scholarly journals Big Data in Studying Acute Pain and Regional Anesthesia

2021 ◽  
Vol 10 (7) ◽  
pp. 1425
Author(s):  
Lukas M. Müller-Wirtz ◽  
Thomas Volk
Keyword(s):  
Big Data ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Acute Pain ◽  
Management Strategies ◽  
Administrative Databases ◽  
Treatment Quality ◽  
Clinical Registries ◽  
Pain Outcomes ◽  
The Status

The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyses have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, the utilization of big data in acute pain and regional anesthesia research has considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.

scholarly journals Big Data in Studying Acute Pain and Regional Anesthesia

2021 ◽  
Author(s):  
Lukas M. Müller-Wirtz ◽  
Thomas Volk
Keyword(s):  
Big Data ◽  
Postoperative Pain ◽  
Regional Anesthesia ◽  
Acute Pain ◽  
Management Strategies ◽  
Administrative Databases ◽  
Treatment Quality ◽  
Clinical Registries ◽  
Pain Outcomes ◽  
The Status

The digital transformation of healthcare is advancing, leading to an increasing availability of clinical data for research. Perioperative big data initiatives were established to monitor treatment quality and benchmark outcomes. However, big data analyzes have long exceeded the status of pure quality surveillance instruments. Large retrospective studies nowadays often represent the first approach to new questions in clinical research and pave the way for more expensive and resource intensive prospective trials. As a consequence, utilization of big data in acute pain and regional anesthesia research considerably increased over the last decade. Multicentric clinical registries and administrative databases (e.g., healthcare claims databases) have collected millions of cases until today, on which basis several important research questions were approached. In acute pain research, big data was used to assess postoperative pain outcomes, opioid utilization, and the efficiency of multimodal pain management strategies. In regional anesthesia, adverse events and potential benefits of regional anesthesia on postoperative morbidity and mortality were evaluated. This article provides a narrative review on the growing importance of big data for research in acute postoperative pain and regional anesthesia.

Acute Pain Management

1995 ◽  
Vol 83 (5) ◽  
pp. 1090-1094 ◽  
Author(s):  
Carol A. Warfield ◽  
Cynthia H. Kahn
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Postoperative Pain Management ◽  
Management Information ◽  
Acute Pain Management ◽  
The Status ◽  
The U.S

Abstract Background The objective of the survey was to assess the status of acute pain management in U.S. hospitals and attitudes of adults in the U.S. toward postoperative pain management, information that has not been previously available.

scholarly journals A Systematic Review of Postoperative Pain Outcome Measurements Utilised in Regional Anesthesia Randomized Controlled Trials

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
E. Pushpanathan ◽  
T. Setty ◽  
B. Carvalho ◽  
P. Sultan
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Randomized Controlled Trials ◽  
Regional Anesthesia ◽  
Outcome Measures ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pain Outcomes ◽  
Pain Outcome ◽  
Meta Analyses

Introduction. Regional anesthesia is a rapidly growing subspecialty. There are few published meta-analyses exploring pain outcome measures utilised in regional anesthesia randomized controlled trials (RCTs), which may be due to heterogeneity in outcomes assessed. This systematic review explores postoperative pain outcomes utilised in regional anesthesia RCTs. Methods. A literature search was performed using three databases (Medline, Embase, and CINAHL). Regional anesthesia RCTs with postoperative pain as a primary outcome were included if written in English and published in one of the top 20 impact factor journals between 2005 and 2017. Study quality was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Results. From the 31 included articles, 15 different outcome measures in total were used to assess postoperative pain. The most commonly (16/31) used outcome measures were verbal numerical grading of pain out of 10, total opioid consumption, and visual analogue scale 10 cm (VAS). The need for analgesia was used as an outcome measure where studies did not use a pain rating score. Ten studies reported pain scores on activity and 27/31 studies utilised ≥2 pain outcomes. Time of measurement of pain score also varied with a total of 51 different time points used in total. Conclusion. Analysis of the articles demonstrated heterogeneity and inconsistency in choice of pain outcome and time of measurement within regional anesthesia studies. Identification of these pain outcomes utilised can help to create a definitive list of core outcomes, which may guide future researchers when designing such studies.

scholarly journals Postoperative Pain Management

2021 ◽  
Vol 16 (SP1) ◽  
pp. 5-17
Author(s):  
Yusuke Mazda ◽  
Sandra Jadin ◽  
James S. Kahn
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Management Strategies ◽  
Postoperative Pain Management ◽  
Douleur Postopératoire ◽  
Basic Understanding ◽  
Interventional Pain Management ◽  
Short And Long Term

ABSTRACTAfter surgery, over 80% of people experience moderate-to-severe acute pain. Poorly controlled postoperative pain limits recovery and is associated with detrimental short- and long-term morbidity. While surgeons have traditionally been responsible for postoperative pain management, all clinicians providing care for surgical patients have a basic understanding of common pharmacologic and interventional pain management strategies. In this review, we discuss the consequences of acute pain, approaches to pain assessment, and an overview of commonly used therapies to manage postoperative pain. RÉSUMÉAprès une opération, plus de 80 % des gens ressentent des douleurs aiguës modérées à intenses. Une douleur postopératoire mal maîtrisée limite le rétablissement et est associée à une morbidité défavorable à court et à long terme. Bien que les chirurgiens soient habituellement responsables du traitement de la douleur postopératoire, il est impératif que tous les cliniciens qui soignent des patients ayant subi une intervention chirurgicale aient une connaissance de base des stratégies pharmacologiques et interventionnelles courantes relatives au traitement de la douleur. Dans cette revue, nous abordons les conséquences de la douleur aiguë, les approches de l’évaluation de la douleur et un aperçu des traitements couramment utilisés pour traiter la douleur postopératoire.

scholarly journals Pain mechanisms and management in corneal cross-linking: a review

2021 ◽  
Vol 6 (1) ◽  
pp. e000878
Author(s):  
Emilie Sophie van der Valk Bouman ◽  
Heather Pump ◽  
David Borsook ◽  
Boris Severinsky ◽  
Robert PL Wisse ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Clinical Care ◽  
Tear Film ◽  
Cross Linking ◽  
Common Procedure ◽  
Pain Mechanisms ◽  
Pain Outcomes ◽  
Pain Chronification ◽  
The Difference

Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.

scholarly journals FRI0412 DOES SEVERE ACUTE POSTOPERATIVE PAIN RESULT IN MORE LONG-TERM PAIN AFTER TOTAL HIP OR KNEE ARTHROPLASTY (THA OR TKA) FOR OSTEOARTHRITIS?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 805.2-805
Author(s):  
D. A. J. M. Latijnhouwers ◽  
C. H. Martini ◽  
R. G. H. H. Nelissen ◽  
H. M. J. Van der Linden ◽  
T. P. M. Vliet Vlieland ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Acute Pain ◽  
Missing Values ◽  
Rating Scale ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Mixed Effect ◽  
Total Hip ◽  
Chronic Postsurgical Pain

Background:Chronic pain is a frequently reported unfavourable outcome of total hip and knee arthroplasties (THA/TKA) (7-23% and 10-34%, respectively) in osteoarthritis (OA) patients (1), which is difficult to treat as underlying mechanisms are not fully understood. Acute postoperative pain has been identified as risk factor for development of long-term pain in other surgical procedures, such as mastectomy and thoracotomy (2). However, the effect of acute postoperative pain on development of long-term pain in THA and TKA patients is unknown.Objectives:To investigate if acute pain following THA/TKA in OA patients is associated with long-term pain and if acute pain affects the course of pain up to 1-year postoperatively.Methods:From a longitudinal multicenter study, OA patients scheduled for primary THA or TKA were included. Acute pain scores, using Numeric Rating Scale (NRS), were routinely collected as part of standard care (≤72 hours after surgery). In case of ≥2 NRS scores the two highest scores were averaged (n=160), else the single score was taken. Pain was dichotomized into severe (NRS≥5) and mild (NRS<5). Pain was assessed preoperatively, at 3 (only THA), 6 and 12 months postoperatively using HOOS/KOOS subscale pain. Separate mixed-effect models for THA and TKA patients were used, with dichotomized acute pain as fixed-effect and long-term pain as outcome, while adjusting for confounders (age, sex, BMI, preoperative pain, mental component scale of the SF12 (MCS-12), and duration of the surgery and hospitalization). We included an interaction between time of measurement and acute postoperative pain to analyse whether effect modification was present. Missing values in preoperative pain and MCS-12 were imputed using multiple imputation methods.Results:81 THA and 87 TKA patients were included, of whom 32.1% and 56.3% reported severe acute pain. The results did not show an associated between severe acute pain and long term pain (THA: β=2.0, 95%-CI:-10.9-7.0; TKA: β=3.8, 95%-CI:-10.6-2.9). Furthermore, It seems that there is no effect present of difference in severity of acute pain and the course of pain over time (THA 6-months: β=6.4, 95%-CI:1.9-10.9 and 12-months: β=0.2, 95%-CI:-4.4-4.8; TKA 12-months: β=3.2, 95%-CI:-0.5-6.8).Conclusion:We did not find an association between acute pain and the development of long-term pain nor that severity of acute pain affects the course of postoperative pain in THA and TKA patients. The fact that THA and TKA patients often experience chronic preoperative pain might be a possible explanation for this finding. Nonetheless, future studies including additional measures of acute pain and pain sensitization in patients with chronic preoperative pain are necessary to draw stronger conclusions.References:[1]Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ open. 2012;2(1):e000435.[2]Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert review of neurotherapeutics. 2009;9(5):723-44.Acknowledgments:We would like to thank the study group that consists of: B.L. Kaptein, Leiden University Medical Center, Leiden; S.B.W Vehmeijer, Reinier de Graaf Hospital, Delft; R. Onstenk, Groene Hart Hospital, Gouda; S.H.M. Verdegaal, Alrijne Hospital, Leiderdorp; H.H. Kaptijn, LangeLand Hospital, Zoetermeer; W.C.M. Marijnissen, Albert Schweitzer Hospital, Dordrecht; P.J. Damen, Waterland Hospital, Hoorn; the NetherlandsDisclosure of Interests:None declared

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