Advances in Postoperative Pain Management and Chronic Postoperative Pain: Part II

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: 10 November 2024 | Viewed by 2327

Special Issue Editor


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Guest Editor
Unit of Anesthesiology, Intensive Care Medicine and Pain Medicine, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
Interests: awareness anesthesia; anesthesia brain monitoring; memory and anesthesia; postoperative delirium; postoperative cognitive dysfunction; opioids research; pain assessment
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Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Special Issue, entitled “Advances in Postoperative Pain Management and Chronic Postoperative Pain: Part II”. This is a new volume, which follows the publication of 13 papers in the first volume. You can find more details by following the link below:

https://www.mdpi.com/journal/jcm/special_issues/chronic_postoperative_pain

Acute pain is usually associated with a specific illness or trauma. It is expected to be limited to the time taken to repair the damage. The most characteristic acute pain is postoperative pain (POP). It is generally predictable and characterized by its strong intensity and short duration. The clinical features of POP vary from subject to subject and in the same patient over time. This variability is due to the pre-existing pathology and location, type, and invasiveness of the surgery. However, the characteristics of POP also depend on other components, such as psychological factors that intersect with cultural, religious, socio-economic aspects, and others.

Clinically, POP involves a plethora of unpleasant sensory and emotional experiences associated, or not, with autonomic and behavioral responses. The complex humoral responses that initially work to maintain the homeostasis, when excessive and prolonged, can cause organic, psychological, and behavioral alterations (e.g., anxiety, insomnia, depression, etc.) and can become particularly difficult to treat. Consequently, if not properly treated, POP can assume the characteristics of a complex chronic pain issue. Remarkably, chronic POP (CPOP) is defined by painful symptomatology in the operated area unrelated to previous pain, present for more than 3 months, and without any link to surgical complications.

This Special Issue will identify the gaps in the prevention, diagnosis, and management of POP/CPOP based on a combination of original research and review papers.

Topics of interest to this Special Issue include the following:

  • The epidemiology of POP/CPOP;
  • Clinical features of POP in different populations (e.g., in children) and surgical settings (e.g., robotic surgery);
  • Diagnostic approaches;
  • Prevention of POP/CPOP;
  • Interventions for POP/CPOP management;
  • Psychological issues;
  • New strategies useful for diagnosis and therapy (e.g., AI-based approaches).

Dr. Marco Cascella
Guest Editor

Manuscript Submission Information

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Keywords

  • postoperative pain
  • chronic postoperative pain
  • pain mechanisms
  • postoperative pain management
  • physiopathology of chronic postoperative pain
  • local anesthetics
  • non-invasive analgesic procedures
  • opioids

Published Papers (2 papers)

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Review

35 pages, 1429 KiB  
Review
A Scoping Review of the Effect of EEG Neurofeedback on Pain Complaints in Adults with Chronic Pain
by Britt B. Schuurman, Richel L. Lousberg, Jan U. Schreiber, Therese A. M. J. van Amelsvoort and Catherine J. Vossen
J. Clin. Med. 2024, 13(10), 2813; https://doi.org/10.3390/jcm13102813 - 10 May 2024
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Abstract
Background and Aim: Non-pharmacological treatments such as electroencephalogram (EEG) neurofeedback have become more important in multidisciplinary approaches to treat chronic pain. The aim of this scoping review is to identify the literature on the effects of EEG neurofeedback in reducing pain complaints in [...] Read more.
Background and Aim: Non-pharmacological treatments such as electroencephalogram (EEG) neurofeedback have become more important in multidisciplinary approaches to treat chronic pain. The aim of this scoping review is to identify the literature on the effects of EEG neurofeedback in reducing pain complaints in adult chronic-pain patients and to elaborate on the neurophysiological rationale for using specific frequency bands as targets for EEG neurofeedback. Methods: A pre-registered scoping review was set up and reported following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews (PRISMA-ScR). The data were collected by searching for studies published between 1985 and January 2023 in PubMed, EMBASE, and PsycINFO. Results: Thirty-two studies on various types of chronic pain were included. The intervention was well-tolerated. Approximately half of the studies used a protocol that reinforced alpha or sensorimotor rhythms and suppressed theta or beta activity. However, the underlying neurophysiological rationale behind these specific frequency bands remains unclear. Conclusions: There are indications that neurofeedback in patients with chronic pain probably has short-term analgesic effects; however, the long-term effects are less clear. In order to draw more stable conclusions on the effectiveness of neurofeedback in chronic pain, additional research on the neurophysiological mechanisms of targeted frequency bands is definitely worthwhile. Several recommendations for setting up and evaluating the effect of neurofeedback protocols are suggested. Full article
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14 pages, 1993 KiB  
Review
Nanotechnology for Pain Management
by Jacques E. Chelly, Shiv K. Goel, Jeremy Kearns, Orkun Kopac and Senthilkumar Sadhasivam
J. Clin. Med. 2024, 13(9), 2611; https://doi.org/10.3390/jcm13092611 - 29 Apr 2024
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Abstract
Introduction: In the context of the current opioid crisis, non-pharmacologic approaches to pain management have been considered important alternatives to the use of opioids or analgesics. Advancements in nano and quantum technology have led to the development of several nanotransporters, including nanoparticles, [...] Read more.
Introduction: In the context of the current opioid crisis, non-pharmacologic approaches to pain management have been considered important alternatives to the use of opioids or analgesics. Advancements in nano and quantum technology have led to the development of several nanotransporters, including nanoparticles, micelles, quantum dots, liposomes, nanofibers, and nano-scaffolds. These modes of nanotransporters have led to the development of new drug formulations. In pain medicine, new liposome formulations led to the development of DepoFoam™ introduced by Pacira Pharmaceutical, Inc. (Parsippany, NJ, USA). This formulation is the base of DepoDur™, which comprises a combination of liposomes and extended-release morphine, and Exparel™, which comprises a combination of liposomes and extended-release bupivacaine. In 2021, Heron Therapeutics (San Diego, CA, USA) created Zynrelef™, a mixture of bupivacaine and meloxicam. Advancements in nanotechnology have led to the development of devices/patches containing millions of nanocapacitors. Data suggest that these nanotechnology-based devices/patches reduce acute and chronic pain. Methods: Google and PubMed searches were conducted to identify studies, case reports, and reviews of medical nanotechnology applications with a special focus on acute and chronic pain. This search was based on the use of keywords like nanotechnology, nano and quantum technology, nanoparticles, micelles, quantum dots, liposomes, nanofibers, nano-scaffolds, acute and chronic pain, and analgesics. This review focuses on the role of nanotechnology in acute and chronic pain. Results: (1) Nanotechnology-based transporters. DepoDur™, administered epidurally in 15, 20, or 25 mg single doses, has been demonstrated to produce significant analgesia lasting up to 48 h. Exparel™ is infiltrated at the surgical site at the recommended dose of 106 mg for bunionectomy, 266 mg for hemorrhoidectomy, 133 mg for shoulder surgery, and 266 mg for total knee arthroplasty (TKA). Exparel™ is also approved for peripheral nerve blocks, including interscalene, sciatic at the popliteal fossa, and adductor canal blocks. The injection of Exparel™ is usually preceded by an injection of plain bupivacaine to initiate analgesia before bupivacaine is released in enough quantity from the depofoarm to be pharmacodynamically effective. Finally, Zynrelef™ is applied at the surgical site during closure. It was initially approved for open inguinal hernia, abdominal surgery requiring a small-to-medium incision, foot surgery, and TKA. (2) Nanotechnology-based devices/patches. Two studies support the use of nanocapacitor-based devices/patches for the management of acute and chronic pain. A randomized study conducted on patients undergoing unilateral primary total knee (TKA) and total hip arthroplasty (THA) provided insight into the potential value of nanocapacitor-based technology for the control of postoperative acute pain. The results were based on 2 studies, one observational and one randomized. The observational study was conducted in 128 patients experiencing chronic pain for at least one year. This study suggested that compared to baseline, the application of a nanocapacitor-based Kailo™ pain relief patch on the pain site for 30 days led to a time-dependent decrease in pain and analgesic use and an increase in well-being. The randomized study compared the effects of standard of care treatment to those of the same standard of care approach plus the use of two nanocapacitor-based device/patches (NeuroCuple™ device) placed in the recovery room and kept in place for three days. The study demonstrated that the use of the two NeuroCuple™ devices was associated with a 41% reduction in pain at rest and a 52% decrease in the number of opioid refills requested by patients over the first 30 days after discharge from the hospital. Discussion: For the management of pain, the use of nano-based technology has led to the development of nano transporters, especially focus on the use of liposome and nanocapacitors. The use of liposome led to the development of DepoDur™, bupivacaine Exparel™ and a mixture of bupivacaine and meloxicam (Zynrelef™) and more recently lidocaine liposome formulation. In these cases, the technology is used to prolong the duration of action of drugs included in the preparation. Another indication of nanotechnology is the development of nanocapacitor device or patches. Although, data obtained with the use of nanocapacitors are still limited, evidence suggests that the use of nanocapacitors devices/patches may be interesting for the treatment of both acute and chronic pain, since the studies conducted with the NeuroCuple™ device and the based Kailo™ pain relief patch were not placebo-controlled, it is clear that additional placebo studies are required to confirm these preliminary results. Therefore, the development of a placebo devices/patches is necessary. Conclusions: Increasing evidence supports the concept that nanotechnology may represent a valuable tool as a drug transporter including liposomes and as a nanocapacitor-based device/patch to reduce or even eliminate the use of opioids in surgical patients. However, more studies are required to confirm this concept, especially with the use of nanotechnology incorporated in devices/patches. Full article
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