ABSTRACT
SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.
Subject(s)
COVID-19 , Chronic Pain , Chronic Pain/epidemiology , Humans , Pain Management , Pandemics , SARS-CoV-2ABSTRACT
SARS-CoV-2 infection has evolved into a pandemic and a Public Health Emergency of International Importance that has forced health organizations at the global, regional and local levels to adopt a series of measures to address to COVID-19 and try to reduce its impact, not only in the social sphere but also in the health sphere, modifying the guidelines for action in the health services. Within these recommendations that include the Pain Treatment Units, patients with suspected or confirmed SARS-CoV-2 infection may be waiting for medical consult or interventional procedures for the management of chronic pain refractory to other therapies. A series of guidelines aimed at reducing the risk of infection of health personnel, other patients and the community are included in this manuscript.
Subject(s)
Chronic Pain/therapy , Implantable Neurostimulators , Infusions, Spinal/instrumentation , Delivery, Obstetric , Diathermy , Electric Countershock , Electromagnetic Fields/adverse effects , Humans , Intraoperative Care/methods , Magnetic Resonance Imaging , Peripheral Nerves , Preoperative Care/methods , Radiotherapy , Tomography, X-Ray Computed , Transcutaneous Electric Nerve StimulationABSTRACT
Pain is one of the most common reasons for seeking medical care and the frequency of prescription of opioid analgesics by both primary care physicians and specialists has increased. It is therefore unsurprising that many patients with chronic pain who must undergo scheduled or emergency surgery will be on long-term medication, including opioids. Managing postoperative pain, even with high doses of drugs, seems to be more difficult in regular users of such analgesics, possibly because of an apparent association of opioid use with increased tolerance and hyperalgesia. Postoperative pain relief should be carefully tailored in these cases by means of a management plan worked out along with the patient. Adjuvants may be particularly useful; the most thoroughly studied adjuvants are nonsteroidal anti-inflammatory drugs and ketamine. Regional anesthesia offers a particularly attractive approach when long-term users of opioids must undergo surgery.
Subject(s)
Analgesics, Opioid , Drug Tolerance , Pain, Postoperative/drug therapy , Analgesics, Opioid/therapeutic use , Chronic Disease , Humans , Pain/drug therapy , Practice Guidelines as Topic , Time FactorsABSTRACT
El dolor representa uno de los motivos más frecuentes de demanda de atención médica entre la población. Se ha producido un notable incremento en la prescripción de opiáceos tanto por parte de los médicos de atención primaria como por parte de los especialistas en el tratamiento del dolor. No es de extrañar pues que muchos de los pacientes que se nos presentan a día de hoy para cirugía electiva o de urgencia estén en tratamiento por dolor crónico y entre los fármacos que toman se encuentren los opiáceos. El manejo del dolor postoperatorio parece ser más difícil en los pacientes consumidores crónicos, incluso cuando las dosis de los mismos no son muy altas. La explicación a estos fenómenos parece encontrarse en los fenómenos de tolerancia e hiperalgesia inducida por opioides. El manejo perioperatorio del dolor en los pacientes consumidores crónicos de opiáceos debe hacerse de manera individualizada y cuidadosa. Por ello es recomendable, conjuntamente con el paciente, crear un plan para el manejo perioperatorio del dolor antes de la cirugía. En este grupo de pacientes el uso de adyuvantes juega un papel especialmente útil. Entre los de tipo farmacológico los más investigados son los AINEs y la ketamina. Las técnicas de anestesia regional son una elección especialmente atractiva en el paciente que consume opiáceos de manera crónica(AU)
Pain is one of the most common reasons for seeking medical care and the frequency of prescription of opioid analgesics by both primary care physicians and specialists has increased. It is therefore unsurprising that many patients with chronic pain who must undergo scheduled or emergency surgery will be on long-term medication, including opioids. Managing postoperative pain, even with high doses of drugs, seems to be more difficult in regular users of such analgesics, possibly because of an apparent association of opioid use with increased tolerance and hyperalgesia. Postoperative pain relief should be carefully tailored in these cases by means of a management plan worked out along with the patient. Adjuvants may be particularly useful; the most thoroughly studied adjuvants are nonsteroidal anti-inflammatory drugs and ketamine. Regional anesthesia offers a particularly attractive approach when long-term users of opioids must undergo surgery(AU)
Subject(s)
Humans , Male , Female , Opioid Peptides/therapeutic use , Postoperative Care/trends , Ketamine/therapeutic use , Pain/epidemiology , Cyclooxygenase 2 Inhibitors/therapeutic use , Acetaminophen/therapeutic use , Anesthesia, Epidural , Anesthesia, Conduction/methods , Anesthesia, Conduction/trends , Pain/complications , Pain/drug therapy , Hyperalgesia/therapy , Peripheral NervesABSTRACT
OBJECTIVE: This case report describes an ultrasound approach to the transversus abdominis plane (TAP) local anesthetic block. This block induces sensory blockade in the lower half of the abdomen where the pulse generator or the infusion pump is to be housed in a subcutaneous pocket, and therefore provides an alternate to general anesthesia or administration of high-dose local anesthetics. CASE REPORT: We report two cases of neuromodulation procedures-implantation of an internal morphine pump for severe somatic pain refractory to other therapies and placement of a double-stimulator generator for dorsal column stimulation in a patient diagnosed with postoperative failed-back syndrome. We successfully used ultrasound-guided TAP block to achieve ipsilateral sensory block of dermatomes T9-L1 in the context of a monitored anesthesia care multimodal approach. CONCLUSION: TAP block can be a potentially useful substitute to general anesthesia or local anesthesia for the pocket formation in neuromodulation techniques, and it provides adequate anesthesia of the abdominal wall. This block is potentially an important addition to the monitored anesthesia care protocol.
Subject(s)
Abdomen/diagnostic imaging , Anesthetics, Local/administration & dosage , Nerve Block/methods , Pain Management , Pain/diagnostic imaging , Ultrasonography, Interventional/methods , Abdomen/surgery , Aged , Chronic Disease , Female , Humans , Male , Middle Aged , Pain MeasurementABSTRACT
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Subject(s)
Humans , Female , Infusion Pumps, Implantable , Ultrasonography , Osteoarthritis/drug therapy , Arthralgia/drug therapyABSTRACT
INTRODUCTION: Intense chronic pain is a very important health problem, as it has a high prevalence (5-10%), a multifactorial aetiology and its management is very often a very complex affair. Treatment of severe cases sometimes requires interventional approaches, such as continuous intrathecal infusion of opioids. CASE REPORT: We report the case of a 38-year-old female with intense neuropathic pain in the lower back and the lower limbs secondary to three operations on the L5-S1 lumbar segment. After implementing several different pharmacological regimes involving both oral and implanted systems (spinal cord stimulation and subarachnoid infusion pump with different pharmacological combinations) with no clinical improvement, intrathecal infusion with ziconotide was included in the protocol. CONCLUSIONS: Ziconotide is the first specific neuronal blocker that acts on the calcium channel by blocking the N-type voltage-dependent calcium channels. It is a new non-opioid analgesic with approved indication in the treatment of intense chronic pain, in patients who require intrathecal analgesics and are refractory to other analgesic treatments. Therefore, we shall have to consider this drug as a therapeutic alternative in patients do not experience sufficient relief with the pharmacological agents and means currently available to treat them.
