Pain assessment in animal models: do we need further studies?

In the last two decades, animal models have become important tools in understanding and treating pain, and in predicting analgesic efficacy. Although rodent models retain a dominant role in the study of pain mechanisms, large animal models may predict human biology and pharmacology in certain pain conditions more accurately. Taking into consideration the anatomical and physiological characteristics common to man and pigs (median body size, digestive apparatus, number, size, distribution and communication of vessels in dermal skin, epidermal–dermal junctions, the immunoreactivity of peptide nerve fibers, distribution of nociceptive and non-nociceptive fiber classes, and changes in axonal excitability), swines seem to provide the most suitable animal model for pain assessment. Locomotor function, clinical signs, and measurements (respiratory rate, heart rate, blood pressure, temperature, electromyography), behavior (bright/quiet, alert, responsive, depressed, unresponsive), plasma concentration of substance P and cortisol, vocalization, lameness, and axon reflex vasodilatation by laser Doppler imaging have been used to assess pain, but none of these evaluations have proved entirely satisfactory. It is necessary to identify new methods for evaluating pain in large animals (particularly pigs), because of their similarities to humans. This could lead to improved assessment of pain and improved analgesic treatment for both humans and laboratory animals

Efficacia dell'infusione intralesionale di anestetico locale e steroide in pazienti sottoposti a chirurgia addominale maggiore ed analisi della risposta infiammatoria mediante catetere di microdialisi: studio clinico randomizzato in doppio cieco

Il dolore acuto post operatorio è l’insieme di risposte neurovegetative, psicologiche e comportamentali, che conducono ad una spiacevole esperienza sensoriale ed emotiva. E’ ormai riconosciuto come uno dei fattori di rischio fondamentali per lo sviluppo del dolore cronico post operatorio sia l’inadeguata gestione del dolore acuto nelle ore successive all’intervento chirurgico. Numerose alternative terapeutiche sono state descritte. In questo studio è stato utilizzato la tecnica d’infusione di farmaci direttamente nella ferita chirurgica, non solo per la capacità di ridurre il consumo di oppioidi ma anche per il possibile ruolo nella prevenzione del dolore cronico. Questo studio clinico ha lo scopo di individuare un protocollo analgesico, con somministrazione di anestetico locale e steroide intralesionale, valido per i sette giorni successivi ad un intervento di chirurgia addominale maggiore. Tale protocollo è finalizzato a produrre un dimezzamento dei consumi di analgesici oppioidi mantenendo comunque un ottimo controllo del dolore con riduzione degli effetti collaterali e minore incidenza di dolore cronico post operatorio. Parallelamente lo studio si propone anche di misurare grazie al posizionamento di un catetere di micro dialisi, l’infiammazione periferica e lo stress ossidativo. Lo studio è multicentrico, controllato, randomizzato, in doppio cieco a gruppi paralleli di fase III. Si tratta di un progetto finanziato dal Ministero dell’Istruzione, dell’Università e della Ricerca nell’ambito del progetto “New nanotechnology and biomedical approaches to improve postoperative pain treatment reducing risk related to opioids”, vincitore del grant “Progetti di Ricerca Giovani Ricercatori”. Risultati: Sono stati arruolati complessivamente 120 pazienti sottoposti a chirurgia addominale maggiore con approccio laparotomico e conformi ai criteri di inclusione. 16 pazienti sono stati esclusi del’analisi per non rispettare i criteri di inclusione. Nel presente analisi sono presentati i dati per i restanti 104 pazienti. Sono stati trovati differenze significative riguardando il consumo di morfina, nonostante il trend inferiore per il gruppo CWI. Inoltre sono state trovate differenze significative in quanto riguarda dolore a riposo. Non sono state riscontrate effetti avversi, complicanze, utilizzo di farmaci rescue. In quanto riguarda la MD, Analisi IL 6 fra pazienti con Trattamento e Pazienti con Placebo trovano una differanza statisticamente significativa alla 72 h ( p= 0.034). Conclusioni: I pazienti trattati con anestetico locale in infusione a livello della ferita chirurgica mostrano una riduzione del consumo di morfina in tutto il periodo postoperatorio, inoltre questi pazienti hanno anche dimostrato una migliore analgesia (punteggi NRS < 4) dalle quarantotto ore postoperatorie fino alla dimissione. Non vi sono state differenze significative tra i due gruppi in studio per quanto riguarda l’insorgenza di PONV. L’infusione di Metilprednisolone, non ha comportato ritardi nella guarigione delle ferite né tantomeno effetti collaterali. Con i dati raccolti fin’ora, è possibile affermare che la somministrazione di anestetico locale e steroide attraverso catetere infusivo di ferita sia un approccio razionale al trattamento dell’infiammazione locale e del dolore postoperatorio con effetto sull’iperalgesia primaria. I dati di stress ossidativo e infiammazione aprono nueve possibilità di ricerca per prossimi protocolli

Opioid use for Chronic Pain Management in Italy: Results from the Orthopedic Instant Pain Survey Project

Pain is a common symptom in orthopedic patients, but is managed sub-optimally, partly due to scarce opioid use in severe cases. The aim of the Orthopedic Instant Pain Survey (POIS) was to evaluate changes in pain management in Italian orthopedic practice 2 years after a legislative change (Law 38/2010) simplifying opioid access for pain control. A web-based survey on the knowledge of this law and trends observed in clinical practice for severe pain treatment was administered to 143 Italian orthopedic specialists. In total, 101 (70%) respondents showed a high level of knowledge. Nevertheless, 54.5% stated that they do not use opioids for severe osteo-articular pain management. Main barriers to opioid use are fear of adverse events (61.4%), especially nausea/vomiting and constipation, and patient resistance (29.7%). A modest knowledge of pain classification was also demonstrated. Opioid use remains very limited in Italian orthopedic practice. Physicians' fear of side effects showed poor knowledge of strategies for effective management of opioid-related adverse events, such as combined oral prolonged-release oxycodone/naloxone. Continuing educational programs could improve delivery of evidence-based pain management

Opioid use for chronic pain management in Italy: results from the Orthopedic Instant Pain survey project

Pain is a common symptom in orthopedic patients, but is managed sub-optimally, partly due to scarce opioid use in severe cases. The aim of the Orthopedic Instant Pain Survey (POIS) was to evaluate changes in pain management in Italian orthopedic practice 2 years after a legislative change (Law 38/2010) simplifying opioid access for pain control. A web-based survey on the knowledge of this law and trends observed in clinical practice for severe pain treatment was administered to 143 Italian orthopedic specialists. In total, 101 (70%) respondents showed a high level of knowledge. Nevertheless, 54.5% stated that they do not use opioids for severe osteo-articular pain management. Main barriers to opioid use are fear of adverse events (61.4%), especially nausea/vomiting and constipation, and patient resistance (29.7%). A modest knowledge of pain classification was also demonstrated. Opioid use remains very limited in Italian orthopedic practice. Physicians’ fear of side effects showed poor knowledge of strategies for effective management of opioid-related adverse events, such as combined oral prolonged-release oxycodone/naloxone. Continuing educational programs could improve delivery of evidence-based pain management

Historical and sociocultural aspects of soil organic matter and soil organic carbon benefits

International audienceIn this chapter, soil organic matter (SOM) benefits will be considered from two different perspectives: (i) the scientific perception of 'SOM benefits' between the 18th century and today; and (ii) how various contemporary religions and societies, including farmers of Western cultures, perceive soil and SOM benefits. Perceptions of the benefits of SOM (or humus) varied greatly in Western culture according to changes in historical scientific theories. Different periods can be considered. In the first part of 19th century, the 'theory of humus' by Thaer, dealing with a large popularity of SOM management for soil humus, was considered as the main nutrient for plants. In 1840, the new 'theory of the mineral nutrition of plants by Liebig demonstrated that humus was not the main source of nutrients for plants, with the consequence that there was no important need to manage organic fertilization: the popularity of humus was largely decreasing. With the emergence of environmental problems due to bad SOM management, the popularity of OM management is newly increasing. The best example is the concept that soil could be a large reservoir for atmospheric carbon sequestration, and this confers special attention to plant residue management. In addition to scientific knowledge or economic considerations, the practices of farmers around the world are also highly dependent on their own culture (religious and cult aspects). To illustrate this point, this chapter gives as examples not only the beliefs of the Buryat (Lake Baikal) and the Dogon people (Mali) but also the opinions of three groups of French farmers towards soil and the benefits of SOM, dealing with completely different attitudes vis-a-vis the adoption of different agricultural alternatives

Double epidural catheter technique in a patient with severe COPD undergoing major abdominal surgery: A case report

Chronic Obstructive Pulmonary Disease (COPD) leads to the development of postoperative pulmonary complications (PPC), such as atelectasis, pneumonia and respiratory failure. The use of epidural anesthesia, alone or combined with general anesthesia, is known to reduce the incidence of PPC and shorten tracheal intubation time. In major procedures involving both the lower and upper abdomen, central neuraxial block at a single level may be inadequate to provide sufficient metameric extension of anesthesia. This limitation could be overcome with the use of double epidural catheter (DEC), has proved effective in diverse surgical scenarios