Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain

2015 ◽  
Vol 59 (2) ◽  
pp. 98-99 ◽  
Author(s):  
Karen Wong ◽  
Rachel Phelan ◽  
Eija Kalso ◽  
Imelda Galvin ◽  
David Goldstein ◽  
...  
Keyword(s):  
Antidepressant Drugs ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals Antidepressant Drugs for Prevention of Acute and Chronic Postsurgical Pain

2014 ◽  
Vol 121 (3) ◽  
pp. 591-608 ◽  
Author(s):  
Karen Wong ◽  
Rachel Phelan ◽  
Eija Kalso ◽  
Imelda Galvin ◽  
David Goldstein ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Therapeutic Potential ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Safety Evaluation ◽  
Pain Reduction ◽  
Chronic Postoperative Pain ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Antidepressant Use

Abstract Background: This review evaluates trials of antidepressants for acute and chronic postsurgical pain. Methods: Trials were systematically identified using predefined inclusion and exclusion criteria. Extracted data included the following: pain at rest and with movement, adverse effects, and other outcomes. Results: Fifteen studies (985 participants) of early postoperative pain evaluated amitriptyline (three trials), bicifadine (two trials), desipramine (three trials), duloxetine (one trial), fluoxetine (one trial), fluradoline (one trial), tryptophan (four trials), and venlafaxine (one trial). Three studies (565 participants) of chronic postoperative pain prevention evaluated duloxetine (one trial), escitalopram (one trial), and venlafaxine (one trial). Heterogeneity because of differences in drug, dosing regimen, outcomes, and/or surgical procedure precluded any meta-analyses. Superiority to placebo was reported in 8 of 15 trials for early pain reduction and 1 of 3 trials for chronic pain reduction. The majority of positive trials did not report sufficient data to estimate treatment effect sizes. Many studies had inadequate size, safety evaluation/reporting, procedure specificity, and movement-evoked pain assessment. Conclusions: There is currently insufficient evidence to support the clinical use of antidepressants—beyond controlled investigations—for treatment of acute, or prevention of chronic, postoperative pain. Multiple positive trials suggest the therapeutic potential of antidepressants, which need to be replicated. Other nontrial evidence suggests potential safety concerns of perioperative antidepressant use. Future studies are needed to better define the risk–benefit ratio of antidepressants in postoperative pain management. Higher-quality trials should optimize dosing, timing and duration of antidepressant treatment, trial size, patient selection, safety evaluation and reporting, procedure specificity, and assessment of movement-evoked pain relevant to postoperative functional recovery.

The different mechanisms of peripheral and central TLR4 on chronic postsurgical pain in rats

2021 ◽  
Author(s):  
Xuemin Han ◽  
Jinping Shao ◽  
Xiuhua Ren ◽  
Yaru Li ◽  
Wenli Yu ◽  
...  
Keyword(s):  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals A prospective cohort register-based study of chronic postsurgical pain and long-term use of pain medication after otorhinolaryngological surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nina Graf ◽  
Katharina Geißler ◽  
Winfried Meißner ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Rating Scale ◽  
Numeric Rating Scale ◽  
Postsurgical Pain ◽  
Average Pain Intensity ◽  
Chronic Postsurgical Pain ◽  
Average Pain ◽  
Patients At Risk ◽  
Perioperative Assessment ◽  
Numeric Rating

AbstractData on chronic postsurgical pain (CPSP) after otorhinolaryngological surgery are sparse. Adult in-patients treated in 2017 were included into the prospective PAIN OUT registry. Patients’ pain on the first postoperative day (D1), after six months (M6) and 12 months (M12) were evaluated. Determining factor for CPSP was an average pain intensity ≥ 3 (numeric rating scale 0–10) at M6. Risk factors associated with CPSP were evaluated by univariate and multivariate analyses. 10% of 191 included patients (60% male, median age: 52 years; maximal pain at D1: 3.5 ± 2.7), had CPSP. Average pain at M6 was 0.1 ± 0.5 for patients without CPSP and 4.2 ± 1.2 with CPSP. Average pain with CPSP still was 3.7 ± 1.1 at M12. Higher ASA status (Odds ratio [OR] = 4.052; 95% confidence interval [CI] = 1.453–11.189; p = 0.007), and higher minimal pain at D1 (OR = 1.721; CI = 1.189–2.492; p = 0.004) were independent predictors of CPSP at M6. Minimal pain at D1 (OR = 1.443; CI = 1.008–2.064; p = 0.045) and maximal pain at M6 (OR = 1.665; CI = 1.340–2.069; p < 0.001) were independent predictors for CPSP at M12. CPSP is an important issue after otorhinolaryngological surgery. Better instrument for perioperative assessment should be defined to identify patients at risk for CPSP.

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