Ugeskrift for laeger
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Total knee arthroplasty (TKA) is associated with considerable postoperative pain which may be difficult to manage. This article describes advantages and disadvantages of the different analgesic techniques used for pain treatment after TKA, for example i.v. patient-controlled analgesia, epidural pain treatment, and peripheral nerve blocks (especially femoral and sciatic blocks). Randomised studies suggest that peripheral nerve blocks have the best effect and have fewest side effects. Intra-articular administration of analgesics is the most recently introduced technique.
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The purpose of this survey was to map the sale of analgesics in the Danish primary care sector from 2000 to 2004. ⋯ In 2004, every fifth Danish citizen bought analgesics on prescription. Between 2000 and 2004, the number increased. In particular, the number of users of NSAIDs was large. The number of users of strong opioids did not increase as did the number of users of the other groups of analgesics, but within that group there was a shift to more expensive drugs.
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Genetic factors can explain a significant amount of the variance in the perception of pain, sensitivity to painful stimuli and development of chronic pain. Twin studies, association studies and linkage analysis have located DNA sequences and SNPs that may be involved in the regulation of pain. Individual genes have an influence on the reaction to experimental painful stimuli, and certain genes are probably involved in painful clinical conditions. Optimal pain control and counselling of patients may be achievable through research into the genetic mechanisms involved in pain.
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Substantial progress has been made in our understanding of acute pain mechanisms, and our insight into postoperative convalescence and rehabilitation has increased dramatically. There is a lack of evidence for pre-emptive analgesia, whereas studies of antihyperalgesic drugs and multimodal analgesic regimens are promising. The use of opioids should be restricted, and it may be rational to develop procedure-specific pain treatment guidelines. There is a need for increased collaboration and integration of acute pain treatment and multimodal postoperative rehabilitation efforts.
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Chronic pain constitutes a major health care and social problem. Around 20% of adults in a number of Western countries suffer from severe to moderate chronic pain that seriously affects their quality of life. That chronic pain may be an adverse outcome of surgery has been overlooked so far, but new studies suggest that chronic pain even after minor surgery is far more frequent than previously assumed. This article presents epidemiological, clinical and pathophysiological aspects of chronic postoperative pain and offers suggestions for pain management and prophylaxis.