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  • Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain
    Drugs, 2015
    Co-Authors: Hance Clarke, Michael Poon, Aliza Weinrib, Rita Katznelson, Kirsten Wentlandt, Joel Katz
    Abstract:

    Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient’s quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of Preventive Analgesia, and considers novel strategies to help treat acute post-operative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain.

  • Preventive Analgesia: Quo Vadimus?
    Anesthesia and analgesia, 2011
    Co-Authors: Joel Katz, Hance Clarke, Zeʼev Seltzer
    Abstract:

    The classic definition of preemptive Analgesia requires 2 groups of patients to receive identical treatment before or after incision or surgery. The only difference between the 2 groups is the timing of administration of the drug relative to incision. The constraint to include a postincision or postsurgical treatment group is methodologically appealing, because in the presence of a positive result, it provides a window of time within which the observed effect occurred, and thus points to possible mechanisms underlying the effect: the classic view assumes that the intraoperative nociceptive barrage contributes to a greater extent to postoperative pain than does the postoperative nociceptive barrage. However, this view is too restrictive and narrow, in part because we know that sensitization is induced by factors other than the peripheral nociceptive barrage associated with incision and subsequent noxious intraoperative events. A broader approach to the prevention of postoperative pain has evolved that aims to minimize the deleterious immediate and long-term effects of noxious perioperative afferent input. The focus of Preventive Analgesia is not on the relative timing of analgesic or anesthetic interventions, but on attenuating the impact of the peripheral nociceptive barrage associated with noxious preoperative, intraoperative, and/or postoperative stimuli. These stimuli induce peripheral and central sensitization, which increase postoperative pain intensity and analgesic requirements. Preventing sensitization will reduce pain and analgesic requirements. Preventive Analgesia is demonstrated when postoperative pain and/or analgesic use are reduced beyond the duration of action of the target drug, which we have defined as 5.5 half-lives of the target drug. This requirement ensures that the observed effects are not direct analgesic effects. In this article, we briefly review the history of preemptive Analgesia and relate it to the broader concept of Preventive Analgesia. We highlight clinical trial designs and examples from the literature that distinguish Preventive Analgesia from preemptive Analgesia and conclude with suggestions for future research.

  • Preventive Analgesia is associated with reduced pain disability 3 weeks but not 6 months after major gynecologic surgery by laparotomy.
    Anesthesiology, 2004
    Co-Authors: Joel Katz, Lorenzo Cohen
    Abstract:

    Background: Most studies of preemptive or Preventive Analgesia restrict outcomes to pain and analgesic consumption in the acute postoperative period. The potential longer-term effects on these and other domains of functioning have received little empirical attention. The purpose of this study was to follow up patients who had received general anesthesia plus epidural fentanyl and lidocaine before (group 1) or after (group 2) incision or general anesthesia plus a sham epidural (group 3). Methods: Patients were contacted approximately 3 weeks and 6 months after surgery. A follow-up pain questionnaire and the McGill Pain Questionnaire were administered by telephone. The Mental Health Inventory and Pain Disability Index were mailed to patients, completed, and mailed back. Results: One hundred thirty-one of the 141 patients (93%) were reached 3 weeks after surgery (n 41, n 48, and n 42 in groups 1, 2, and 3, respectively), and 109 (77%) were reached at 6 months (n 35, n 37, and n 37 in groups 1, 2, and 3, respectively). Multivariate analysis of covariance indicated that that even after controlling for age and presence or absence of preoperative pain, Pain Disability Index scores (mean SD) at the first follow-up were significantly lower in group 1 (17.3 12.8) and group 2 (18.1 17.0) compared with group 3 (26.3 18.3). McGill Pain Questionnaire and Mental Health Inventory scores did not differ significantly among the groups. There were no significant differences at the 6-month follow-up. Conclusion: The short-term beneficial effects of Preventive epidural Analgesia translated into less pain disability 3 weeks after surgery. Progress in understanding the processes involved in postsurgical recovery and the risk factors for chronic postsurgical pain would be aided by baseline and postsurgical measures of relevant psychological, emotional, and physical variables. THE majority of patients who undergo surgery recover uneventfully and within weeks typically resume their normal daily activities. However, chronic postsurgical pain (CPSP) develops in an alarming proportion of patients. The magnitude of the problem is evidenced by recent studies that document the epidemiology and growing awareness of CPSP in the surgical community. 1– 6 For example, a prospective study of approximately 5,000 postsurgical patients estimated the incidence of acute neuropathic pain in the days after surgery to be between 1 and 3%. 7 Follow-up showed that 56% continued to have ongoing pain 1 yr later. This means that each year, between 0.05 and 1.5% of postsurgical patients continue to have pain 1 yr after surgery. These statistics are staggering, especially when one considers the total number of patients worldwide who undergo surgery each year. It comes as no surprise then to see that almost 25% of more than 5,000 patients referred to chronic pain treatment centers have CPSP. 8 Little is known about the biomedical and psychosocial factors that predict development of CPSP. 9,10

  • A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia
    Anesthesia and analgesia, 2004
    Co-Authors: Colin J. L. Mccartney, Avinash Sinha, Joel Katz
    Abstract:

    We evaluated in a qualitative systematic review the effect of N-methyl-d-aspartate (NMDA) receptor antagonists on reducing postoperative pain and analgesic consumption beyond the clinical duration of action of the target drug (Preventive Analgesia). Randomized trials examining the use of an NMDA ant

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Kar-lok Wong - One of the best experts on this subject based on the ideXlab platform.