Dolor persistente postcirugía / Persistent postsurgical pain

Marzo 27, 2018. No. 3035

Dolor persistente y anomalías sensoriales después de la abdominoplastia. Persistent Pain and Sensory Abnormalities after Abdominoplasty. Presman B1, Finnerup K1, Andresen SR1, Nikolajsen L1, Finnerup NB1. Author information Plast Reconstr Surg Glob Open. 2015 Dec 9;3(11):e561. doi: 10.1097/GOX.0000000000000542. eCollection 2015 Nov. Abstract BACKGROUND: Persistent postsurgical pain is a well-recognized problem after a number of common surgical procedures, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after cosmetic surgical procedures. We, therefore, decided to study the incidence and characteristics of persistent pain after abdominoplasty, which is one of the most frequent cosmetic surgical procedures. METHODS: In September 2014, a link to a web-based questionnaire was mailed to 217 patients who had undergone abdominoplastybetween 2006 and 2014 at the Department of Plastic Surgery, Aalborg University Hospital, Denmark. The questionnaire included questions about pain and sensory abnormalities located to the abdominal skin, and physical and psychological function; patient satisfaction with surgery was rated on a 4-point scale. RESULTS: One hundred seventy patients answered the questionnaire. Fourteen patients (8.2%) reported pain within the past 7 days related to the abdominoplasty. Abnormal abdominal skin sensation was common and reported by 138 patients (81%). Sensory hypersensitivity was associated with the presence of persistent pain. Satisfaction with the procedure was reported by 149 (88%) patients. The majority of patients reported improvement on all physical and psychological factors. Patients with pain were more often disappointed with the surgery and unwilling to recommend the surgery. CONCLUSIONS: Overall, patients were satisfied with the procedure, although abnormal abdominal skin sensation was common. However, there is a risk of developing persistent neuropathic pain after abdominoplasty, and patients should be informed about this before surgery. PDF Dolor postquirúrgico persistente en niños y jóvenes: predicción, prevención y manejo. Persistent postsurgical pain in children and young people: prediction, prevention, and management. Williams G1, Howard RF1, Liossi C2,3. Author information Pain Rep. 2017 Aug 21;2(5):e616. doi: 10.1097/PR9.0000000000000616. eCollection 2017 Sep. Abstract Ensuring optimum preoperative and postoperative pain management should always be a priority in children. KEYWORDS: Pediatrics; Postsurgical pain; Surgery PDF La asociación entre la esperanza, el estado civil, la depresión y el dolor persistente en hombres y mujeres después de una cirugía cardíaca. The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. Bjørnnes AK1,2, Parry M3, Lie I4, Falk R5, Leegaard M6, Rustøen T7,8. Author information BMC Womens Health. 2018 Jan 2;18(1):2. doi: 10.1186/s12905-017-0501-0. Abstract BACKGROUND: Cardiac surgery is a major life event, and outcomes after surgery are associated with men's and women's ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. ....  CONCLUSION: Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. KEYWORDS: Cardiac surgery; Depression; Hope; Marital status; Persistent pain PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Ketamina en dolor por anemia falciforme / Ketamine and sickle cell disease pain

Enero 28, 2018. No. 2977 La evaluación del uso de ketamina para el control del dolor con la crisis de células falciformes en el embarazo: un informe de 2 casos. Evaluating the Use of Ketamine for Pain Control With Sickle Cell Crisis in Pregnancy: A Report of 2 Cases. Gimovsky AC, Fritton K, Viscusi E, Roman A. A A Pract. 2018 Jan 1;10(1):20-22. doi: 10.1213/XAA.0000000000000624. Abstract Sickle cell crises occur frequently during pregnancy and are difficult to treat, even with high-dose opioids. Analgesia with ketamine has been suggested as an alternative, but its use during pregnancy is underreported. Two pregnant patients with uncontrolled sickle cell pain were treated with ketamine. Patient A reported no decrease in her pain, but her opioid requirements decreased. Patient B's pain resolved during ketamine administration. No serious maternal or neonatal adverse effects occurred. Ketamine may be considered as an adjunct analgesic in pregnant patients with sickle cell pain, although prospective clinical data are needed to fully assess its efficacy. PDF El papel de un régimen de dosis bajas de ketamina-midazolam en el tratamiento de la crisis dolorosa severa en pacientes con enfermedad de células falciformes. The role of a low-dose ketamine-midazolam regimen in the management of severe painful crisisin patients with sickle cell disease. Tawfic QA1, Faris AS2, Kausalya R3. Author information J Pain Symptom Manage. 2014 Feb;47(2):334-40. doi: 10.1016/j.jpainsymman.2013.03.012. Epub 2013 Jul 12 Abstract CONTEXT: Acute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration. OBJECTIVES: We studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis. METHODS: A retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics. A ketamine-midazolam regimen was added to the ongoing opioids as an initial bolus of ketamine 0.25mg/kg, followed by infusion of 0.2-0.25mg/kg/h. A midazolam bolus of 1mg followed by infusion of 0.5-1mg/h was added to reduce ketamine emergence reactions. Reduction in morphine daily requirements and improvement in pain scores were the determinants of ketamine-midazolam effect. The t-tests were used for statistical analysis. RESULTS: Nine patients were assessed, with mean age of 27±11 years. Morphine requirement was significantly lower after adding the IV ketamine-midazolam regimen. The mean±SD IV morphine requirement (milligram/day) in the pre-ketamine day (D0) was 145.6±16.5, and it was 112±12.2 on Day 1 (D1) of ketamine treatment (P=0.007). The Numeric Rating Scale scores on D0 ranged from eight to ten (mean 9.1), but improved to range from five to seven (mean 5.7) on D1. There was a significant improvement in pain scores after adding ketamine-midazolam regimen (P=0.01). CONCLUSION: Low-dose ketamine-midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sicklecell disease with severe painful crisis. Further controlled studies are required to prove this effect. Sickle cell disease; ketamine; midazolam; pain management; painful crisis PDF Crisis drepanocítica y tratamiento del dolor A. Rojas-Martínez, E. Calderón, M.A. Vidal, F. Arroyo, R. García-Hernández y L.M. Torres Rev Soc Esp Dolor 2015; 22(4): 165-167 RESUMEN La drepanocitosis incluye un grupo de desórdenes genéticamente heredados en los que a baja saturación de oxígeno ocurre la agregación de polímeros rígidos de hemoglobina S desoxigenada, otorgando forma de hoz al hematíe y dañando el endotelio vascular por medio de múltiples mecanismos, obstruyendo concomitantemente la microcirculación y produciendo una estimulación de nociceptores. Los pacientes con drepanocitosis pueden presentar múltiples tipos de dolor dependiendo de las estructuras lesionadas, siendo el de tipo músculo-esquelético el más frecuente. La base del manejo del dolor es el reconocimiento y la evaluación de la severidad, ya que de esta dependerá la prescripción del tratamiento analgésico. Las crisis vasooclusivas son la manifestación más característica de esta enfermedad. Una vez instaurado el dolor, el manejo inicial debe enfocarse en proveer control rápido del mismo, garantizándose dosis terapéuticas de los fármacos, y en la detección de complicaciones. Debe evitarse el uso no indicado de las terapias y el tratamiento infraterapéutico, acompañado de un seguimiento cuidadoso, prevención y tratamiento de los efectos adversos. El tratamiento del dolor crónico se hace de forma multidisciplinaria, considerando estrategias no farmacológicas. Palabras clave: Drepanocitosis. Células falciformes. Crisis veno-oclusivas. Opioides. Dolor intenso. PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Dolor en pediatría / Pediatric pain

Enero 20, 2018. No. 2969

Los enfoques metodológicos actuales en la evaluación de la modulación condicionada del dolor en pediatría. Current methodological approaches in conditioned pain modulation assessment in pediatrics. Hwang PS1, Ma ML1,2,3, Spiegelberg N1, Ferland CE1,2,3,4,5. Author information J Pain Res. 2017 Dec 12;10:2797-2802. doi: 10.2147/JPR.S150857. eCollection 2017. Abstract Conditioned pain modulation (CPM) paradigms have been used in various studies with healthy and non-healthy adult populations in an attempt to elucidate the mechanisms of pain processing. However, only a few studies so far have applied CPM in pediatric populations. Studies finding associations with chronic pain conditions suggest that deficiencies in underlying descending pain pathways may play an important role in the development and persistence of pain early in life. Twelve studies were identified using a PubMed search which examine solely pediatric populations, and these are reviewed with regard to demographics studied, methodological approaches, and conclusions reached. This review aimed to provide both clinicians and researchers with a brief overview of the current state of research regarding the use of CPM in children and adolescents, both healthy and clinical patients. The implications of CPM in experimental and clinical settings and its potential to aid in refining considerations to individualize treatment of pediatric pain syndromes will be discussed. KEYWORDS: chronic pain; conditioned pain modulation; descending endogenous pain inhibition; pediatrics PDF Safe Anaesthesia Worldwide Delivering safe anaesthesia to the world's poorest people Informes / Information World Congress on Regional Anesthesia & Pain Medicine April 19-21, 2018, New York City, USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Receptores purinérgicos y dolor / Pain and purinergic receptors

Octubre 28, 2017. No. 2895

Señalización purinérgica en microglia en la patogenia del dolor neuropático. Purinergic signaling in microglia in the pathogenesis of neuropathic pain. Inoue K1. Author information Proc Jpn Acad Ser B Phys Biol Sci. 2017;93(4):174-182. doi: 10.2183/pjab.93.011. Abstract Nerve injury often causes debilitating chronic pain, referred to as neuropathic pain, which is refractory to currently available analgesics including morphine. Many reports indicate that activated spinal microglia evoke neuropathic pain. The P2X4 receptor (P2X4R), a subtype of ionotropic ATP receptors, is upregulated in spinal microglia after nerve injury by several factors, including CC chemokine receptor CCR2, the extracellular matrix protein fibronectin in the spinal cord, interferon regulatory factor 8 (IRF8) and IRF5. Inhibition of P2X4R function suppresses neuropathic pain, indicating that microglial P2X4R play a key role in evoking neuropathic pain. PDF Microglia en la médula espinal y dolor neuropático Microglia in the spinal cord and neuropathic pain. Tsuda M1. Author information J Diabetes Investig. 2016 Jan;7(1):17-26. doi: 10.1111/jdi.12379. Epub 2015 Jun 23. Abstract In contrast to physiological pain, pathological pain is not dependent on the presence of tissue-damaging stimuli. One type of pathological pain- neuropathic pain - is often a consequence of nerve injury or of diseases such as diabetes. Neuropathic pain can be agonizing, can persist over long periods and is often resistant to known painkillers. A growing body of evidence shows that many pathological processes within the central nervous system are mediated by complex interactions between neurons and glial cells. In the case of painful peripheral neuropathy, spinal microglia react and undergo a series of changes that directly influence the establishment of neuropathic pain states. After nerve damage, purinergic P2X4 receptors (non-selective cation channels activated by extracellular adenosine triphosphate) are upregulated in spinal microglia in a manner that depends on the transcription factors interferon regulatory factor 8 and 5, both of which are expressed in microglia after peripheral nerve injury. P2X4 receptor expression on the cell surface of microglia is also regulated at the post-translational level by signaling from CC chemokine receptor chemotactic cytokine receptor 2. Furthermore, spinal microglia in response to extracellular stimuli results in signal transduction through intracellular signaling cascades, such as mitogen-activated protein kinases, p38 and extracellular signal-regulated protein kinase. Importantly, inhibiting the function or expression of these microglial molecules suppresses the aberrant excitability of dorsal horn neurons and neuropathic pain. These findings show that spinal microglia are a central player in mechanisms for neuropathic pain, and might be a potential target for treating the chronic pain state. KEYWORDS: Microglia; Painful diabetic neuropathy; Purinergic receptors PDF Identificación de agonistas de receptor A3 como nuevos analgésicos no narcóticos Identification of A3 adenosine receptor agonists as novel non-narcotic analgesics. Janes K1, Symons-Liguori AM1, Jacobson KA2, Salvemini D1. Author information Br J Pharmacol. 2016 Apr;173(8):1253-67. doi: 10.1111/bph.13446. Epub 2016 Mar 6. Abstract Chronic pain negatively impacts the quality of life in a variety of patient populations. The current therapeutic repertoire is inadequate in managing patient pain and warrants the development of new therapeutics. Adenosine and its four cognate receptors (A1 , A2A , A2B and A3 ) have important roles in physiological and pathophysiological states, including chronic pain. Preclinical and clinical studies have revealed that while adenosine and agonists of the A1 and A2A receptors have antinociceptive properties, their therapeutic utility is limited by adverse cardiovascular side effects. In contrast, our understanding of the A3 receptor is only in its infancy, but exciting preclinical observations of A3 receptor antinociception, which have been bolstered by clinical trials of A3 receptor agonists in other disease states, suggest pain relief without cardiovascular side effects and with sufficient tolerability. Our goal herein is to briefly discuss adenosine and its receptors in the context of pathological pain and to consider the current data regarding A3 receptor-mediated antinociception. We will highlight recent findings regarding the impact of the A3 receptor on pain pathways and examine the current state of selective A3 receptor agonists used for these studies. The adenosine-to-A3 receptor pathway represents an important endogenous system that can be targeted to provide safe, effective pain relief from chronic pain. PDF XXVII Congreso Peruano de Anestesiología Lima, Noviembre 2-4, 2017 Informes / Informataion LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org