Pain is a universal phenomenon; every human being have had experienced some type of and some degree of pain during his or her life span. Roughly one third to one half of the whole population has suffered from chronic pain. During the recent past the approach towards management of chronic pain has dramatically changed. The opioid epidemic created alarm in the developed countries, and forced the clinicians to seek new pharmaceutical agents with less side effects and less potential for abuse.
Objectives: To assess the prevalence of chronic pain, its physical and psychosocial impact on daily life, and the various therapies adopted to alleviate pain. Method: The cross-sectional population-based telephonic survey was conducted from May to July 2021 at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, and comprised patients of either gender aged at least 18 years suffering from chronic pain who visited the institutional laboratory collection centres. In the first phase, people who were suffering from chronic pain were screened, while in the second phase, data was collected using a detailed questionnaire exploring pain history, treatment and its effects. The data was compiled and analysed using Antlere’s AI based software. Results: Of the 4,801 patients contacted, 757(15.75%) were suffering from chronic pain (15.75%). (201, 20%) subjects reported that there pain score was 5/10 on the numerical rating scale. Back pain was the major complaint (183, 18%) among the subjects. Of the total, 335(44.25%) were having active treatment, and 226 (67%) of them said the medication was effective. Overall, 706 (93%) patients had never visited a pain management specialist. Furthermore, 252 (33%) participants were diagnosed with depression, and 106 (14%) patients said that they were suicidal at some point in life. Conclusion: There was found to be a serious lack of awareness regarding pain management. Key Words: Chronic, Pain, Pakistan, Survey, Prevalence, Back Pain.
This book is a combination of pain medicine and psychology. It targets optimising the chronic pain before surgery to prevent the development of chronic post-surgical pain and to prevent the flair of acute on chronic pain episodes. The book has 11 chapters. First chapter describes the scope of the problem, the economic burden and related complications. There is an overview of consequences of pain chronification and opioid use. Multiple papers are cited with detailed results on pre-op and post-op problems of opioids with effects on length of stay and success rates of surgery
Maxillofacial neoplasms, though relatively rare, are potentially devastating tumors, that may require medical or surgical intervention. Among all the head and neck tumors, sino-nasal tumors make up 3%. Such tumors can be very vascular as well as extremely painful. Conventional analgesic treatment in a cascading manner usually proves to be inadequate and unsatisfactory
Background & Objectives: Radiation therapy is one of the modalities used in cancer treatment to destroy rapidly growing tumor mass. The fractionated radiation session targets up to four fields of 90 sec each, over 10-15 min. Young children require deep sedation or general anesthesia to make them immobile, for the safe delivery of radiation fractions. Common drugs used for sedation are propofol, ketamine and midazolam. Repeated exposure to anesthetic drugs over a short period of time may lead to development of tolerance and increased dose requirements. We aimed to determine if drug tolerance phenomenon develops in children receiving frequent doses of anesthetic drugs over a short time period. Methodology: This is a retrospective observational study of the pediatric population who underwent frequent radiotherapy sessions with deep sedation from January to May 2019. The data of the first and last day of drugs administered was analyzed to determine if the dose requirement for any of the three drugs increased over time. Results: We collected data of twenty-one patients and applied two tailed student’s t-test on the mean dose of drugs on the first day and the last day of the treatment. It remained unchanged with insignificant p value (propofol p = 0.15; midazolam p = 0.5; ketamine p = 0.32). To minimize the drug augmenting each other’s effect, multilinear regression analysis of the drugs over the time period showed that there was neither an increase nor a decrease in the doses used (αi- propofol coefficient 0.019 ± 0.053; βi- midazolam coefficient -0.002 ± 0.007; γi- ketamine coefficient 0.049 ± 0.218)). The overall duration of the recovery time was not different from the first to the last day of radiotherapy. Conclusion: Frequent and repeated doses of sedative drugs over a short period of time in children undergoing repeated deep sedation for radiation therapy, do not result in the development of tolerance. Key words: Sedation; Tolerance; Radiotherapy Citation: Iqbal A, Saleem H, Durrani RS. Tolerance development in children undergoing repeated exposure to anesthesia drugs for radiation therapy. Anaesth. pain intensive care 2020;24(5): Received: 7 July 2020, Reviewed: 26 August 2020, Accepted: 3 September 2020
Insulinoma is an insulin-producing tumor arising from the pancreas and secreting insulin in large quantities, which manifests itself as low blood sugar. It is a rare tumor with and incidence of only 4 cases per million developing every year. Other signs and symptoms include shakes, nervousness, vomiting, pulses, perspiration, and neuroglycopenic signs like migraine, vertigo, loss of vision, tiredness, loss of vision, amnesia, uncertainty, or convulsions. Anesthetic management aims to regulate irregular blood glucose levels as well as blood pressure. The authors present anesthetic management of two cases in this case report and discuss the consequences of insulinoma and the risks and their management during anesthesia. Key words: Tumor, Insulin producing; Diagnostic Imaging / methods; Hepatectomy; Humans; Insulinoma / diagnosis; Insulinoma / therapy; Pancreatectomy; Pancreatic Neoplasms / diagnosis; Pancreatic Neoplasms / therapy; Treatment Outcome Citation: Farooq O, Butt FR, Durrani RS. Anesthetic management of insulinoma; case report and review of literature. Anaesth. pain intensive care 2022;26(4):563-568; DOI: 10.35975/apic.v26i4.1967 Received: November 18, 2021; Reviewed: March 2022; Accepted: March 22, 2022
Human abilities are often described to be comprising of many synonymous traits including efficiency, proficiency, capability, and competency etc. The researchers include three main pillars of an individual professional or a whole system; e.g., knowledge, skill and attitude. This invited editorial covers the first two of the three, although all the three must interplay to enhance the abilities of healthcare professionals. The need of a balance of both has been emphasized, as without the one, the second will be become useless. Key words: Knowledge; Skill; Ability; Training Citation: Usman A, Gardezi AB, Durrani RS, Abid M. Knowledge and skill. Anaesth. pain intensive care 2021;25(5):_; DOI: 10.35975/apic.v25i5.1620 Received: September 15, 2021, Accepted: September 20, 2021
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