Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders

AbstractPurpose of ReviewThis review summarizes selected recent evidence on issues important for preoperative pain evaluation.Recent FindingsOpioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.SummaryPreoperative pain and psychological factors can affect postoperative pain outcomes. More work is needed in the future to develop practical interventions in the preoperative period to address these factors.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research

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For more than a century, clinicians have noticed a paradoxical phenomenon: certain patients who are taking opioids (which are supposed to numb pain) become more sensitive to pain than those who are not taking opioids. The earliest observation of this phenomenon can be traced back to the British physician Sir Clifford Allbutt, who, in 1870, described it: “at such times I have certainly felt it a great responsibility to say that pain, which I know is an evil, is less injurious than morphia, which may be an evil. Does morphia tend to encourage the very pain it pretends to relieve?” Research studies and clinical ob...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Pain Management Source Type: blogs
Conclusion: These findings support the hypothesis that in FM a deteriorated function of cortical inhibition, indexed by a higher SICI parameter, a lower function of the DPMS, together with a higher level of BDNF indicate that FM has different pathological substrates from depression. They suggest that an up-regulation phenomenon of intracortical inhibitory networks associated with a disruption of the DPMS function occurs in FM. Introduction Major depressive disorder (MDD) and fibromyalgia (FM) present overlapped symptoms. Although the connection between these two disorders has not been elucidated yet, the disruption...
Source: Frontiers in Human Neuroscience - Category: Neuroscience Source Type: research
Joong-Goo Kim1,2, Han-Bin Lee2 and Sang-Beom Jeon2* 1Department of Neurology, Jeju National University Hospital, Jeju, South Korea 2Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Objectives: The use of dexmedetomidine and ketamine (DEX–KET) combination for magnetic resonance imaging (MRI) sedation has not been evaluated. We investigated the efficacy and safety of DEX–KET for sedation of patients undergoing MRI of the brain. Methods: This quasi-experimental study was conducted to compare the DEX–KET combination and midazolam for MRI sed...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion and Future Directions G protein bias may either be affinity/potency-dominant or efficacy-dominant (Table 1). A potential concern is that, despite using the same cellular assays, variations in agonist potency were determined by different, or even the same labs, potentially due to differences in expression levels of the receptor and signaling proteins that occurred during cell passaging. For example the reported arrestin recruitment potency for U69,593 has been reported to be as low as 67.7 nM (Spetea et al., 2017) and as high as 410 nM (Dunn et al., 2018), similarly for U50,488 potency has ranged from 36 to 1000...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
In conclusion, our data show some of the brain modifications probably responsible for the behavioral phenotype associated with TBI and suggest the CBD as a pharmacological tool to improve neurological dysfunctions caused by the trauma. Introduction The phytocannabinoid cannabidiol (CBD), the major non-psychoactive constituent of Cannabis sativa, exhibits a broad spectrum of potential therapeutic properties, including neuroprotective effects in Central Nervous System (CNS) disorders (Fernández-Ruiz et al., 2013; De Gregorio et al., 2018; Schonhofen et al., 2018). Through a multitarget mechanism, CBD shows pot...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionThe study findings provide evidence for the reliability and validity of 2- and 4-item versions of the Japanese Pain Self-Efficacy Questionnaire for use in clinical and research settings.
Source: Journal of Anesthesia - Category: Anesthesiology Source Type: research
Abstract This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have ...
Source: Paediatric Anaesthesia - Category: Anesthesiology Authors: Tags: Paediatr Anaesth Source Type: research
Summary This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999‐2010; concomitantly heroin use and fatal overdoses have increase...
Source: Pediatric Anesthesia - Category: Anesthesiology Authors: Tags: EDUCATIONAL REVIEW Source Type: research
Conclusions: Currently available immersive virtual reality technology with myolectric and motion tracking control may represent a possible therapy option for treatment-resistant phantom limb pain. Keywords: virtual reality, phantom limb pain, rehabilitation, amputation, therapy, pain Innov Clin Neurosci. 2017;14(7–8):3–7 Phantom limb pain (PLP), the sensation of pain in an absent limb, is a frequent complication after amputation, with reported prevalence rates ranging from 40 to 85 percent.1,2 While the exact mechanism of PLP remains to be elucidated, peripheral and central neural factors are thought to contrib...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Case Report Current Issue amputation pain phantom limb pain rehabilitation therapy virtual reality Source Type: research
AbstractNeuropathic pain, a maladaptive and chronic condition that can develop after a lesion or disease affecting the somatosensory system, is characterized by allodynia, hyperalgesia and spontaneous pain, and comorbidities such as sleep deprivation, depression and anxiety. The activation of microglial cells in response to nerve injury has been implicated in the development of neuropathic pain. Mediators such as Neuregulin-1, matrix metalloproteinase (MMP)-2, MMP-9, The chemokine (C-C motif) ligand 2 (CCL2) and fractalkine are released after nerve injury and are involved in the activation of microglial cells. These activa...
Source: British Journal of Anaesthesia - Category: Anesthesiology Source Type: research
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