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By Gérard Mick, Virginie Guastella

Primum non nocere… The incontrovertible fact that a surgery can go away any type of ache casts a shadow over this guiding principle, that is noticeable because the foundation of clinical perform and anchor of its precept ethic…

It is all of the extra excellent in that drugs has in basic terms paid cognizance to this paradoxical power ache state of affairs for the earlier few years. Clarifying the information obtained during this box has turn into all of the extra pressing for any care-giver this present day faced by way of a sound request from sufferers: Why and the way can a surgery, that's speculated to carry aid, go away at the back of an unacceptable sequela?

This is the strategy which the participants to this new topic of significant medical curiosity invite you to stick with as you're employed your manner via this book.

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Extra resources for Chronic Postsurgical Pain

Example text

The phenomenon of hypersensitivity to pain has been observed in preclinical trials in animals. In the rat, the existence of an initial painful lesion, even if it is healed, for example a surgical incision to a paw, causes a hypersensitivity to pain which is only revealed if a second tissue insult (inflammation) is administered (Fig. 2a, b). This observation is particularly interesting because hypersensitivity to pain also occurs if this second injury (inflammation) affects the paw contralateral to the first lesion (incision), thus clearly indicating a sensitisation process of central origin (Fig.

Dualé These investigations have been carried out after certain operations that cause CPSP (inguinal herniorrhaphy, mastectomy, mandibular surgery and thoracotomy) and have shown changes in the function of peripheral fibres and/or the perception of certain sensations when stimulating the area around the scar [74, 103, 106, 139– 142]. Quite surprisingly, a ‘‘standard profile’’ appears to emerge, with lowered mechanical thresholds and raised heat thresholds. Two comments can be made at this stage: • this confirms the peripheral mononeuropathy after these operations [143]; • this profile can be linked to mechanistic hypotheses such as functional alterations of (temperature-sensitive) C fibres and reinforcement of the activity of large-calibre fibres [32, 74, 144].

From this point of view, four types of analgesics could be proposed: (1) pure antinociceptive analgesics, such as paracetamol; (2) hyperalgesic analgesics, such as opioids; (3) true anti-hyperalgesics such as NMDA antagonists [29, 40] and gabapentinoids [27]; (4) antihyperalgesic analgesics such as nitrous oxide [26] and nefopam [2]. Other treatment strategies that have no analgesic effect of their own but are capable of inhibiting sensitisation processes may be added to the use of opioid analgesics, for example certain nutritional approaches such as low-polyamine diets [41, 42], which are capable in animals of inhibiting sensitisation processes induced by acute or chronic administration of opioid substances.

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