducible cerebral representation of ongoing post-surgical pain. Howard MA, Krause K, Khawaja N, Massat N, Zelaya F, Schumann G, Huggins JP, Vennart W, Williams SC, Renton TF. Department of Neuroimaging, Institute of Psychiatry, Kings College London, London, United Kingdom. Matthew.Howard@kcl.ac.uk PLoS One. 2011 Feb 23;6(2):e17096. Abstract Development of treatments for acute and chronic pain conditions remains a challenge, with an unmet need for improved sensitivity and reproducibility in measuring pain in patients. Here we used pulsed-continuous arterial spin-labelling [pCASL], a relatively novel perfusion magnetic-resonance imaging technique, in conjunction with a commonly-used post-surgical model, to measure changes in regional cerebral blood flow [rCBF] associated with the experience of being in ongoing pain. We demonstrate repeatable, reproducible assessment of ongoing pain that is independent of patient self-report. In a cross-over trial design, 16 participants requiring bilateral removal of lower-jaw third molars underwent pain-free pre-surgical pCASL scans. Following extraction of either left or right tooth, repeat scans were acquired during post-operative ongoing pain. When pain-free following surgical recovery, the pre/post-surgical scanning procedure was repeated for the remaining tooth. Voxelwise statistical comparison of pre and post-surgical scans was performed to reveal rCBF changes representing ongoing pain. In addition, rCBF values in predefined pain and control brain regions were obtained. rCBF increases (5-10%) representing post-surgical ongoing pain were identified bilaterally in a network including primary and secondary somatosensory, insula and cingulate cortices, thalamus, amygdala, hippocampus, midbrain and brainstem (including trigeminal ganglion and principal-sensory nucleus), but not in a control region in visual cortex. rCBF changes were reproducible, with no rCBF differences identified across scans within-session or between post-surgical pain sessions. This is the first report of the cerebral representation of ongoing post-surgical pain without the need for exogenous tracers. Regions of rCBF increases are plausibly associated with pain and the technique is reproducible, providing an attractive proposition for testing interventions for on-going pain that do not rely solely on patient self-report. Our findings have the potential to improve our understanding of the cerebral representation of persistent painful conditions, leading to improved identification of specific patient sub-types and implementation of mechanism-based treatments. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044150/pdf/pone.0017096.pdf

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