Unlike drugs, orthopedic surgeries can be sold to the public before they undergo any rigorous testing to ensure they are safe and effective.
Thus, millions of surgeries for knee, shoulder, and back pain have been done even without any research to confirm they actually work.
Recently, a significant amount of such research has been completed, and it has found that many popular surgeries work no better than a placebo. And yet many of these surgeries are still being performed at the rate of hundreds of thousands per year. Continue reading
Genetics May Play Role in Chronic Pain After Surgery – 14-Dec-2017 – Newswise
Genetics may play a role in determining whether patients experience chronic pain after surgery, suggests a study published today in the Online First edition of Anesthesiology, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA).
Aside from genetic factors, the study also found patients younger than 65 years old, males and those with a prior history of chronic pain were at increased risk.
“Our study not only shows there are common genetic variations among people that may help to identify whether they are at high-risk for developing chronic pain after surgery, but it also helps explain why only a fraction of patients ever even experience persistent pain,” said lead researcher Matthew T.V. Chan, M.D
Chronic postsurgical pain is one of the most common and serious complications after surgery.
…the authors say it is likely that millions of patients worldwide suffer from pain around the surgical wound area months, or even years, after surgery.
The researchers collected blood samples from 1,152 surgical patients to look for genetic variations in 54 “pain-related” genes, which have been shown to be associated with pain sensation.
One year after surgery, 21 percent of patients reported chronic postsurgical pain. Among these patients, 33 percent rated their pain as severe.
During the follow-up period, patients with pain reported difficulties with
- general activity,
- relations with others,
- sleep, and
- enjoyment of life.
General health status was also adversely affected by pain.
One genetic variation in particular – a gene found in the nervous-system called brain-derived neurotrophic factor (BDNF) – was found to be most associated with increased chronic postsurgical pain. Researchers also confirmed the finding in a mouse model.
The authors concluded that genetic variations accounted for a higher percentage of chronic postsurgical pain (between 7 percent and 12 percent) compared to clinical risk factors such as age, sex, smoking history or anesthesia technique (between 3 percent and 6 percent).
Original article: Genetics May Play Role in Chronic Pain After Surgery
Persistent Postsurgical Pain – Practical Pain Management
Surgery is often counterproductive for chronic pain, so beware!
More than 45 million surgical procedures are performed in the United States each year. It has been estimated that acute postoperative pain will develop into persistent postoperative pain (PPP) in 10% to 50% of individuals after common operations.
Since chronic pain can be severe in up to 10% of these patients, PPP represents a major clinical problem—affecting at least 450,000 people each year. Continue reading
It is our view that the diagnostic terms post laminectomy syndrome (ICD-9 code 722.8) or failed back syndrome are inaccurate, misleading, can be construed as disparaging, and should be discarded.
Disparaging to whom? I suspect doctors do not like any term that insinuates their methods failed, no matter how true that is.
These authors couldn’t even bring themselves to call this painful syndrome by its *real* name: it’s not called “failed back syndrome”, but rather “failed back surgery syndrome” because, in this case, it is the surgery that failed, not the back. Continue reading
Israeli researchers have devised a multivariable index that appears to accurately reflect patients’ experience of pain during surgery.
This kind of objective “pain measurement” is the holy grail of pain management, but I wouldn’t trust it – would you?
I suspect not.
Pain is such a primal sensation with a literally overpowering impact that I cannot bring myself to trust some device, no matter how ingenious, to detect the enormity and full significance of this sensation. Continue reading
Ketamine not effective in surgery study | National Institutes of Health (NIH) by Tianna Hicklin, Ph.D. – June 20, 2017
At a Glance:
Researchers found that low doses of ketamine did not reduce delirium, postoperative pain, or other complications related to major surgeries.
The results suggest that the common practice of giving ketamine to patients during surgery may need to be re-evaluated. Continue reading
What is worse, the Opioid Epidemic or the Stupidity Epidemic? – National Pain Report – June 8, 2017- By Dr. Jay Joshi, CEO/Medical Director – National Pain Centers in Chicago.
I didn’t get far into this article before I began to doubt what the author was saying:.
When other physicians, especially in the university setting, were prescribing “opiates for everyone”, “there are no dose limits”, and “opiates are not addictive as long as you have pain”, I felt compelled to stand up for logic and common sense.
Challenging a valid statement about dose limits is a denial of fact.
From what I’ve read about pain and opioids, there is no valid dosage limit or maximum dosage for opioids as long as enough tolerance has developed over time. Continue reading
Minimally Invasive SI Joint Fusion May Lessen Pain, Improve Quality of Life – Practical Pain Management – May 2017
Minimally invasive sacroiliac (SI) joint fusion was associated with significant improvements in pain relief and disability, as well as a decreased reliance on opioids, according to findings of a retrospective study published in Neurosurgery.
This study compared outcomes against conservative management (CM) or SI joint denervation, demonstrating that pain and disability levels returned to baseline levels with traditional approaches. Continue reading
A practical, common problem in pain management is how to handle a patient already maintained on opioids and about to undergo surgery.
The American Pain Society recently released new guidelines for the perioperative and postoperative pain management.
The guidelines recommend that clinicians should counsel patients to continue regularly prescribed opioids during the preoperative period unless there is a plan to taper or discontinue opioids. Continue reading
Does Opioid Cessation Prior to Surgery Help or Hurt? – April 4, 2017 By Thomas G. Ciccone
Patients receiving opioids prior to elective abdominal surgery had slightly longer hospital stays and were at higher risk of being discharged to a rehabilitation facility than opioid-naïve patients, according to the results of a new study.
“Chronic opioid use complicates management following surgery, and increases postoperative healthcare utilization and costs independent of other risk factors.”
None of these studies consider that opioids are prescribed for severe pain. Severe pain before surgery or unsuccessful surgery is what affects continuing opioid use. Continue reading