Regional anesthesia and pain medicine
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Reg Anesth Pain Med · Feb 2025
ReviewRisk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain.
Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience after surgery is persistent postoperative opioid use (PPOU), or opioid use beyond the typical recovery period. Often defined as beyond 3 months postsurgery, PPOU is frequently conflated with chronic postsurgical pain (CPSP), where pain persists well after the expected healing time following surgery. ⋯ Despite the overlap of some factors, studies typically employ different frameworks when examining PPOU and CPSP, with a biopsychosocial model applied for CPSP and little emphasis on an individual's social environment employed for PPOU. Additionally, existing studies predominantly rely on retrospective insurance claims data, which may not capture the full scope of risk factors. To fill gaps in understanding, investigations may prospectively assess and analyze patient-reported outcomes, implement similar frameworks, and concurrently measure both conditions to advance the scientific understanding of PPOU and CPSP.
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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
ReviewChronic postsurgical pain and transitional pain services: a narrative review highlighting European perspectives.
Chronic postsurgical pain (CPSP) is a significant, often debilitating outcome of surgery, impacting patients' quality of life and placing a substantial burden on healthcare systems worldwide. CPSP (pain persisting for more than 3 months postsurgery) leads to both physical and psychological distress. Recognized as a distinct chronic pain entity in International Classification of Diseases, 11th Revision, CPSP enables better reporting and improved management strategies. Despite advancements in surgical care, CPSP remains prevalent, affecting 5%-85% of patients, with higher rates following thoracotomies, amputations, mastectomies and joint replacements. ⋯ Future research should focus on large-scale studies integrating various factors to facilitate CPSP prediction, refine prevention strategies and reduce its long-term impact.
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Reg Anesth Pain Med · Feb 2025
Global estimates of prevalence of chronic painful neuropathy among patients with chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis of data from 28 countries, 2000-24.
Although the prevalence of chemotherapy-induced peripheral neuropathy (CIPN) has been reported, the proportion of patients with CIPN who report chronic painful neuropathy remains poorly understood, despite its significant impact on patients' quality of life and treatment outcomes. ⋯ This study provides the first comprehensive global estimate of the prevalence of chronic painful CIPN, highlighting its significant burden on patients worldwide. The variation in prevalence across geographical regions, chemotherapy regimens, and primary cancers underscores the need for tailored pain management strategies and further research to address potential disparities.