V. Flampouraris, M. Kokolaki, S. Kandreviotou, A. Niaka, Andromachi Papadopoulou
If you’re patient in an ICU, this fact is in itself a traumatic unpleasant event. Covid 19 patients who admitted to the intensive care unit urgently, are provided with a wide range of machines for safe monitoring. Objective-purpose: The purpose is to record the physical and emotional unpleasant experience during their hospitalisation in ICU. Material-methods: We conducted a study of 18 patients, (44 to 82 years old), ASA II-III, 12 men and 6 women. We filled out a questionnaire. 1. What was the difficulty in communication? 2. What was scary in the environment (ICU)? 3. Do you suffer from insomnia? (noises from ventilators or monitors). 4. Do you feel pain ?(VAS scale) 5. Do you feel muscle weakness? 6. Do you know where are you ?(disorientation) 7. Do you want to talk to your family? 8. Emotional changes (anger, aggression, arousal.) 9. Can you swallow?Results: (8) Covid 19 patients difficulty in communication. (14) Covid 19 patients were scary. (12) Covid 19 patients suffered from insomnia. (16) Covid 19 patients felt pain VAS >8. (18) Covid 19 patients felt weakness. (11) Covid 19 patients with disorientation. (6) Covid 19 patients with emotional changes (anger, aggression, arousal). (12) Covid 19 patients: difficulty swallowing. Symptoms such as muscle weakness or insomnia persist 6 months after discharge from the hospital.Conclusions: Memories of posttraumatic stress in Covid 19 patients in an ICU appear to be different, unprecedented and particularly stressful. These patients need a long term psychological support ie desensitisation. A plan is required : I start from the beginning to live.
{"title":"Posttraumatic stress in Covid 19 patients after extubation in an intensive care unit (ICU)","authors":"V. Flampouraris, M. Kokolaki, S. Kandreviotou, A. Niaka, Andromachi Papadopoulou","doi":"10.22514/sv.2021.183","DOIUrl":"https://doi.org/10.22514/sv.2021.183","url":null,"abstract":"If you’re patient in an ICU, this fact is in itself a traumatic unpleasant event. Covid 19 patients who admitted to the intensive care unit urgently, are provided with a wide range of machines for safe monitoring. Objective-purpose: The purpose is to record the physical and emotional unpleasant experience during their hospitalisation in ICU. Material-methods: We conducted a study of 18 patients, (44 to 82 years old), ASA II-III, 12 men and 6 women. We filled out a questionnaire. 1. What was the difficulty in communication?\u00002. What was scary in the environment (ICU)?\u00003. Do you suffer from insomnia? (noises from ventilators or monitors).\u00004. Do you feel pain ?(VAS scale)\u00005. Do you feel muscle weakness?\u00006. Do you know where are you ?(disorientation)\u00007. Do you want to talk to your family?\u00008. Emotional changes (anger, aggression, arousal.)\u00009. Can you swallow?Results: (8) Covid 19 patients difficulty in communication. (14) Covid 19 patients were scary. (12) Covid 19 patients suffered from insomnia. (16) Covid 19 patients felt pain VAS >8. (18) Covid 19 patients felt weakness. (11) Covid 19 patients with disorientation. (6) Covid 19 patients with emotional changes (anger, aggression, arousal). (12) Covid 19 patients: difficulty swallowing. Symptoms such as muscle weakness or insomnia persist 6 months after discharge from the hospital.Conclusions: Memories of posttraumatic stress in Covid 19 patients in an ICU appear to be different, unprecedented and particularly stressful. These patients need a long term psychological support ie desensitisation. A plan is required : I start from the beginning to live.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44857641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pain treatment is often compromised by adverse reactions, low efficacy, and potentially dangerous drug interactions. Genetics may, in some cases, help avoid such issues and it is conceivable that, in the near future, the treatment of chronic pain will be guided -at least in part- by the genetic background of individual patients. A typical example is the polymorphisms of the cytochrome enzymes (e.g., P450); understanding their impact on substrate metabolism can significantly help to avoid lack of efficacy and adverse events for medications often used in the treatment of chronic pain, such as opioids, NSAIDs and membrane stabilizers (antiepileptics). There is abundant literature on other relevant examples, such as receptors polymorphisms (e.g., OPRM1), HLA genotypes (e.g., HLA-A*31:01), enzyme and transporter polymorphisms (e.g., COMT, UGT, ABCB1), cytokine profiles (π.χ. IL-6), ion channel and transcriptional factor polymorphisms etc. Current research, using data from channelopathies and ion channel mutations related to pain transduction and conduction, attempts to develop treatments for chronic pain syndromes which will utilize a guided and individualized approach to achieve safer and more efficacious therapies. Accordingly, genetics has allowed for the identification of novel modes of action for old compounds already used for the treatment of chronic pain. By combining pharmacogenetics, proteomics, epigenetics and neurophysiology, it is foreseeable that we will manage to approach the underlying pathophysiology of chronic pain in an individualized manner and, consequently, to adapt the treatment. In addition, genetic therapy (e.g., RNAi, ASOs, CRISPRi-KRAB) may further help manage difficult chronic pain syndromes. There are still many barriers to overcome, such as the availability of genetical analytics and their performance, the cost-effectiveness ratio, the lack of relevant data from randomized controlled clinical trials, as well as the limited number of approved treatments with different modes of action for chronic pain.
慢性疼痛治疗往往受到不良反应、低疗效和潜在危险的药物相互作用的影响。在某些情况下，遗传学可以帮助避免这些问题，可以想象，在不久的将来，慢性疼痛的治疗将由个体患者的遗传背景指导-至少部分指导。一个典型的例子是细胞色素酶的多态性(如P450);了解它们对底物代谢的影响可以显著帮助避免治疗慢性疼痛的药物缺乏疗效和不良事件，如阿片类药物、非甾体抗炎药和膜稳定剂(抗癫痫药)。其他相关的例子也有大量的文献，如受体多态性(如OPRM1)、HLA基因型(如HLA- a *31:01)、酶和转运体多态性(如COMT、UGT、ABCB1)、细胞因子谱(pi .χ. 1)等。IL-6)、离子通道和转录因子多态性等。目前的研究，利用与疼痛传导和传导相关的通道病变和离子通道突变的数据，试图开发慢性疼痛综合征的治疗方法，这些方法将利用指导和个性化的方法来实现更安全、更有效的治疗。因此，遗传学已经允许识别已经用于治疗慢性疼痛的旧化合物的新作用模式。通过结合药物遗传学、蛋白质组学、表观遗传学和神经生理学，可以预见，我们将设法以个体化的方式接近慢性疼痛的潜在病理生理学，从而适应治疗。此外，基因治疗(例如，RNAi, aso, crispr - krab)可能进一步帮助治疗难治性慢性疼痛综合征。目前仍有许多障碍需要克服，例如基因分析的可用性及其性能、成本-效果比、缺乏随机对照临床试验的相关数据，以及批准的治疗慢性疼痛的不同作用模式的治疗方法数量有限。
{"title":"Genetics-guided treatment for chronic pain","authors":"E. Raptis","doi":"10.22514/sv.2021.199","DOIUrl":"https://doi.org/10.22514/sv.2021.199","url":null,"abstract":"Chronic pain treatment is often compromised by adverse reactions, low efficacy, and potentially dangerous drug interactions. Genetics may, in some cases, help avoid such issues and it is conceivable that, in the near future, the treatment of chronic pain will be guided -at least in part- by the genetic background of individual patients. A typical example is the polymorphisms of the cytochrome enzymes (e.g., P450); understanding their impact on substrate metabolism can significantly help to avoid lack of efficacy and adverse events for medications often used in the treatment of chronic pain, such as opioids, NSAIDs and membrane stabilizers (antiepileptics). There is abundant literature on other relevant examples, such as receptors polymorphisms (e.g., OPRM1), HLA genotypes (e.g., HLA-A*31:01), enzyme and transporter polymorphisms (e.g., COMT, UGT, ABCB1), cytokine profiles (π.χ. IL-6), ion channel and transcriptional factor polymorphisms etc. Current research, using data from channelopathies and ion channel mutations related to pain transduction and conduction, attempts to develop treatments for chronic pain syndromes which will utilize a guided and individualized approach to achieve safer and more efficacious therapies. Accordingly, genetics has allowed for the identification of novel modes of action for old compounds already used for the treatment of chronic pain. By combining pharmacogenetics, proteomics, epigenetics and neurophysiology, it is foreseeable that we will manage to approach the underlying pathophysiology of chronic pain in an individualized manner and, consequently, to adapt the treatment. In addition, genetic therapy (e.g., RNAi, ASOs, CRISPRi-KRAB) may further help manage difficult chronic pain syndromes. There are still many barriers to overcome, such as the availability of genetical analytics and their performance, the cost-effectiveness ratio, the lack of relevant data from randomized controlled clinical trials, as well as the limited number of approved treatments with different modes of action for chronic pain.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42342933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: The aim of this study was to compare the efficacy and safety between ropivacaine 0.25% and ropivacaine 0.2% combined with a 0.025 mg/kg morphine regimen, administered as a continuous epidural infusion for analgesia after cesarean section delivery. Materials and methods: We compared 55 parturient women undergoing a cesarean section delivery with a combined spinal-epidural technique. All women received intrathecally 2–2.3 mL ropivacaine 0.75% combined with 0.3 mL fentanyl through a G27 needle. An epidural catheter was inserted immediately after spinal anesthesia. Two hours after the onset of spinal anesthesia a ropivacaine 0.25% continuous epidural infusion (7 mL/h) was administered in group A whereas a ropivacaine 0.2% combined with 0.025 morphine epidural infusion (7 mL/h) was administered in group B. The degree of motor and sensory block (using a Bromage and VAS score 1–10) were evaluated immediately after, 2 h, 4 h, 8 h and 12 h after the onset of continuous epidural infusion administration. We also evaluated all patients’ blood pressure (BP) and heart rate at the same time intervals. Results: There were no statistically significant differences in hemodynamic parameters, sensory block or analgesic effect between the groups however there were differences in motor block (Bromage score in group A 0.7 ± 0.5 vs 0.2 ± 0.4 in group B, p = 0.002). Conclusion: The use of a local anesthetic and morphine combination in group B provided efficient epidural analgesia accomplishing a lower motor blockade compared to group A.
目的：本研究的目的是比较0.25%罗哌卡因和0.2%罗哌卡因联合0.025mg/kg吗啡方案在剖宫产术后硬膜外连续输注镇痛的有效性和安全性。材料和方法：我们比较了55名剖宫产产妇采用腰麻-硬膜外联合技术分娩的情况。所有女性通过G27针鞘内注射2–2.3 mL 0.75%罗哌卡因和0.3 mL芬太尼。脊髓麻醉后立即插入硬膜外导管。脊麻开始后两小时，a组给予0.25%的罗哌卡因硬膜外连续输注（7 mL/h），而B组给予0.2%的罗哌嗪联合0.025吗啡硬膜外输注（7mL/h），持续硬膜外输注给药开始后8小时和12小时。我们还评估了所有患者在相同时间间隔的血压（BP）和心率。结果：血流动力学参数差异无统计学意义，结论：与A组相比，B组使用局麻药和吗啡联合应用可提供有效的硬膜外镇痛，实现较低的运动阻滞。
{"title":"Comparison of two different local anesthetic infusion methods (with or without opioids) for epidural analgesia after cesarean section delivery","authors":"Spanopoulos Konstantinos, Papagiannopoulou Ofilia, P. KousidisIoiannis, Anagnostou Georgios, Zografidou Polixeni, Tsiotsiou Maria, Gogali Despoina, Pinas Dimitrios, Grenda Georgia, Grigoriou Ioulia, Goutziomitrou Evangelia","doi":"10.22514/sv.2021.166","DOIUrl":"https://doi.org/10.22514/sv.2021.166","url":null,"abstract":"Aim: The aim of this study was to compare the efficacy and safety between ropivacaine 0.25% and ropivacaine 0.2% combined with a 0.025 mg/kg morphine regimen, administered as a continuous epidural infusion for analgesia after cesarean section delivery. Materials and methods: We compared 55 parturient women undergoing a cesarean section delivery with a combined spinal-epidural technique. All women received intrathecally 2–2.3 mL ropivacaine 0.75% combined with 0.3 mL fentanyl through a G27 needle. An epidural catheter was inserted immediately after spinal anesthesia. Two hours after the onset of spinal anesthesia a ropivacaine 0.25% continuous epidural infusion (7 mL/h) was administered in group A whereas a ropivacaine 0.2% combined with 0.025 morphine epidural infusion (7 mL/h) was administered in group B. The degree of motor and sensory block (using a Bromage and VAS score 1–10) were evaluated immediately after, 2 h, 4 h, 8 h and 12 h after the onset of continuous epidural infusion administration. We also evaluated all patients’ blood pressure (BP) and heart rate at the same time intervals. Results: There were no statistically significant differences in hemodynamic parameters, sensory block or analgesic effect between the groups however there were differences in motor block (Bromage score in group A 0.7 ± 0.5 vs 0.2 ± 0.4 in group B, p = 0.002). Conclusion: The use of a local anesthetic and morphine combination in group B provided efficient epidural analgesia accomplishing a lower motor blockade compared to group A.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43227829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Ioannou, A. Liampas, A. Artemiadis, S. Kalampokini, P. Bargiotas, G. Hadjigeorgiou, P. Zis
Background: Coeliac disease (CD) is a long-term autoimmune disorder that primarily affects the small intestine. Classic symptoms include gastrointestinal problems such as chronic diarrhoea, abdominal distention, malabsorption, loss of appetite, and among children failure to grow normally. Often patients present with neurological manifestations, such as cerebellar ataxia and peripheral neuropathy, even in the absence of any gastrointestinal symptoms. Chronic pain is a major determinant of poor quality of life in patients with coeliac disease, however it has been previously shown that a strict gluten free diet is beneficial in dramatically reducing the odds of suffering from pain. The aim of this cross-sectional study was to establish the prevalence of chronic pain in patients with coeliac disease. Methods: Patients with CD and healthy volunteers were prospectively evaluated. Pain was assessed with the use of the painDETECT and the DN4 questionnaires. Results: Sixty-one patients with CD (79% females, mean age 39.6 ± 12.9 years) and 61 age and gender matched healthy volunteers were recruited. Patients had a diagnosis of CD for a mean of 6.7 ± 4.7 years (ranging from 0 to 18 years). The prevalence of chronic pain was 57% in the healthy volunteers group and 59% in the CD group (p = 0.854). In both groups the prevalence of neuropathic pain was established to be 20%. The most commonly reported painful area in both groups was low back pain (26% in the CD group and 20% in the healthy control group). In the CD group, patients with pain were significantly older compared to patients without pain (43.6 ± 12.5 years vs 33.8 ± 11.4 years, p = 0.003). No differences between these two sub-groups were found regarding gender, BMI or CD duration. Conclusions: Chronic pain is very prevalent in CD and is very similar to the prevalence observed in the general population.
{"title":"Chronic pain in patients with coeliac disease: Cross sectional study","authors":"C. Ioannou, A. Liampas, A. Artemiadis, S. Kalampokini, P. Bargiotas, G. Hadjigeorgiou, P. Zis","doi":"10.22514/sv.2021.171","DOIUrl":"https://doi.org/10.22514/sv.2021.171","url":null,"abstract":"Background: Coeliac disease (CD) is a long-term autoimmune disorder that primarily affects the small intestine. Classic symptoms include gastrointestinal problems such as chronic diarrhoea, abdominal distention, malabsorption, loss of appetite, and among children failure to grow normally. Often patients present with neurological manifestations, such as cerebellar ataxia and peripheral neuropathy, even in the absence of any gastrointestinal symptoms. Chronic pain is a major determinant of poor quality of life in patients with coeliac disease, however it has been previously shown that a strict gluten free diet is beneficial in dramatically reducing the odds of suffering from pain. The aim of this cross-sectional study was to establish the prevalence of chronic pain in patients with coeliac disease. Methods: Patients with CD and healthy volunteers were prospectively evaluated. Pain was assessed with the use of the painDETECT and the DN4 questionnaires. Results: Sixty-one patients with CD (79% females, mean age 39.6 ± 12.9 years) and 61 age and gender matched healthy volunteers were recruited. Patients had a diagnosis of CD for a mean of 6.7 ± 4.7 years (ranging from 0 to 18 years). The prevalence of chronic pain was 57% in the healthy volunteers group and 59% in the CD group (p = 0.854). In both groups the prevalence of neuropathic pain was established to be 20%. The most commonly reported painful area in both groups was low back pain (26% in the CD group and 20% in the healthy control group). In the CD group, patients with pain were significantly older compared to patients without pain (43.6 ± 12.5 years vs 33.8 ± 11.4 years, p = 0.003). No differences between these two sub-groups were found regarding gender, BMI or CD duration. Conclusions: Chronic pain is very prevalent in CD and is very similar to the prevalence observed in the general population.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48539391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic pain is the most common symptom for which patients seek medical care and surgery is the cause of chronic pain for 22.5% of these patients [1]. “Chronic post-surgical pain” (CPSP) is defined as pain persisting at least 3 months after surgery [1]. CPSP can occur following various operations, ranging from simple (herniorrhaphy, caesarean section or dental extraction) to complicated surgeries (thoracotomy, radical mastectomy or hysterectomy) [2]. The amount of injury to the tissues or nerves and the degree of inflammation differs by operation type and procedure for the same surgery. Since there is less tissue trauma in minimally invasive surgery, less chronic pain is expected than in open procedures. However, results have not always been positive. For instance, there is a reduced incidence of moderate to severe CPSP with laparoscopic cholecystectomy (8.8%) than with open cholecystectomy (28%). Minimally invasive surgery is also recommended for orthopedic surgery to limit tissue damage and nerve injury [3]. Unfortunately, arthroscopic surgeries can also lead to CPSP due to injury to the nerves. In the case of thoracotomy, many factors are related to CPSP. These include the surgical approach [video-assisted thoracoscopic surgery (VATS) vs open thoracotomy], the type of incision for open procedures (posterolateral vs. muscle sparing vs. sternotomy vs. transverse sternothoracotomy), rib resection or retraction, the extent of intercostal nerve preservation, and the method of rib approximation after the procedure. However, VATS does not reduce the incidence of CPSP, despite there being some reduction in the incidence of acute postoperative pain compared to open thoracotomy [3]. Despite there being insufficient evidence to recommend a definite surgical technique to eliminate the possibility of CPSP, surgeons can minimize the risk of CPSP by choosing a minimally invasive surgical technique, employing careful dissection to avoid injury to nerves, avoiding extensive surgery whenever possible, and/or minimizing the duration of surgery if possible [3].
{"title":"Current minimally invasive surgery and chronic postsurgical pain S54","authors":"V. Nyktari","doi":"10.22514/sv.2021.197","DOIUrl":"https://doi.org/10.22514/sv.2021.197","url":null,"abstract":"Chronic pain is the most common symptom for which patients seek medical care and surgery is the cause of chronic pain for 22.5% of these patients [1]. “Chronic post-surgical pain” (CPSP) is defined as pain persisting at least 3 months after surgery [1]. CPSP can occur following various operations, ranging from simple (herniorrhaphy, caesarean section or dental extraction) to complicated surgeries (thoracotomy, radical mastectomy or hysterectomy) [2]. The amount of injury to the tissues or nerves and the degree of inflammation differs by operation type and procedure for the same surgery. Since there is less tissue trauma in minimally invasive surgery, less chronic pain is expected than in open procedures. However, results have not always been positive. For instance, there is a reduced incidence of moderate to severe CPSP with laparoscopic cholecystectomy (8.8%) than with open cholecystectomy (28%). Minimally invasive surgery is also recommended for orthopedic surgery to limit tissue damage and nerve injury [3]. Unfortunately, arthroscopic surgeries can also lead to CPSP due to injury to the nerves. In the case of thoracotomy, many factors are related to CPSP. These include the surgical approach [video-assisted thoracoscopic surgery (VATS) vs open thoracotomy], the type of incision for open procedures (posterolateral vs. muscle sparing vs. sternotomy vs. transverse sternothoracotomy), rib resection or retraction, the extent of intercostal nerve preservation, and the method of rib approximation after the procedure. However, VATS does not reduce the incidence of CPSP, despite there being some reduction in the incidence of acute postoperative pain compared to open thoracotomy [3]. Despite there being insufficient evidence to recommend a definite surgical technique to eliminate the possibility of CPSP, surgeons can minimize the risk of CPSP by choosing a minimally invasive surgical technique, employing careful dissection to avoid injury to nerves, avoiding extensive surgery whenever possible, and/or minimizing the duration of surgery if possible [3].","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43207834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Interventional pain management techniques have a definite place in the management of chronic pain. Inclusion of interventional pain management techniques in the patient’s treatment plan should be guided by the best available evidence on efficacy and safety with respect to the diagnosis. Between 2009 and 2011 a series of 26 articles on evidence-based medicine for interventional pain medicine according to clinical diagnoses were published but during the last years the high number of publications justified an update. These new data were published in Pain Practice on 2019. For 28 different pain indications a total of 113 interventions were evaluated. Twenty-seven (24%) interventions were new compared to the previous guidelines and the recommendation changed for only 3 (2.6%) of the interventions. The quality of evidence may seem rather low and the strength of the recommendations weak. However, this must be viewed in the context of guideline methodology. The fact that the quality of the evidence is rather low does not mean that the effect of the treatment is minimal; it indicates the need for clinical research. However, performing RCTs for (interventional) pain management techniques have many difficulties. When the quality of the evidence is low, this does not mean that the intervention is not effective. And the quality of the evidence may be high, indicating that the intervention is not effective. When the recommendation is very low, there is a high need for more research. The recommendations formulated in guidelines are valid for a specific patient population; however, they may not be valid for the individual patient with comorbidities. The correct application of interventional pain management techniques requires an excellent knowledge of the neuroanatomy, experience in the interpretation of the images obtained during the procedure, and adequate training. Therefore, it is preferred that such interventions be performed in specialized centers.
{"title":"Evidence based Interventional pain medicine techniques","authors":"A. Tsaroucha","doi":"10.22514/sv.2021.195","DOIUrl":"https://doi.org/10.22514/sv.2021.195","url":null,"abstract":"Interventional pain management techniques have a definite place in the management of chronic pain. Inclusion of interventional pain management techniques in the patient’s treatment plan should be guided by the best available evidence on efficacy and safety with respect to the diagnosis. Between 2009 and 2011 a series of 26 articles on evidence-based medicine for interventional pain medicine according to clinical diagnoses were published but during the last years the high number of publications justified an update. These new data were published in Pain Practice on 2019. For 28 different pain indications a total of 113 interventions were evaluated. Twenty-seven (24%) interventions were new compared to the previous guidelines and the recommendation changed for only 3 (2.6%) of the interventions. The quality of evidence may seem rather low and the strength of the recommendations weak. However, this must be viewed in the context of guideline methodology. The fact that the quality of the evidence is rather low does not mean that the effect of the treatment is minimal; it indicates the need for clinical research. However, performing RCTs for (interventional) pain management techniques have many difficulties. When the quality of the evidence is low, this does not mean that the intervention is not effective. And the quality of the evidence may be high, indicating that the intervention is not effective. When the recommendation is very low, there is a high need for more research. The recommendations formulated in guidelines are valid for a specific patient population; however, they may not be valid for the individual patient with comorbidities. The correct application of interventional pain management techniques requires an excellent knowledge of the neuroanatomy, experience in the interpretation of the images obtained during the procedure, and adequate training. Therefore, it is preferred that such interventions be performed in specialized centers.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41519892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Nianiarou, Zoi Gambopoulou, D. Solomou, M. Karathanou, D. Papadopoulou, E. Stavropoulou
Introduction: Diabetic neuropathy is a common complication of diabetes, occurring in 25–50% of patients, with pain partaking in the clinical picture of about half of the patients. At the same time, there are many studies confirming the high prevalence of mental disorders in diabetes patients, and recent research signifies the bidirectional relationship that seems to exist. In this review, we examined the existing literature regarding the role of anxiety and depression in diabetic neuropathy. Methods: Utilizing PubMed as our search engine, we performed a search of the existing literature of the last decade. The key-words used were “depression” “anxiety” “pain” and “diabetic neuropathy”. This search led us to 189 results, and out of those 13 were found to correlate with our criteria and were used in this paper. Results: From the analysis of the existing literature we cite studies concluding that people with depression are more susceptible to the development of diabetes. Moreover, anxiety and depression are correlated with complications and higher prevalence of painful neuropathy. In diabetic patients, symptoms of anxiety and depression are independently connected with more pain. At a pathophysiology level, disorders in the cellular function of the CNS, such as central sensitization and changes in neuroglia, are noticed both in neuropathic pain and depression. Conclusions: This review highlights the connection between pain and depression in patients with diabetic neuropathy, with emphasis on the effect of anxiety and depression in neuropathic pain. With the association with the pathophysiological pathways and the clinical phenotype further researched, new goals in the prevention and the treatment of pain in diabetic neuropathy can be studied.
{"title":"Relationship between depression, anxiety, and pain perception in diabetic neuropathy","authors":"Maria Nianiarou, Zoi Gambopoulou, D. Solomou, M. Karathanou, D. Papadopoulou, E. Stavropoulou","doi":"10.22514/sv.2021.156","DOIUrl":"https://doi.org/10.22514/sv.2021.156","url":null,"abstract":"Introduction: Diabetic neuropathy is a common complication of diabetes, occurring in 25–50% of patients, with pain partaking in the clinical picture of about half of the patients. At the same time, there are many studies confirming the high prevalence of mental disorders in diabetes patients, and recent research signifies the bidirectional relationship that seems to exist. In this review, we examined the existing literature regarding the role of anxiety and depression in diabetic neuropathy. Methods: Utilizing PubMed as our search engine, we performed a search of the existing literature of the last decade. The key-words used were “depression” “anxiety” “pain” and “diabetic neuropathy”. This search led us to 189 results, and out of those 13 were found to correlate with our criteria and were used in this paper. Results: From the analysis of the existing literature we cite studies concluding that people with depression are more susceptible to the development of diabetes. Moreover, anxiety and depression are correlated with complications and higher prevalence of painful neuropathy. In diabetic patients, symptoms of anxiety and depression are independently connected with more pain. At a pathophysiology level, disorders in the cellular function of the CNS, such as central sensitization and changes in neuroglia, are noticed both in neuropathic pain and depression. Conclusions: This review highlights the connection between pain and depression in patients with diabetic neuropathy, with emphasis on the effect of anxiety and depression in neuropathic pain. With the association with the pathophysiological pathways and the clinical phenotype further researched, new goals in the prevention and the treatment of pain in diabetic neuropathy can be studied.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44957654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Koutoulaki, Amalia Mathioudaki, V. Nyktari, G. Stefanakis, P. Vasilos, S. Ilia, G. Frantzeskos, A. Papaioannou
Introduction: Neuropathic pain is caused by a lesion or disease of the somatosensory system and affects 7–10% of the population [1–3]. The aim of this study was the analysis of patients referred with neuropathic pain to the University Hospital of Heraklion pain clinic (2019–2020) in terms of characteristics, underlying disease, treatment and response to treatment. Methods: Patients diagnosed with neuropathic pain (Pain Detect questionnaire) were recruited. Pain intensity was assessed using NAS. Data were in the form of qualitative or quantitative variables and were expressed as frequencies and % frequencies. The x2 test was used to detect statistically significant differences in percentages or correlations between the categorical variables. Statistical analysis was performed using IBM SPSS Statistics 26.0 (IBM Corp., Chicago, IL, USA). Acceptance limit was set to α = 0.05. Results: 120 patients (age 64.0 ± 15.1 years, men 55.8%, cancer history 50%) were included. Merely neuropathic pain occurred in 43.3% of patients. Patients were allocated into two groups: benign pain group —with herpes zoster (23%) and spine diseases (14%) as the most frequent causes—and malignant pain group (mainly due to gynaecological, breast or lung cancer). The groups did not differ in the main symptoms—burning (46.7%), allodynia (23.3%), hyperalgesia (28.3%)—nor in the pain location (most often in lower extremities and pelvis). Both groups experienced sleep disorders—poorer sleep quality in malignant pain (36.7% vs 16.7%)—and poor psychological state (33.9% in benign, 28.8% in malignant pain). NSAIDs use was more common in benign (58.3% vs 15.9%, p 30% following initial treatment and a corresponding reduction in further modification. Conclusions: Most patients with neuropathic pain were >50 years old, reported a burning sensation and experienced effects on quality of life (quality of sleep, psychological state).
{"title":"Audit of patients of the pain clinic of the University Hospital of Heraklion with neuropathic pain during the period 2019–2020","authors":"E. Koutoulaki, Amalia Mathioudaki, V. Nyktari, G. Stefanakis, P. Vasilos, S. Ilia, G. Frantzeskos, A. Papaioannou","doi":"10.22514/sv.2021.158","DOIUrl":"https://doi.org/10.22514/sv.2021.158","url":null,"abstract":"Introduction: Neuropathic pain is caused by a lesion or disease of the somatosensory system and affects 7–10% of the population [1–3]. The aim of this study was the analysis of patients referred with neuropathic pain to the University Hospital of Heraklion pain clinic (2019–2020) in terms of characteristics, underlying disease, treatment and response to treatment. Methods: Patients diagnosed with neuropathic pain (Pain Detect questionnaire) were recruited. Pain intensity was assessed using NAS. Data were in the form of qualitative or quantitative variables and were expressed as frequencies and % frequencies. The x2 test was used to detect statistically significant differences in percentages or correlations between the categorical variables. Statistical analysis was performed using IBM SPSS Statistics 26.0 (IBM Corp., Chicago, IL, USA). Acceptance limit was set to α = 0.05. Results: 120 patients (age 64.0 ± 15.1 years, men 55.8%, cancer history 50%) were included. Merely neuropathic pain occurred in 43.3% of patients. Patients were allocated into two groups: benign pain group —with herpes zoster (23%) and spine diseases (14%) as the most frequent causes—and malignant pain group (mainly due to gynaecological, breast or lung cancer). The groups did not differ in the main symptoms—burning (46.7%), allodynia (23.3%), hyperalgesia (28.3%)—nor in the pain location (most often in lower extremities and pelvis). Both groups experienced sleep disorders—poorer sleep quality in malignant pain (36.7% vs 16.7%)—and poor psychological state (33.9% in benign, 28.8% in malignant pain). NSAIDs use was more common in benign (58.3% vs 15.9%, p 30% following initial treatment and a corresponding reduction in further modification. Conclusions: Most patients with neuropathic pain were >50 years old, reported a burning sensation and experienced effects on quality of life (quality of sleep, psychological state).","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48304241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ζoi Masourou, N. Papagiannakis, D. Mitsikostas, K. Theodoraki
Background: Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by heterogeneity of presentation and prognosis, which can occasionally result in serious complications, such as the formation of subdural hematoma (SDH). This case series aims to emphasize that SIH remains a diagnostic and therapeutic challenge; it can present with a far broad clinical spectrum of symptoms, can lead to SDH and if conservative treatment fails, an epidural blood patch (EBP) is a viable treatment option. Although the exact aetiology of SIH is not known, it is believed to be due to cerebrospinal fluid (CBF) leak or a low CBF pressure. Case report: Three patients (two males and one female) with age ranging between 38-53 years old who presented with complaints not only of an orthostatic headache, but with a variety of symptoms of SIH, including the formation of two SDHs in one of them, were included in this series. These patients did not respond to conservative management and subsequently, given the clinical and radiological evidence of SIH, were referred to the Anaesthesia Department for an EBP. The exact site of the CSF leak was identified with imaging modalities, including magnetic resonance imaging (MRI) of the brain and spinal cord, prior to the EBP. All three patients were subjected to an EBP with an 18-gauge epidural needle placed into the middle epidural compartment at the T12–L3 level. A total of between 30–43 mL of autologous blood was collected from the patients’ left basilic vein and was injected into the epidural space under strict aseptic conditions. Two lumbar (L1–L2, L2–L3) and one thoracic (T11–T12) EBPs were performed on the three patients. All patients reported complete resolution of symptoms following the EBPs, while MRI imaging improved substantially. Discussion: This report describes three cases of SIH with CSF leak originating from the cervical, the thoracic and the lumbar level. The EBP restored CSF volume and relieved the patients' persistent symptoms. MRI helps in showing indirect signs of low volume of CSF, though it may not be possible to find the actual site of leak. In conclusion, EBP is a well-accepted and beneficial treatment modality for SIH when conventional measures fail.
{"title":"Epidural blood patch in the management of the syndrome of spontaneous intracranial hypotension: An effective therapeutic approach","authors":"Ζoi Masourou, N. Papagiannakis, D. Mitsikostas, K. Theodoraki","doi":"10.22514/sv.2021.165","DOIUrl":"https://doi.org/10.22514/sv.2021.165","url":null,"abstract":"Background: Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by heterogeneity of presentation and prognosis, which can occasionally result in serious complications, such as the formation of subdural hematoma (SDH). This case series aims to emphasize that SIH remains a diagnostic and therapeutic challenge; it can present with a far broad clinical spectrum of symptoms, can lead to SDH and if conservative treatment fails, an epidural blood patch (EBP) is a viable treatment option. Although the exact aetiology of SIH is not known, it is believed to be due to cerebrospinal fluid (CBF) leak or a low CBF pressure. Case report: Three patients (two males and one female) with age ranging between 38-53 years old who presented with complaints not only of an orthostatic headache, but with a variety of symptoms of SIH, including the formation of two SDHs in one of them, were included in this series. These patients did not respond to conservative management and subsequently, given the clinical and radiological evidence of SIH, were referred to the Anaesthesia Department for an EBP. The exact site of the CSF leak was identified with imaging modalities, including magnetic resonance imaging (MRI) of the brain and spinal cord, prior to the EBP. All three patients were subjected to an EBP with an 18-gauge epidural needle placed into the middle epidural compartment at the T12–L3 level. A total of between 30–43 mL of autologous blood was collected from the patients’ left basilic vein and was injected into the epidural space under strict aseptic conditions. Two lumbar (L1–L2, L2–L3) and one thoracic (T11–T12) EBPs were performed on the three patients. All patients reported complete resolution of symptoms following the EBPs, while MRI imaging improved substantially. Discussion: This report describes three cases of SIH with CSF leak originating from the cervical, the thoracic and the lumbar level. The EBP restored CSF volume and relieved the patients' persistent symptoms. MRI helps in showing indirect signs of low volume of CSF, though it may not be possible to find the actual site of leak. In conclusion, EBP is a well-accepted and beneficial treatment modality for SIH when conventional measures fail.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47479750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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