Canadian journal of anaesthesia = Journal canadien d'anesthésie
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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 is a selective narrative review of the latest information about the epidemiology, impact, and prevention of chronic post-surgical pain (CPSP), intended primarily for those without a special interest in pain medicine. ⋯ Reduction of CPSP is a worthy long-term outcome for anesthesia providers to consider as they plan the perioperative care of their patients. More evidence is needed about the effect of currently used analgesics and other perioperative techniques on CPSP.
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Review
The transition from acute to chronic pain: understanding how different biological systems interact.
Although pain is an adaptive sensory experience necessary to prevent further bodily harm, the transition from acute to chronic pain is not adaptive and results in the development of a chronic clinical condition. How this transition occurs has been the focus of intense study for some time. The focus of the current review is on changes in neuronal plasticity as well as the role of immune cells and glia in the development of chronic pain from acute tissue injury and pain. ⋯ A better understanding of how chronic pain develops at a mechanistic level can aid clinicians in treating their patients by showing how the underlying biology of chronic pain contributes to the clinical manifestations of pain. A thorough understanding of how chronic pain develops may also help identify new targets for future analgesic drugs.
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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.