Regional anesthesia and pain medicine
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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
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.
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Reg Anesth Pain Med · Feb 2025
Review Meta AnalysisPrevalence of and recommendation for measuring chronic postsurgical pain in children: an updated systematic review and meta-analysis.
According to the prior 2017 review (Rabbitts et al), approximately 20% of children and adolescents develop chronic postsurgical pain (CPSP; ie, pain persisting >3 months after surgery) after major surgeries, which is associated with adverse functional and psychological consequences. A major barrier was that definitions of CPSP applied were highly variable. Since that prior review was conducted (n=4 studies in meta-analysis), numerous relevant studies have been published warranting an update. ⋯ CRD42022306340.