Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Oct 2011
ReviewFunctional and structural imaging of pain-induced neuroplasticity.
The understanding of the mechanisms underlying chronic pain is of major scientific and clinical interest. This review focuses on neuroimaging studies of pain-induced neuroplastic changes in the human brain and discusses five major categories of pain-induced neuroplastic changes. ⋯ Recent work has substantially broadened our insights into neuroplastic changes that are involved in pain chronification. Future research will focus on the question of whether neuroimaging techniques can be used in the individual chronic pain patient as a biomarker that would allow for an objective diagnosis of different pain conditions and for the prediction of individual responses to specific therapies.
-
Curr Opin Anaesthesiol · Oct 2011
ReviewPhantom limb pain and bodily awareness: current concepts and future directions.
Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management. ⋯ Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.
-
Trauma, surgery, and burns are three common clinical scenarios that are associated with significant acute pain. This review describes the pathophysiology of acute pain utilizing three preclinical models: surgery, burn, and fracture. ⋯ Peripheral mediators of acute pain can vary depending upon the type of injury. Treatment aimed toward those mediators specific to the injury may improve acute pain management in the future. It will be important to translate these findings into clinical trials in the future.
-
Regional anesthesia is commonly used to provide intraoperative anesthesia and postoperative analgesia. Potential complications of both neuraxial and peripheral regional techniques include infectious sequelae. This review examines important components of practice that are known to minimize the risk of infection associated with regional anesthesia. ⋯ Infectious complications associated with regional anesthesia are exceedingly rare events. Adherence to strict aseptic guidelines as published by the American Society of Regional Anesthesia and Pain Medicine, American Society of Anesthesiologists, and the Royal College of Anaesthetists may reduce the risk of infectious complications.
-
Curr Opin Anaesthesiol · Oct 2011
ReviewAneurysmal subarachnoid hemorrhage: an update on the medical complications and treatments strategies seen in these patients.
Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating condition with high mortality and poor outcome among survivors. Early surgical or endovascular securing of the aneurysm is the norm, and management of these patients is precarious due to their unstable intracranial physiology and the severe systemic medical complications common in SAH. ⋯ Growing knowledge of the physiologic derangements associated with poor outcomes in SAH can improve our understanding of the widespread physiologic changes occurring with SAH and with further research, may provide clinicians with a direction for increasingly meaningful intervention. Ongoing investigation of our current therapeutics enable clinicians to apply them more judiciously to suitable patients, thereby enhancing the benefit and minimizing the complications of such treatments. Furthermore, by re-evaluating previously disproved treatments through the use of novel regimens or administration routes, promising treatment options are emerging.