Pain that persists after the surgical wound has healed could be the result of somatic nociception, the consequence of ongoing inflammation (e.g. infection, haematoma), a manifestation of neuropathic pain from surgical injury to peripheral nerves (e.g. complex regional pain syndromes, neuralgias)3 , or from visceral nociception. chronic post surgical pain has been defined as “pathological pain that persists for longer than two months post surgery”.
Recently, a mechanism of neuronal plasticity in primary afferent nociceptive nerve fibres
(nociceptors) has been identified by which an acute inflammatory insult or environmental stressor can trigger longlasting hypersensitivity of nociceptors to inflammatory cytokines.
Preoperative risk factors include …show more content…
Gabapentin and the Nmethyldaspartate antagonist, ketamine, are similar in improving early pain control and in decreasing opioid consumption.One key issue is its safety and tolerability, with psychotomimetic adverse effects being the major concern.
In surgery with high risks of neuropathic pain, the preventative use of gabapentin and pregabalin may be considered.
Fear beliefs should be assessed and addressed through reassurance that pain does not necessarily equal harm. For high fear patients, cognitive behavioural therapy may be needed.5
Is
she a candidate for NSAIDs? Why or why not?
No, Patients with neuropathic pain do not respond to nonsteroidal antiinflammatory drugs and resistance or insensitivity to opiates is common.
Furthermore Mesalamine may cause kidney problems, and combining it with other medications that can also affect the kidney such as ibuprofen may increase that risk. You may need a dose adjustment or more frequent monitoring by patient’s physician to safely use both medications.
Along
with opioid dosing, what adjuvant would you utilize and why?
Ketamine is a sedative/analgesic that is a noncompetitive antagonist at the NMDA receptor, it
Recently, a mechanism of neuronal plasticity in primary afferent nociceptive nerve fibres
(nociceptors) has been identified by which an acute inflammatory insult or environmental stressor can trigger longlasting hypersensitivity of nociceptors to inflammatory cytokines.
Preoperative risk factors include …show more content…
Gabapentin and the Nmethyldaspartate antagonist, ketamine, are similar in improving early pain control and in decreasing opioid consumption.One key issue is its safety and tolerability, with psychotomimetic adverse effects being the major concern.
In surgery with high risks of neuropathic pain, the preventative use of gabapentin and pregabalin may be considered.
Fear beliefs should be assessed and addressed through reassurance that pain does not necessarily equal harm. For high fear patients, cognitive behavioural therapy may be needed.5
Is
she a candidate for NSAIDs? Why or why not?
No, Patients with neuropathic pain do not respond to nonsteroidal antiinflammatory drugs and resistance or insensitivity to opiates is common.
Furthermore Mesalamine may cause kidney problems, and combining it with other medications that can also affect the kidney such as ibuprofen may increase that risk. You may need a dose adjustment or more frequent monitoring by patient’s physician to safely use both medications.
Along
with opioid dosing, what adjuvant would you utilize and why?
Ketamine is a sedative/analgesic that is a noncompetitive antagonist at the NMDA receptor, it