Articles: pain-clinics.
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In order to prevent short-term complication, patients with frailty syndrome require special attention and care in the perioperative context. The implementation of a frailty screening and if possible, an advanced geriatric assessment in the clinical routine should take into account the clinical setting, the patient population as well as time and human resources. ⋯ Key aspects of such pathways include physiotherapeutic interventions, nutritional counselling, adequate pain medication, delirium prevention, patient blood management and extended perioperative monitoring. An interdisciplinary shared decision-making process together with patients can help develop realistic and individual treatment concepts to improve safety and outcome of frail patients.
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Anesthesia and analgesia · Nov 2022
Randomized Controlled TrialPilot Findings of Pharmacogenomics in Perioperative Care: Initial Results From the First Phase of the ImPreSS Trial.
Pharmacogenomics, which offers a potential means by which to inform prescribing and avoid adverse drug reactions, has gained increasing consideration in other medical settings but has not been broadly evaluated during perioperative care. ⋯ Our pilot data for result access rates suggest interest in pharmacogenomics by anesthesia providers, even if opportunities to alter prescribing in response to high-risk genotypes were infrequent. This pilot phase has also uncovered unique considerations for implementing pharmacogenomic information in the perioperative care setting, and new strategies including adding the involvement of surgery teams, targeting patients likely to need intensive care and dedicated pain care, and embedding pharmacists within rounding models will be incorporated in the follow-on randomized phase to increase engagement and likelihood of affecting prescribing decisions and clinical outcomes.
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Psychological trauma is typically accompanied by physical pain, and posttraumatic stress disorder (PTSD) often cooccurs with chronic pain. Clinical reports suggest that pain after trauma may be part of re-experiencing symptomatology. Classical conditioning can underlie visual re-experiencing because intrusions can occur as conditioned responses (CRs) to trauma-related cues. ⋯ Our data support that spatiotemporally associating innocuous cues with pain (CS) endows these cues to elicit conditioned pain responses in the absence of noxious stimulation. In this way pain can emerge as a CR with emotional and sensory components. Classical conditioning presents a possible mechanism explaining pain intrusions and, more broadly, pain experienced without a nociceptive input.