Clinical Case Database / Category: Patient Management

Chronic pain in the acute elective surgical setting

Publication details

Kirsty Dolphin, Janine Mendham
Foundation Years Journal, volume 9, issue 8, p.15 (123Doc Education, London, September 2015)

Abstract

This summary covers the pathophysiology of pain alongside analgesic approaches to management of acute pain in patients with chronic pain as a case study. It will take you through a case from pre-operative assessment and the use of adjuvant therapy through to potential complications of acute pain management with questions to test yourself throughout.

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Authors

Kirsty Dolphin (Corresponding author)

Foundation Year 2 Doctor
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB
Kirsty.Dolphin@nbt.nhs.uk

Janine Mendham

Consultant Anaesthetist and Pain Clinician
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB
Janine.Mendham@nbt.nhs.uk

References

1. British Pain Society. Living with pain https://www.britishpainsociety.org/people-with-pain/frequently-asked-questions/
2. Woolf CJ. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004, 140:441-451.
3. Woolf CJ and Thompson SW. The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation; implications for the treatment of post-injury pain hypersensitivity state. Pain 1991, 44:293-9.
4. Pain Europe. WHO analgesic ladder http://www.paineurope.com/articles/reassessing-the-need-for-step-2-of-the-who-analgesic-ladder.
5. Albrecht E, Kirkham KR, Liu SS, et al. Peri-operative intravenous administration of magnesium sulphate and postoperative pain: a meta-analysis. Anaesthesia 2013, 68:79-90.
6. De Oliveira GS, Castro-Alves LJ, Khan JH, et al. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anaesthesiology 2013, 119:178-90.
7. Loftus RW, Yeager MP, Clark JA et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anaesthesiology 2010, 113:639-46
8. Sung CS, Lin SH, Chan KH, et al. Effect of oral clonidine premedication on perioperative hemodynamic response and postoperative analgesic requirement for patients undergoing laparoscopic cholecystectomy. Indian J Anaesth 2011, 55:26–30.
9. Hidalgo MP, Auzani JA, Rumpel LC, et al. The clinical effect of small oral clonidine doses on perioperative outcomes in patients undergoing abdominal hysterectomy. Anaesth analg 2005, 100:795-802.
10. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anaesth analg 2005, 101:5-22.
11. Fletcher D and Martinez V. Opioid induced hyperalgesia after surgery: a systematic review and a meta-analysis. Br J Anaesthesia , 2014,112:991-1004
12. Farrell C and McConaghy P. Perioperative management of patients taking treatment for chronic pain. BMJ 2012, 3:345.
13. Thomas V. Psychological characteristics and the effectiveness of patient-controlled analgesia. Br J Anaesth 1995, 74:271-6.
14. Taylor N, Hall G and Salmon P. Is patient controlled analgesia controlled by the patient? Soc Sci Med 1996, 43:1137-43.
15. Clarke H, Bonin RP, Orser BA, et al. The prevention of chronic postsurgical pain using gabapentin and pregabalin: a combined systematic review and meta-analysis. Anaesth analg 2012, 115:428-42.
16. Electronic Medicines Compendium. Summary of product characteristic https://www.medicines.org/uk/EMC/medicine/16787
17. Ashburn M, Lazarre Odgen L, Zhang J, et al. The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003, 46:291-297.
18. Boyer EW and Shannon M. The serotonin syndrome. N Engl J Med 2005, 352:1112.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.