Current treatment options for acute pain

Abstract

The pain that accompanies surgical procedures remains prevalent and is an aspect of the perioperative experience that generates the greatest concern for patients about to undergo surgery. There is also a growing recognition of the extent that acute painful experiences can lead to longer-term painful consequences, even when tissue healing appears to be complete. The neurobiologic basis of this has been partially elucidated. The key observations are that multiple sites and multiple receptors collectively contribute, and that noxious stimuli initiate a cascade of events that sensitise the nervous system so that subsequent noxious stimuli are perceived with greater intensity and even previously non-painful stimuli can be painful. Incorporating these observations into effective perioperative regimens designed to limit acute pain and its consequences leads to a multimodal pre-emptive approach to acute pain management. Acute perioperative pain is an ideal setting for the use of pre-emptive analgesic techniques because the timing of noxious stimuli is known in advance and surgical sensitisation of the nervous system is ongoing despite adequate levels of general anaesthesia with volatile anaesthetics. The relevant neurobiology of pain, reviewed in this article, is the basis for advocating an aggressive, multimodal, pre-emptive approach to acute pain therapy throughout the entire perioperative period. A growing body of outcome studies demonstrates the long-term efficacy of this approach.

Responses of Heart Rate Variability to Acute Pain After Minor Spinal Surgery

“…27 Ushiyama et al 28 observed a relationship between sympathetic activation, surgical stress, and noncardiac postoperative complications such as leakages of anastomoses, delays in wound healing due to wound inflammation, and infections. 30,31 HRV has also been applied in monitoring sympathetic neural drive blockade by analgesia, revealing the superiority of thoracic epidural analgesia to patient-controlled analgesia. 29 This protocol involving systemic medication and wound infiltration with local anesthetic has been adopted by our team as a procedure-specific postoperative pain management plan recommended by experts.…”

General Anesthetics Sensitize the Capsaicin Receptor Transient Receptor Potential V1

“…One strategy is through the use of nonpungent agents such as sevoflurane; these nonpungent VGAs have no activity at TRPA1 (Matta et al, 2008) and significantly less activity at TRPV1 compared with pungent VGAs. Another strategy is the use of preemptive analgesia with local anesthetics and opioids (Wilder-Smith, 2000;Gottschalk et al, 2002). However, although these drugs would inhibit C-fiber discharge and transmission in the spinal cord, they would not prevent direct activation of TRPV1 and TRPA1 and the resultant neuropeptide secretion at nerve terminals.…”

Pain Experience of Children with Sickle Cell Disease Who Had Prolonged Hospitalizations for Acute Painful Episodes

“…The unpredictable, recurrent, intense, and frequently persistent nature of pain associated with SCD poses a difficult challenge in terms of management. There is a growing recognition that acute painful experiences can lead to long‐term painful consequences, even when the inflammatory and hemolytic process accompanying the VOE appears to have resolved [4]. The severity of acute painful episodes varies widely and a small subset of patients had frequent hospitalizations.…”