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Current Pain and Headache Reports

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01-02-2018 | Other Pain (A Kaye and N Vadivelu, Section Editors)

Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications

Authors: Daniel J. Pak, R. Jason Yong, Alan David Kaye, Richard D. Urman

Published in: Current Pain and Headache Reports | Issue 2/2018

Abstract

Purpose of Review

The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature.

Recent Findings

Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible.

Summary

Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.

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Title: Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications
Authors: Daniel J. Pak
R. Jason Yong
Alan David Kaye
Richard D. Urman
Publication date: 01-02-2018
Publisher: Springer US
Published in: Current Pain and Headache Reports / Issue 2/2018
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI: https://doi.org/10.1007/s11916-018-0666-8

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Springer Medicine

Chronification of Pain: Mechanisms, Current Understanding, and Clinical Implications

Abstract

Purpose of Review

Recent Findings

Summary

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Abstract

Purpose of Review

Recent Findings

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