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10 June 2012
HOT TOPICS: Pain Medicine - Last year's top publications -
Ian POWER (Edinburgh, United Kingdom)
Last year’s top publications in pain medicine will be the focus of a session on Sunday, presented by Professor Patricia Lavand’homme (University Catholic of Louvain and Department of Anaesthesiology, St Luc Hospital UCL Medical School, Brussels, Belgium). Lavand’homme, who is also Chair of the ESA subcommittee on Acute and Chronic Pain, will put the findings of each paper into context.
Despite the availability of multiple analgesics, relieving acute postoperative pain remains a challenge for some patients as 30% of them experience severe pain. Pain resulting from an incision is mainly driven by inflammatory processes, and steroids may be considered as the ultimate anti-inflammatory drug. Currently, they are used at low dose for the prophylaxis of postoperative nausea and vomiting. “The meta-analysis of De Oliveira et al, published in Anesthesiology
, shows that steroids, particularly when administered before surgery or at the induction of anaesthesia, ameliorate 4-hour and 24-hour postoperative pain not only at rest, but also during mobilisation,” says Lavand’homme. “More studies are needed to clearly define the risk-benefit ratio of perioperative steroid administration.”
Another paper covered in session is the meta-analysis ‘Effect of Perioperative Systemic α2 Agonists on Postoperative Morphine Consumption and Pain Intensity’ (Blaudszun and colleagues, in press, also in Anesthesiology
). This paper, unsurprisingly, concludes that perioperative systemic α2 agonists, clonidine and the more α2 selective dexmedetomidine, decrease postoperative opioid consumption, pain intensity, and nausea. Common adverse effects are bradycardia and arterial hypotension.
“This paper is the opportunity to compare α2 agonists—which are currently used in clinical practice based on personal habits rather than evidence—with other analgesic and antihyperalgesic adjuvants in terms of postoperative analgesia, opioid sparing effect and prevention of opioid-induced side effects,” says Lavand’homme. This is a crucial study since, she says, the impact of administration of perioperative α2 agonists on chronic pain or hyperalgesia currently remains unclear because valid data are lacking. Lavand’homme will mention an ongoing trial (POISE-2 / PeriOperative Ischemic Evaluatation-2) which will include 10 000 patients and should be completed by 2014. This study will have, as one of its secondary endpoints, the impact of perioperative clonidine on the development of persistent pain after surgery.
Other papers covered in the session will be include Johansen et al: Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study (Pain
, in press). Papers regarding new developments in the field of opioid therapy will be discussed: chronic pain patients under chronic opioid treatment demonstrate worse acute postoperative pain
resolution than chronic pain patients who don’t use opioids (Chapman et al, J Pain
2011); Preclinical pharmacology and opioid combinations. (Pasternak, Pain Medicine
, 2012). Time-permitting, Lavand’homme will also cover the Science
paper ‘Erasure of a Spinal Memory Trace of Pain by a Brief, High-Dose Opioid Administration’ (Drdla-Schutting and colleagues); and also another article in press with Pain
: Conditioned pain modulation (CPM) predicts duloxetine efficacy in painful diabetic neuropathy (Yarnitsky and colleagues).
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