Articles: chronic.
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Chronic pain after surgery is a major public health problem and a major concern for perioperative physicians. Thoracic surgery presents a unique challenge, as thoracotomy is among the highest risk surgeries to develop persistent postsurgical pain. The purpose of this review is to discuss the relevance of research in pain epigenetics to patients with persistent pain after thoracic surgery. ⋯ The transition from acute to chronic pain after thoracic surgery may be mediated by epigenetics. Here, we discuss epigenetic modifications that have been discovered in animal models of chronic pain that may predispose patients to persistent neuropathic pain after thoracic surgery.
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Addiction to alcohol and illicit drugs occurs in approximately 10% of the Canadian population and thus likely affects numerous perioperative patients. Provision of perioperative analgesia to these patients is challenging for physiological and behavioural reasons. Seven electronic databases were searched to identify papers addressing the perioperative management of analgesia in addicted patients. ⋯ Perioperative analgesic management of addicted patients remains poorly understood. Most clinical trials specifically exclude addicted patients. Suggestions for management are provided.
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The purpose of this article is to review the literature and to highlight current practice regarding the management of the chronic pain patient presenting for surgery. ⋯ Successful management of the complex pain patient requires knowledge of the art and science of perioperative medicine.
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This article describes the rationale for the creation of pain medicine as a subspecialty in Canada and outlines a brief history of its development. ⋯ With the inception of this subspecialty, the treatment of acute pain, cancer pain, and chronic non-cancer pain will be further integrated within the Canadian healthcare system.