Biological inflammatory markers mediate the effect of preoperative pain-related behaviours on postoperative analgesics requirements

Peer reviewedPublisher PD

Réveil peropératoire et memorisation: prévalence et aspects cliniques dans un Pays Sub-Saharien

Objective: To study intraoperative memorization in the service of general surgery of Yalgado Ouedroago teaching Hospital (YO-TH) in Burkina Faso. Methods: It was a prospective study in the service of general surgery of YOTH over 7 months. The inclusion criteria were: age ≥ 18 years, absence of psychiatric disorder, American Society of Anesthesiology (ASA) score less than 4, informed consent written. Patients were interviewed at recovery. The questionnaire of Brice et al [8] was used and data were analyzed with SPHINX version 5.0.1 Results: A total of 475 patients were included. The mean age was 40.4 ± 16.3 years. The sex ratio was 1.4. The majority (56%) took psychoactive substance and 78.1% of patients had ASA score 2 or 3. Seven (1.4%) patients reported an explicit perioperative memorization (EPOM +). The mean age of EPOM + patients was 26.8 ± 6.57 years with a sex ratio 1.3. There was difference between EPOM + patients and EMPO - for age (p = 0.0001), occupation (p = 0.009) and antecedent of local anesthesia (p = 0.004). Five patients reported auditory perceptions, four cases of visual perceptions and two tactile perceptions. Pain was the most unpleasant memorization recorded. The psychological consequences of EPOM + were anxiety (2 cases). Conclusion: The frequency of EPOM is low in our context and the main cause was a slight anesthesia

When Inequality is Equitable: Validity, Propriety and Third Party Allocations

The author summarizes theories of equity and distributive justice that predict actors use legitimate distribution rules to act to maintain or to restore equity. He elaborates those ideas, distinguishing legitimacy based on validity (socially supported) from propriety (acceptance by the focal actor). Experimental research showed strong effects of both types of legitimacy on behavior, with validity having slightly stronger effects.This research was supported by a grant from the National Science Foundation (SOC #7817^3<»), Morris Zelditch, Jr.» Principal Investigator. Computations were supported by a grant from the Office of the Dean of Graduate Studies and Research at Stanford University

Patient-controlled analgesia in chronic pain patients: experience with a new device designed to be used with implanted programmable pumps.

BACKGROUND: Intrathecal drug delivery using implantable pumps is an effective method to control stable chronic pain. However, the appropriate alleviation of unpredictable pain fluctuations remains challenging. A possible solution is the use of patient-controlled analgesia (PCA) by means of a specific device--the personal therapy manager (PTM)--designed to be used with implanted programmable pumps. METHODS: A multicenter (n = 17), open-label registry recording 168 patients suffering from chronic pain with unsatisfactory control of pain episodes was initiated. While 79 patients (47%) (group A) already carried an implanted pump at enrollment, all other patients were implanted after being registered in the study (group B). Parameters assessed included pain relief (visual analog score, VAS), quality of life (EQ-5D), patient and physician satisfaction, medication use, PTM programming parameters and adverse events. Final follow-up was at 12 months. RESULTS: At 12 months, there was a significant reduction (29%) of the overall average VAS compared with baseline (P < 0.01) in patients with newly implanted devices (group B). All patients tended to decrease the concomitant pain medication and the quality of life tended to improve (10% on the EQ-5D scale). In total, 85% of patients were satisfied with the PTM. No serious adverse events related to the use of the PTM device were observed. CONCLUSIONS: Patient-controlled analgesia using a PTM with a programmable, implantable pump system is an effective therapy for the treatment of chronic pain and allows patients to feel that they have more control over unpredictable pain fluctuations

Les opiacés en douleur chronique non-cancéreuse : l’évolution de ces trois dernières décennies nous pousse- t-elle à les abandonner ?

Suite au succès dans la douleur cancéreuse, les opiacés ont été largement utilisés en douleur chronique non-cancéreuse. Cependant, les preuves de leur efficacité à long terme dans cette indication sont réduites. Les objectifs de diminution de la douleur, d’augmentation de la qualité de vie et d’amélioration fonctionnelle sont rarement atteints. Les effets secondaires peuvent être graves. L’augmentation importante de décès suite à l’ingestion d’opiacés aux Etats-Unis impose de revoir les recommandations pour une plus grande prudence. Une sélection rigoureuse et un suivi rapproché des patients sont indispensables. L’avis d’une consultation de douleur chronique est parfois souhaitable[Opioids in the management of chronic non-cancer pain: Should they be abandoned on account of the progress made over the past three decades?] Due to their efficacy in alleviating cancer pain, opioids have been widely used for managing chronic non-cancer pain despite limited evidence of long-term efficacy in this indication. The goals of achieving decreased pain, increased quality of life, and functional improvement are rarely met, yet these drugs may cause serious side-effects. The significant rise in death cases due to opioid intake the United States warrants greater caution, along with a review of existing recommendations. Careful selection and close monitoring of patients appear essential. In certain cases, the advice of a pain clinic specialist is recommended

Diagnostic reference levels for X-ray investigations in pain management units in Belgium.

X-rays are commonly used in pain treatment centres where infiltrative techniques are performed. Although X-rays are useful in increasing the precision of infiltrative techniques, their use puts patients and staff at risk of radiation exposure. As a result, medical staff now have to obtain a certificate of training on the use of X-rays before being allowed to use X-rays in practice. This analysis was based on 373 detailed registrations of procedure-related parameters in the six centres that participated in this study between January 2009 and July 2009. Examinations chosen for inclusion in this study were the most commonly performed fluoroscopic imaging-guided procedures in a pain management unit: epidurals (cervical/lumbar), facet joint nerve blocks (cervical/lumbar) and transforaminal (cervical/lumbar). The sample size, the dose-area product (DAP) range for whole population, the mean and the third quartile DAP corrected for patient size (DAP(corr)), the screening time range, the mean and the third quartile screening time are presented. The proposed DRLs for epidurals, facet joint nerve blocks and transforaminal are 0.5, 2.5 and 3 Gy cm&sup2; for DAP values and 12, 60 and 50 s for screening times, respectively. In the absence of national diagnostic reference levels (DRLs) for pain management fluoroscopic procedures, these DAP and screening time values provide a possible way of establishing provisional DRLs for local use. The values for each examination type could be used as a baseline against which to monitor the effectiveness of dose reduction strategies as part of the optimisation process that is the goal of any quality control and patient dose monitoring system