Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2025
ReviewUpskilling pain relief after surgery: a scoping review of perioperative behavioral intervention efficacy and practical considerations for implementation.
Perioperative skills-based interventions may support non-pharmacological management of pain and opioid reduction after surgery. Such interventions may target and enhance predictors for surgical recovery and possibly reduce chronic postsurgical pain. Existing meta-analyses are limited by inclusion of studies that are either non-surgical or with outcomes occurring only in the hours after surgery. ⋯ No studies tested whether the interventions enhanced time to pain cessation after surgery. Four studies demonstrated durable analgesic effects at 3-12 months after surgery. We describe the real-world practicality of intervention integration into the perioperative pathway and provide dissemination and implementation methodologies that may increase intervention uptake and therefore fulfill calls from national agencies to better integrate behavioral pain treatments into perioperative care.
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Reg Anesth Pain Med · Feb 2025
ReviewPostamputation pain: a multidisciplinary review of epidemiology, mechanisms, prevention, and treatment.
Despite humanity's long experience with amputations, postamputation pain remains a highly prevalent, incompletely understood, and clinically challenging condition. There are two main types of postamputation pain: residual limb pain (including but not limited to the "stump") and phantom limb pain. ⋯ Central, peripheral, and spinal mechanisms may all contribute to the protean manifestations of persistent postamputation pain; an improved understanding of these mechanisms will be essential to identify the most promising interventions for the prevention and treatment of postamputation pain. Although there are currently no standardized prevention or treatment recommendations for any type of postamputation pain, an evidence-based, multimodal strategy including pharmacological agents, nonsurgical procedures, surgery, complementary and integrative techniques, and assistive technologies may prevent the development of chronic postamputation pain after amputation and/or optimize treatment outcomes.
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Reg Anesth Pain Med · Feb 2025
ReviewChronic postsurgical pain and transitional pain services: a narrative review highlighting European perspectives.
Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements. ⋯ Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact.
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Reg Anesth Pain Med · Feb 2025
ReviewEvidence for regional anesthesia in preventing chronic postsurgical pain.
Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for mitigating CPSP remain uncertain. Regional anesthesia is a potentially beneficial yet debated intervention for mitigating the risk of CPSP. ⋯ Techniques studied include wound infiltration, peripheral nerve blocks, fascial plane blocks, thoracic paravertebral blocks and epidural anesthesia. Current data indicate that epidural anesthesia might decrease CPSP risk following thoracotomy, wound infiltration may be effective after major breast surgery and cesarean delivery, and serratus anterior plane block or pectoralis/interpectoral plane blocks might be beneficial in breast surgery. However, the existing evidence is limited and marked by several constraints especially the multifactorial causes, underscoring the need for further research in this area.
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Reg Anesth Pain Med · Feb 2025
ReviewMachine learning research methods to predict postoperative pain and opioid use: a narrative review.
The use of machine learning to predict postoperative pain and opioid use has likely been catalyzed by the availability of complex patient-level data, computational and statistical advancements, the prevalence and impact of chronic postsurgical pain, and the persistence of the opioid crisis. The objectives of this narrative review were to identify and characterize methodological aspects of studies that have developed and/or tested machine learning algorithms to predict acute, subacute, or chronic pain or opioid use after any surgery and to propose considerations for future machine learning studies. Pairs of independent reviewers screened titles and abstracts of 280 PubMed-indexed articles and ultimately extracted data from 61 studies that met entry criteria. ⋯ We identified variability in sample size, number and type of predictors, and how outcome variables were defined. Patient-reported predictors were highlighted as particularly informative and important to include in such machine learning algorithms, where possible. We hope that findings from this review might inform future applications of machine learning that improve the performance and clinical utility of resultant machine learning algorithms.