Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review

Park, Rex; Mohiuddin, Mohammed; Arellano, Ramiro; Pogatzki-Zahn, Esther; Klar, Gregory; Gilron, Ian

doi:10.2196/22437

Cited by 8 publications

(4 citation statements)

References 33 publications

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“…The lack of patient care in the post-surgical phase results in poorly controlled post-operative pain. Inadequate PO pain management provokes harmful effects on quality of life, contributing to the development of chronic post-surgical pain [ 48 ]. Despite the knowledge regarding the molecular biology and neurology of PO pain, the clinical management of PO pain seems to be unsuccessful [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Dimethyl Fumarate (DMF) Alleviated Post-Operative (PO) Pain through the N-Methyl-d-Aspartate (NMDA) Receptors

et al. 2022

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The management of post-operative (PO) pain has generally been shown to be inadequate; therefore, acquiring a novel understanding of PO pain mechanisms would increase the therapeutic options available. There is accumulating evidence to implicate N-methyl-d-aspartate (NMDA) receptors in the induction and maintenance of central sensitization during pain states by reinforcing glutamate sensory transmission. It is known that DMF protects from oxidative glutamate toxicity. Therefore, NMDA receptor antagonists have been implicated in peri-operative pain management. Recent advances demonstrated that dimethyl fumarate (DMF), a non-opioid and orally bioavailable drug, is able to resolve neuroinflammation through mechanisms that drive nociceptive hypersensitivity. Therefore, in this study, we evaluated the role of DMF on pain and neuroinflammation in a mouse model of PO pain. An incision of the hind paw was performed, and DMF at two different doses (30 and 100 mg/kg) was administered by oral gavage for five consecutive days. Mechanical allodynia, thermal hyperalgesia and locomotor dysfunction were evaluated daily for five days after surgery. Mice were sacrificed at day 7 following PO pain induction, and hind paw and lumbar spinal cord samples were collected for histological and molecular studies. DMF administration significantly reduced hyperalgesia and allodynia, alleviating motor disfunction. Treatment with DMF significantly reduced histological damage, counteracted mast cell activation and reduced the nuclear factor kappa-light-chain-enhancer of the activated B cell (NF-κB) inflammatory pathway, in addition to downregulating tumor necrosis factor-α (TNF-α), Interleukin-1β (Il-1β) and Il-4 expression. Interestingly, DMF treatment lowered the activation of NMDA receptor subtypes (NR2B and NR1) and the NMDA-receptor-interacting PDZ proteins, including PSD93 and PSD95. Furthermore, DMF interfered with calcium ion release, modulating nociception. Thus, DMF administration modulated PO pain, managing NMDA signaling pathways. The results suggest that DMF positively modulated persistent nociception related to PO pain, through predominantly NMDA-receptor-operated calcium channels.

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Section: Discussionmentioning

confidence: 99%

Dimethyl Fumarate (DMF) Alleviated Post-Operative (PO) Pain through the N-Methyl-d-Aspartate (NMDA) Receptors

et al. 2022

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“…The review protocol has been previously published, 36 registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number CRD42020194346), and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) checklist. 34 The systematic review is performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 33 and the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) checklist.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis

Park

Mohiuddin

Arellano

et al. 2023

PR9

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“…1 A meta-analysis estimated the prevalence of moderate-tosevere postoperative pain 1 to 2 weeks after discharge to be up to 58%. 2 Individuals with poorly managed postoperative pain can experience reduced quality of life, impaired physical function, and reduced sleep. 1 Acute postoperative pain may also transition to chronic pain.…”

Section: Postoperative Pain Managementmentioning

confidence: 99%

Opioid-Sparing Effects of IV Acetaminophen for Patients Undergoing Surgery

Santos,

Lachance,

Bailey

2024

cjht

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What Is the Issue? Opioids are often used to help manage postoperative pain. However, their consumption can cause side effects, in addition to the risk of developing dependence with long-term use. Acetaminophen is an alternative analgesic that may provide opioid-sparing benefits for patients undergoing surgery (e.g., the need for patients to use opioids later), but there is a lack of synthesized evidence to confirm. Acetaminophen is available in different formulations, such as IV, oral, and rectal. However, there is uncertainty around the benefits of using 1 formulation over another perioperatively. What Did We Do? To inform decisions about IV acetaminophen, we sought to identify and summarize literature comparing the effectiveness of IV acetaminophen to alternative analgesics (i.e., nonsteroidal anti-inflammatory drugs [NSAIDs]), alternative formulations (i.e., oral or rectal acetaminophen), or placebo for reducing opioid consumption in patients undergoing surgery. A research information specialist conducted a literature search of peer-reviewed and grey literature sources published between January 1, 2019, and January 9, 2024. The search was limited to English-language documents. One reviewer screened articles for inclusion based on predefined criteria. To investigate the true effect of IV acetaminophen, we excluded studies with any intraoperative opioid use. What Did We Find? For adult patients undergoing elective hip surgery, there may be no significant differences in cumulative opioid use between postoperative IV and oral acetaminophen (1 randomized controlled trial). For patients undergoing elective cesarian delivery, postoperative IV acetaminophen may result in a decrease in total morphine consumption after surgery compared to placebo (1 randomized controlled trial). For adult patients undergoing lumbar disc surgery, there may be no significant differences in total morphine consumption for patients receiving intraoperative IV acetaminophen compared to placebo (1 systematic review with 1 relevant RCT). We did not find any studies comparing the opioid-sparing effects of IV acetaminophen to NSAIDs that met our criteria for this review. What Does It Mean? Limited evidence from this review suggests that the opioid-sparing effect of IV acetaminophen may vary across types of surgery when compared to placebo. Additionally, IV acetaminophen may not offer additional opioid-sparing benefits compared to oral administration. However, we require more comprehensive research with rigorous methodological approaches to understand this topic better. Relative to opioids, IV acetaminophen has a preferable side effect profile, including a low risk of dependence; therefore, decision-makers may wish to consider using this formulation in the surgical or postsurgical setting.

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Prevalence of Postoperative Pain Following Hospital Discharge: Protocol for a Systematic Review

Cited by 8 publications

References 33 publications

Dimethyl Fumarate (DMF) Alleviated Post-Operative (PO) Pain through the N-Methyl-d-Aspartate (NMDA) Receptors

Dimethyl Fumarate (DMF) Alleviated Post-Operative (PO) Pain through the N-Methyl-d-Aspartate (NMDA) Receptors

Prevalence of postoperative pain after hospital discharge: systematic review and meta-analysis

Opioid-Sparing Effects of IV Acetaminophen for Patients Undergoing Surgery

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