Articles: chronic-pain.
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Reg Anesth Pain Med · Feb 2025
ReviewRole of peripheral nerve stimulation and percutaneous cryoneurolysis in preventing chronic postsurgical pain.
Poorly controlled pain during the acute postoperative period is associated with the development of persistent or 'chronic' pain lasting months or years after surgery. Relatively small trials suggest that local anesthetic-based peripheral nerve blocks lasting hours or a few days may decrease persistent postsurgical pain for some surgical procedures, but definitive data is lacking. Two possible alternatives-percutaneous cryoneurolysis and peripheral nerve stimulation-are analgesic modalities with the potential to provide weeks or months of pain relief following surgery. This increase in analgesic duration raises the possibility of decreased transition from acute to chronic postsurgical pain. ⋯ This review describes percutaneous cryoneurolysis and peripheral nerve stimulation for perioperative analgesia as well as the available evidence supporting their use to prevent persistent postsurgical pain.
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Reg Anesth Pain Med · Feb 2025
ReviewInnovations in acute and chronic pain biomarkers: enhancing diagnosis and personalized therapy.
Pain affects millions worldwide, posing significant challenges in diagnosis and treatment. Despite advances in understanding pain mechanisms, there remains a critical need for validated biomarkers to enhance diagnosis, prognostication, and personalized therapy. This review synthesizes recent advancements in identifying and validating acute and chronic pain biomarkers, including imaging, molecular, sensory, and neurophysiological approaches. ⋯ Rigorous validation and standardization efforts are also necessary to ensure these biomarkers are clinically useful. Large-scale collaborative research will be vital to driving progress in this field and implementing these biomarkers in clinical practice. This comprehensive review highlights the potential of biomarkers to transform acute and chronic pain management, offering hope for improved diagnosis, treatment personalization, and patient outcomes.
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Reg Anesth Pain Med · Feb 2025
ReviewN-Methyl-D-aspartate receptor antagonists for the prevention of chronic postsurgical pain: a narrative review.
The N-methyl-D-aspartate receptor (NMDAR) has been linked to the development of chronic postsurgical pain (CPSP), defined as pain after surgery that does not resolve by 3 months. Once the combination of a painful stimulus and glutamate binding activates the NMDAR, calcium influx triggers signaling cascades that lead to processes like central sensitization and CPSP. Three of the most widely studied perioperative NMDAR antagonists include ketamine, magnesium, and methadone, with ketamine having garnered the greatest amount of attention. ⋯ Existing meta-analyses of ketamine for CPSP are inconsistent in their findings, and studies of magnesium and methadone are even more limited. Overall, the evidence supporting NMDAR antagonists for CPSP is weak and we recommend that future studies focus on high-risk patients and potentially include combinations of NMDAR antagonists administered together for the longest duration feasible. The results of ongoing trials could have a major influence on the overall direction of the evidence supporting NMDAR antagonists in preventing CPSP.
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Chronic pain after surgery, also known as chronic postsurgical pain (CPSP), is recognized as a significant public health issue with serious medical and economic consequences. Current research on CPSP underscores the significant roles of both peripheral and central sensitization in pain development and maintenance. Peripheral sensitization occurs at the site of injury, through the hyperexcitability of nerve fibers due to surgical damage and the release of inflammatory mediators. ⋯ These glial cells release substances that further increase neuronal excitability, maintaining the sensitized state and contributing to persistent pain. The activation of antinociceptive systems is required for the resolution of pain after surgery, and default in these systems may also be considered as an important component of CPSP. In this review, we will examine the clinical factors underlying CPSP in patients and the mechanisms previously established in preclinical models of CPSP that may explain how acute postoperative pain may transform into chronic pain in patients.