Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers

Rajput, Kanishka; Vadivelu, Nalini

doi:10.1007/s11916-020-00922-3

Cited by 13 publications

(13 citation statements)

References 70 publications

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“…These individuals become chronic pain patients, and the management strategies for such patients are more challenging and more complex; still, they often do not produce totally positive outcomes. This phenomenon of chronification and treatment resistance has been reported for several regional conditions such as low back pain, headaches and several types of oro‐facial pain, as well as a number of widespread pain disorders like fibromyalgia 1,2 …”

Section: Introductionmentioning

confidence: 68%

“…This phenomenon of chronification and treatment resistance has been reported for several regional conditions such as low back pain, headaches and several types of oro‐facial pain, as well as a number of widespread pain disorders like fibromyalgia. 1 , 2 …”

Section: Introductionmentioning

confidence: 99%

“…This phenomenon of chronification and treatment resistance has been reported for several regional conditions such as low back pain, headaches and several types of oro-facial pain, as well as a number of widespread pain disorders like fibromyalgia. 1,2 Among the oro-facial pain conditions, the most prominent ones are the temporomandibular disorders (TMDs). 3 These disorders afflict about 10%-15% of the population at a clinically significant level, that is with symptoms severe enough to require professional treatment.…”

Section: Introductionmentioning

confidence: 99%

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Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Greene

Manfredini

2021

J of Oral Rehabilitation

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Background Based on a variety of studies conducted in recent years, some of the factors that might contribute to the negative treatment responses of some TMD patients have been elucidated. Methods This paper describes known vulnerability factors that make individuals susceptible to developing temporomandibular disorders (TMDs), as well as those that contribute to the perpetuation of such problems. In addition, the topic of iatrogenesis is discussed as a major contributor to the negative outcomes that can be seen in this field. Results At the patient level, anatomical, psychosocial and genetic factors may contribute to individual vulnerability. The anatomy and pathophysiology of muscles, joints, disc and nerves may all be involved in predisposing to TMD symptoms, especially when the patients have pain elsewhere in the body. Among the psychosocial factors, some features may be elucidated by the DC/TMD axis II, while others (eg illness behaviour, Munchausen syndrome, lack of acceptance of non‐mechanical approaches) require careful evaluation by trained clinicians. Genetic predisposition to first onset TMDs and to chronification of symptoms has been identified for individuals with certain psychological traits, presence of comorbid conditions and certain abnormal clinical manifestations. Regarding iatrogenesis, sins of omission may influence the clinical picture, with the main ones being misdiagnosis and undertreatment. Joint repositioning strategies, occlusal modifications, abuse of oral appliances, use of diagnostic technologies, nocebo effect and complications with intracapsular treatments are the most frequent sins of commission that may contribute to chronification of TMDs. The patients who present with massive occlusal and jaw repositioning changes combined with persistent severe orofacial pain are not a rarity within TMD and orofacial pain canters; these patients are the most difficult ones to manage because of this horrific combination of negative factors. Conclusions The information presented in this paper will help clinicians to understand better why some individuals develop temporomandibular disorders, why some of them will progress to becoming chronic patients, and what the appropriate responses may be.

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Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Greene

Manfredini

2021

J of Oral Rehabilitation

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“…A preoperative physical exam allows for baseline characteristics of mobility and functionality, and in chronic pain populations, may allow for careful planning of intraoperative positioning in efforts to mitigate postoperative discomfort [1 ▪▪ ]. Patients taking chronic mu-opioid receptor agonists like morphine, oxycodone, or hydromorphone should generally be advised to continue home doses up to and including the day of surgery [1 ▪▪ ,2]. Fentanyl patches should be identified, and care should be taken to avoid excessive heat or moisture to the patch area; if removed, a new patch may be applied with knowledge that effective levels are reached after 6–12 h [2].…”

Section: General Perioperative Strategies For Opioid Tolerant Patient...mentioning

confidence: 99%

“…Patients taking chronic mu-opioid receptor agonists like morphine, oxycodone, or hydromorphone should generally be advised to continue home doses up to and including the day of surgery [1 ▪▪ ,2]. Fentanyl patches should be identified, and care should be taken to avoid excessive heat or moisture to the patch area; if removed, a new patch may be applied with knowledge that effective levels are reached after 6–12 h [2]. Lastly, managing expectations and outlining strategies for coping mechanisms postoperatively are essential for creating a shared, collaborative goal with the patient; by engaging in this conversation, clinicians may maximize the chance of patients experiencing a successful recovery period.…”

Section: General Perioperative Strategies For Opioid Tolerant Patient...mentioning

confidence: 99%

Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder

Burns

Majdak

Urman

2022

Current Opinion in Anaesthesiology

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Purpose of reviewThe increasing prevalence of opioid tolerant individuals, in combination with the expanding scope and utilization of nonoperating room anesthesia (NORA) necessitates ongoing investigation into best clinical practice for managing surgical/procedural pain in this population. The purpose of this article is to review recent guidelines, identify specific challenges, and offer considerations for managing pain in patients who are opioid tolerant secondary to opioid use disorder (OUD), with or without medications for the treatment of OUD. Recent findingsA comprehensive preoperative evaluation in conjunction with a multidisciplinary, multimodal pain approach is optimal. NORA adds unique situational and environmental challenges for optimizing acute on chronic pain control in tolerant individuals while maintaining safety. Direct and partial/mixed mu-agonists should typically be continued throughout the perioperative period, while mu-antagonists (naltrexone) should be held 72 h. Postprocedural discharge instructions and follow-up must be carefully arranged and ensured. SummaryClinical recommendations continue to evolve as new consensus guidelines are published, although institution-specific guidelines are most often followed. This review focuses on most recent best practices, within NORA and operating room settings, for managing opioid tolerant patients, patients with OUD and those on medications for the treatment of OUD.

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Hypogastric Plexus Blocks

Chung,

Galang

2024

Essentials of Interventional Techniques in Managing Chronic Pain

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Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers

Cited by 13 publications

References 70 publications

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Transitioning to chronic temporomandibular disorder pain: A combination of patient vulnerabilities and iatrogenesis

Perioperative and Periprocedural anesthetic management of opioid tolerant patients and patients with active and medically treated opioid use disorder

Hypogastric Plexus Blocks

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