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Open access

Adriana Miclescu

Abstract

Severe chronic pain is often devastating for the affected individuals causing substantial suffering, health impairment, and a very low quality of life, including significant negative consequences for the patient and for society. Patients with complex pain disorders are seen often in relation to anaesthesia. They deserve special attention and require long time hospitalization and multiple contacts with health-care providers after discharge from hospital. A wider adoption of best perioperative and intraoperative pain management practice is required. This paper reviews current knowledge of perioperative and intraoperative pain management and anaesthetic care of the chronic pain patient. The individual topics covered include the magnitude of the problem created by chronic pain, the management of the patients taking various types of opioids, tolerance and opioid induced hyperalgesia and the multidisciplinary approach to pain management. The preventive and preemptive strategies for reducing the opioid needs and chronic pain after surgery are reviewed. The last section includes the role of acute pain services and an example of the implementation of a transitional pain service with the various benefits it offers; for example, the decrease of the opioid dose after discharge from the hospital. Patients also receive the continuity of care, with not only pain relief but also improvements in physical functioning, quality of life and emotional stress.

Open access

Lilia Suchocka, Kazimierz Popielski and Małgorzata Pasek

Abstract

Introduction. The most frequent type of acute pain is the postoperative pain. The postoperative situation consists of three stages: the preoperative stage, the surgical phase, and the postoperative stage. Each of the stages is equally important, and it is crucial that medical staff should minimize the stress and discomfort related to hospitalization. Specialists suggest that the preparation to surgery should correspond to the patient’s style of responding to stress. The level of individually experienced pain depends not only on the type of surgery, but also on psychological factors and the patient’s personality traits.

Aim. The aim of the study was to analyze the factors that affect the experience of acute pain in postoperative patients.

Material and methods. The study was conducted in Lublin, Poland, and comprised 100 patients of the local surgical wards. After incomplete tests were excluded, the group of 68 patients (37 women and 31 men, aged 20-73) was selected. The following test methods were used: The McGill Pain Questionnaire (MPQ) by R. Melzack, Test Noo-dynamiki [The Test of Noo-Dynamics] (T.N-D) by K. Popielski, Kwestionariusz Poczucia Odpowiedzialności [The Sense of Responsibility Questionnaire] (KPO) by L. Suchocka, The IPAT Anxiety Scale Questionnaire (Self Analysis Form) by R.B. Cattell.

Results. The study results show that the evaluation of pain is affected, at the statistically significant level, by the patients’ subjective experience of feeling ill, their surgery-related discomfort, and the intensity of pain. The patients who are not oriented towards future goals and tasks, closing upon themselves, evaluate the postoperative situation as difficult and distressing. The orientation towards new goals motivates the patients to fast recovery.

Conclusion. The test results confirmed the research hypotheses. The study findings may be useful for medical professionals interested in the functioning of an individual in the situation of disease.

Open access

Andrada Ciucă and Adriana Băban

Abstract

The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. It has been proved that chronic pain is more strongly related to psychological factors than to treatment or illness related factors. Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.

Open access

Elif Erdogan and Ecder Ozenc

Abstract

Objectives: The aim of this study was to analyse the relationship between types of anaesthesia, patients’ demographic variables, preoperative emotional states and the prevalence of postoperative pain. Method: In this randomized prospective study, postoperative pain was assessed in 100 patients, who were ASA (American Society of Anaesthesiologist) I-II and between 18-65 years old, undergoing inguinal herniorrhaphy with either general or spinal anaesthesia. In addition, postoperative pain compared with patients’ demographic properties and psychological conditions in each group was also considered. Acute pain was evaluated at 1, 2, 4, 6, 12 and 24th hours with the Numerical Rating Scale (NRS) and chronic neuropathic pain was at 1, 2 and 3rd months with Douleur Neuropathique 4 Questions (DN4). All patients were treated with the same analgesics after operation. Results: Group spinal anaesthesia had lower acute pain at 1 and 2nd hours but they felt more severe pain at the 24th hour. Also patients’ anxieties were correlated with acute and chronic postoperative pain. Ten patients complained about postoperative chronic pain after 3 months and there was no significant difference between groups. Conclusion: Spinal anaesthesia decreased acute pain intensity at the first postoperative hours. Patients with anxiety felt high pain levels and they had an increased chronic pain prevalence.

Open access

Beata Kubic-Filiks, Agnieszka Koszuta and Jolanta Szymanska

Abstract

Chronic nicotinism has negative effects, both local and systemic. Its local effects are related to both the immediate thermal influence, as well as the toxic action of the substances contained in the smoke. In addition, the microflora colonizing dental plague is changed. The damage and the inflammatory processes that are incurred, affect the bone tissue of the alveolar processes, the mucosa, gums, and the tooth enamel. In this study, the tobacco smoking-related profile of patients being treated by way of implants was determined. Moreover, the relationship between cigarette smoking and pain sensation was assessed in patients undergoing surgical and prosthetic procedures in the oral cavity. The questionnaire survey covered 464 patients receiving prosthetic treatment at the “Dental” Non-Public Health Care Centre in Tomaszow Mazowiecki. The patients answered questions concerning their sex, age, the period of smoking, number of cigarettes smoked per day and the sensation of pain during bone reconstruction, implant placement and prosthetic procedures. The most numerous group of patients treated with implants were women: either non-smoking or smoking for less than 20 years at a level of less than 20 cigarettes a day, and men aged 40-60 years who have been smoking for over 20 years, at more than 20 cigarettes a day. The results of the survey reveal that non-smoking patients felt pain during bone reconstruction, implant placement and prosthetic procedures more frequently.

Open access

Dominique Lossignol

Abstract

Steroids are widely used in oncology and have been demonstrated to possess an anticancer effect or antiswelling effect. They are considered to improve refractory symptoms such as dyspnea or gastrointestinal (GI) obstruction. However, their roles in nonspecific indications are not well proved. Clinical practice and several studies suggest that corticosteroids may be effective in the treatment of bone and neuropathic pain, when administered along with opioids and with other adjuvant analgesics. The decrease in pain intensity is probably connected with both anti-inflammatory and antiswelling effects as well as modulation of neuroimmune interactions and an inhibition of angiogenesis.

Open access

Camelia Ciobotaru, Madalina Iliescu and Oana Arghir

Abstract

Although the knee osteoarthritis is often benign, severe degenerative modifications can determine serious malfunction. In joints affected by arthritic processes, Sodium hyaluronate is found in reduced concentrations, the normal articular cartilage being replaced by fibrocartilage [6].

The present concepts suggest that osteoarthritis is not a predictable stage in ageing and prophylactic and therapeutic approaches could be taken in the future

Open access

A. Bratu, Z. Panti, A. Comanelea, R. Ene and C. Cîrstoiu

Abstract

Introduction. The increasing number of tumor prosthesis in the last decade shows the advance in musculoskeletal oncology. Limb sparing surgery nowadays has to be the focus in surgery, maintaining the patient’s quality of life. Prognosis depends on the histological type of tumor, size, and local extension. Pain is present in almost any cases of bone tumors and can vary in intensity and character. Being the leading symptom is strongly correlated to the quality of life. The purpose of this study was to evaluate pain in patients with primary bone sarcomas before and after surgery. Material and methods. 11 patients were involved in this study over a period of 4 years (2014-2017) from the Orthopedics and Traumatology Department in the University Emergency Hospital in Bucharest. Tumor resection and reconstruction with modular prosthesis was performed in 4 cases, and tumor resection was necessary in 3 cases and amputation in 4 cases. Pain was evaluated before and after surgery using the Visual Analog Scale (VAS). Early postoperative pain control was achieved with epidural catheter, followed by opioid therapy, NSAIDs and Paracetamol in the early stages of mobilization. Results. Surface sarcomas and tumors close to the periosteum, or periosteal involvement has shown a localized and increased pain. Multimodal-analgesia was used for pain management. Within the first 48 hours, analgesia was performed with an epidural catheter by continuous infusion of ropivacaine 0.2% and fentanyl 2mcg/ ml at a rate ranging between 3-6 ml/ h, obtaining a VAS score between 0 and 3. Conclusions. Perioperative pain management has to be individualized to the localization and local soft tissue involvement of the tumor. In late stages of sarcomas or local recurrence, conventional analgesics can be inefficient. Early diagnosis and surgical removal of these tumors is the most important objective for a good prognosis.

Open access

Davina Wildemeersch, Michiel Baeten, Natasja Peeters, Vera Saldien, Marcel Vercauteren and Guy Hans

Abstract

Background. Pupillary response by pupillary dilatation reflex (PDR) is a robust reflex, even measurable during general anaesthesia. However, the ability of infrared pupillometry to detect PDR differences obtained by intraoperative opioid administration in anaesthesized patients remains largely unknown. We analyzed the performance of automated infrared pupillometry in detecting differences in pupillary dilatation reflex response by a inbuilt standardized nociceptive stimulation program in patients under general anesthesia with a standardized propofol/fentanyl scheme. Methods. In this single center, interventional cohort study 38 patients (24-74 years) were enrolled. Patients were anesthetized with propofol until loss of consciousness. Two dynamic pupil measurements were performed in each patient (before opioid administration and after opioid steady state). Automated infrared pupillometry was used to determine PDR during nociceptive stimulations (10-60 mA) applied by a inbuilt pupillary pain index protocol (PPI) to the skin area innervated by the median nerve. Increasing stimulations by protocol are device specific and automatically performed until pupil dilation of > 13%. Pupil characteristics, blood pressure, heart rate values were collected. Results. After opioid administration, patients needed a higher stimulation intensity (45.26 mA vs 30.79 mA, p = 0.00001). PPI score showed a reduction after analgesic treatment (5.21 vs 7.68, p = 0.000001), resulting in a 32.16% score reduction. Conclusions. PDR via automated increased tetanic stimulation may reflect opioid effect under general anaesthesia. Further research is required to detect possible confounding factors such as medication interaction and optimization of individualized opioid dosage.

Open access

Maja Vasiljević, Dragan Ristanović, Milan Jovanović, Darko Davitkov, Ivan Bošnjak, Vanja Krstić and Zoran Stanimirović

Abstract

The aim of this study was to evaluate the parameters of intraoperative and postoperative pain in bitches undergoing laparoscopic or conventional ovariectomy. The study was conducted on 20 healthy, adult bitches of medium and large breeds. All the bitches were subjected to the same anesthetic protocol. Carprofen was applied preoperatively, and general anaesthesia was carried out with a combination of medetomidine, propofol and sevoflurane. The bitches were divided into two groups of 10 individuals each. The first group underwent conventional ovariectomy while the second one was subjected to the laparoscopic procedure. The intensity of intraoperative pain was estimated at different time points by measuring changes in heart and respiratory rate, arterial blood pressure, and body temperature. A multifactor pain scale was used to assess the intensity of postoperative pain. Dogs in the group which was scheduled for conventional ovariectomy (COV group) responded to painful intra-operative stimuli with increased heart rate and respiratory rate. Arterial blood pressure and body temperature decrease was detected in COV group. Laparoscopic ovariectomy induced less intra- and postoperative pain when compared to conventional ovariectomy. Beside that, the total anaesthesia time and postoperative recovery were shorter in dogs that underwent laparascopic ovariectomy.