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Acute pain management in patients with persistent pain
1Nuffield Division of Anaesthetics, Oxford University Hospitals NHS Trust, Oxford, UK. jane.quinlan@ouh.nhs.uk
Current Opinion in Supportive and Palliative Care
|March 13, 2012
Summary
Managing acute pain in patients with chronic pain requires careful consideration due to increased opioid prescriptions. Non-opioid analgesics and targeted therapies are crucial for managing pain exacerbations and avoiding escalating opioid doses.
Area of Science:
- Pain Management
- Pharmacology
- Clinical Research
Background:
- Opioid prescriptions for chronic pain have significantly increased over the last two decades.
- Managing acute pain in patients with chronic pain presents unique challenges.
Purpose of the Study:
- To review the difficulties in managing acute pain in patients with chronic pain.
- To discuss evidence on opioid tolerance and hyperalgesia.
- To explore new research avenues for specific painful conditions.
Main Methods:
- Literature review of studies on acute pain management in chronic pain patients.
- Analysis of evidence regarding opioid tolerance and hyperalgesia.
- Examination of emerging therapeutic targets for specific pain conditions.
Main Results:
- High-dose opioids carry risks of overdose and death; non-opioid analgesics can limit dose escalation.
- Potential treatment targets include oxidative stress and calcium homeostasis in pancreatitis, psychological stressors for abdominal pain, and sickle cell adhesion in vaso-occlusive crises.
- Vertebroplasty and calcitonin show promise for osteoporotic vertebral fractures.
Conclusions:
- Current evidence for acute pain management in chronic pain patients is often extrapolated from opioid-naïve surgical patients.
- Further research is essential to determine appropriate pain management models for this complex patient group.
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