| 1. |
- Werner, Mads U., et al.
(author)
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Postoperativ smärta: större kirurgi
- 2019. - 1
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In: Akut och cancerrelaterad smärta : Smärtmedicin Vol. 1 - Smärtmedicin Vol. 1. - 9789147112876 ; , s. 361-381
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Book chapter (pop. science, debate, etc.)
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| 2. |
- Perez de Sá, Valéria, et al.
(author)
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Hemodilution during bone marrow harvesting in children
- 1991
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In: Anesthesia and Analgesia. - 1526-7598. ; 72:5, s. 645-650
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Journal article (peer-reviewed)abstract
- Eight children (1--17 yr) underwent bone marrow harvesting while in cytostatic-induced remission of their disease (leukemia [n = 6], Ewing sarcoma, and non-Hodgkin lymphoma). After the induction of general anesthesia, all patients were loaded with 10 mL/kg of a 6% high-molecular dextran solution (Macrodex — Pharmacia), which resulted in a significant preoperative decrease in hematocrit (Hct) from 32% ± 6% to 28% ± 5% (hypervolemic hemodilution) and also allowed the procedure to be performed without systemic heparinization. The blood aspirated during the harvest (24 ± 6 mL/kg; mean ± SD) was replaced with a solution of 6% dextran and Ringer's acetate solution, and the Hct decreased from 28% ± 5% to a minimum of 18% ± 3%. Immediately after the harvest, 10 mL/kg of homologous packed red blood cells was transfused, increasing Hct to 25% ± 3%. Oxygen saturation in the superior caval vein (Scvo2) decreased from 79% ± 4% before the harvest to 70% ± 3% (P < 0.01) at the end of it, and then increased to 74% ± 3% after the transfusion of homologous packed red blood cells. There was a strong linear correlation between mean values for Hct and Scvo2 during the various stages (r = 0.99). Mean heart rate decreased gradually during the procedure, from 106 ± 10 to 86 ± 7 beatslmin. There was no significant change in arterial pressure, but cardiac output measured by impedance cardiography was about 30% greater during harvesting than during undisturbed anesthesia. Pulse oximetric saturation was 99% or 100% throughout. Caval venous blood lactate and pyruvate concentrations remained within normal limits in all children. Recovery after anesthesia was uneventful, except in one child in whom severe shivering developed. H is concluded that the hemodilution resulted in a statistically but not clinically significant decrease in Scvo2 that was well tolerated by the patients as judged from hemodynamic responses as well as levels of arterial oxygen saturation (Sao2) and blood lactate.
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| 3. |
- Springborg, Anders Deichmann, et al.
(author)
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High-dose naloxone : Effects by late administration on pain and hyperalgesia following a human heat injury model. A randomized, double-blind, placebo-controlled, crossover trial with an enriched enrollment design
- 2020
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:11
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Journal article (peer-reviewed)abstract
- Severe chronic postsurgical pain has a prevalence of 4–10% in the surgical population. The underlying nociceptive mechanisms have not been well characterized. Following the late resolution phase of an inflammatory injury, high-dose μ-opioid-receptor inverse agonists reinstate hypersensitivity to nociceptive stimuli. This unmasking of latent pain sensitization has been a consistent finding in rodents while only observed in a limited number of human volunteers. Latent sensitization could be a potential triggering venue in chronic postsurgical pain. The objective of the present trial was in detail to examine the association between injury-induced secondary hyperalgesia and naloxone-induced unmasking of latent sensitization. Healthy volunteers (n = 80) received a cutaneous heat injury (47 C, 420 s, 12.5 cm2). Baseline secondary hyperalgesia areas were assessed 1 h post-injury. Utilizing an enriched enrollment design, subjects with a magnitude of secondary hyperalgesia areas in the upper quartile (‘high-sensitizers’ [n = 20]) and the lower quartile (‘low-sensitizers’ [n = 20]) were selected for further study. In four consecutive experimental sessions (Sessions 1 to 4), the subjects at two sessions (Sessions 1 and 3) received a cutaneous heat injury followed 168 h later (Sessions 2 and 4) by a three-step target-controlled intravenous infusion of naloxone (3.25 mg/kg), or normal saline. Assessments of secondary hyperalgesia areas were made immediately before and stepwise during the infusions. Simple univariate statistics revealed no significant differences in secondary hyperalgesia areas between naloxone and placebo treatments (P = 0.215), or between ‘high-sensitizers’ and ‘low-sensitizers’ (P = 0.757). In a mixed-effects model, secondary hyperalgesia areas were significantly larger following naloxone as compared to placebo for ‘high-sensitizers’ (P < 0.001), but not ‘low-sensitizers’ (P = 0.651). Although we could not unequivocally demonstrate naloxone-induced reinstatement of heat injury-induced hyperalgesia, further studies in clinical postsurgical pain models are warranted.
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| 4. |
- Abelev, Betty, et al.
(author)
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Long-range angular correlations on the near and away side in p-Pb collisions at root S-NN=5.02 TeV
- 2013
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In: Physics Letters. Section B: Nuclear, Elementary Particle and High-Energy Physics. - : Elsevier BV. - 0370-2693. ; 719:1-3, s. 29-41
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Journal article (peer-reviewed)abstract
- Angular correlations between charged trigger and associated particles are measured by the ALICE detector in p-Pb collisions at a nucleon-nucleon centre-of-mass energy of 5.02 TeV for transverse momentum ranges within 0.5 < P-T,P-assoc < P-T,P-trig < 4 GeV/c. The correlations are measured over two units of pseudorapidity and full azimuthal angle in different intervals of event multiplicity, and expressed as associated yield per trigger particle. Two long-range ridge-like structures, one on the near side and one on the away side, are observed when the per-trigger yield obtained in low-multiplicity events is subtracted from the one in high-multiplicity events. The excess on the near-side is qualitatively similar to that recently reported by the CMS Collaboration, while the excess on the away-side is reported for the first time. The two-ridge structure projected onto azimuthal angle is quantified with the second and third Fourier coefficients as well as by near-side and away-side yields and widths. The yields on the near side and on the away side are equal within the uncertainties for all studied event multiplicity and p(T) bins, and the widths show no significant evolution with event multiplicity or p(T). These findings suggest that the near-side ridge is accompanied by an essentially identical away-side ridge. (c) 2013 CERN. Published by Elsevier B.V. All rights reserved.
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| 5. |
- Abelev, Betty, et al.
(author)
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Measurement of prompt J/psi and beauty hadron production cross sections at mid-rapidity in pp collisions at root s=7 TeV
- 2012
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In: Journal of High Energy Physics. - 1029-8479. ; :11
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Journal article (peer-reviewed)abstract
- The ALICE experiment at the LHC has studied J/psi production at mid-rapidity in pp collisions at root s = 7 TeV through its electron pair decay on a data sample corresponding to an integrated luminosity L-int = 5.6 nb(-1). The fraction of J/psi from the decay of long-lived beauty hadrons was determined for J/psi candidates with transverse momentum p(t) > 1,3 GeV/c and rapidity vertical bar y vertical bar < 0.9. The cross section for prompt J/psi mesons, i.e. directly produced J/psi and prompt decays of heavier charmonium states such as the psi(2S) and chi(c) resonances, is sigma(prompt J/psi) (p(t) > 1.3 GeV/c, vertical bar y vertical bar < 0.9) = 8.3 +/- 0.8(stat.) +/- 1.1 (syst.)(-1.4)(+1.5) (syst. pol.) mu b. The cross section for the production of b-hadrons decaying to J/psi with p(t) > 1.3 GeV/c and vertical bar y vertical bar < 0.9 is a sigma(J/psi <- hB) (p(t) > 1.3 GeV/c, vertical bar y vertical bar < 0.9) = 1.46 +/- 0.38 (stat.)(-0.32)(+0.26) (syst.) mu b. The results are compared to QCD model predictions. The shape of the p(t) and y distributions of b-quarks predicted by perturbative QCD model calculations are used to extrapolate the measured cross section to derive the b (b) over bar pair total cross section and d sigma/dy at mid-rapidity.
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| 6. |
- Abelev, Betty, et al.
(author)
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Underlying Event measurements in pp collisions at root s=0.9 and 7 TeV with the ALICE experiment at the LHC
- 2012
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In: Journal of High Energy Physics. - 1029-8479. ; :7
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Journal article (peer-reviewed)abstract
- We present measurements of Underlying Event observables in pp collisions at root s = 0 : 9 and 7 TeV. The analysis is performed as a function of the highest charged-particle transverse momentum p(T),L-T in the event. Different regions are defined with respect to the azimuthal direction of the leading (highest transverse momentum) track: Toward, Transverse and Away. The Toward and Away regions collect the fragmentation products of the hardest partonic interaction. The Transverse region is expected to be most sensitive to the Underlying Event activity. The study is performed with charged particles above three different p(T) thresholds: 0.15, 0.5 and 1.0 GeV/c. In the Transverse region we observe an increase in the multiplicity of a factor 2-3 between the lower and higher collision energies, depending on the track p(T) threshold considered. Data are compared to PYTHIA 6.4, PYTHIA 8.1 and PHOJET. On average, all models considered underestimate the multiplicity and summed p(T) in the Transverse region by about 10-30%.
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| 7. |
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| 8. |
- Andersson, E., et al.
(author)
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Analgesic efficacy of sleep-promoting pharmacotherapy in patients with chronic pain : a systematic review and meta-analysis
- 2023
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In: Pain Rep. - : Lippincott Williams & Wilkins. - 2471-2531. ; 8:1, s. e1061-
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Journal article (peer-reviewed)abstract
- Dysregulation of sleep heightens pain sensitivity and may contribute to pain chronification. Interventions which consolidate and lengthen sleep have the potential to improve pain control. The main objective of this systematic review was to examine the effects of sleep-promoting pharmacotherapy on pain intensity in patients with chronic pain. Multiple electronic databases were searched from inception to January 2022 to identify relevant randomized controlled trials (RCTs). Two independent reviewers screened titles, abstracts, and full-text articles; extracted data; and assessed risk of bias for each included study. The GRADE approach was used to determine the strength of evidence. The search identified 624 articles. After full-text screening, 10 RCTs (n = 574 randomized participants) involving 3 pharmacologic interventions (melatonin, zopiclone, and eszopiclone) and 7 different chronic pain populations were included. Minimum clinically significant pain reduction >/=30% was reported in 4 studies. There is low-quality evidence (downgraded due to inconsistency and imprecision) that 2 to 8 weeks treatment with a sleep-promoting medication alone or in combination with an analgesic (6 trials, n = 397) decreases pain intensity compared with placebo or the same analgesic treatment alone (SMD -0.58 [95% confidence interval -1.00, -0.17], P = 0.006). Analyses of associations between changes in sleep and pain outcomes were only provided in 2 articles, with inconsistent findings. Notably, pain-relieving effects were most consistent in melatonin trials. Only 3 studies implemented polysomnography to obtain objective sleep measures. Low-quality evidence indicates that pharmacologic sleep promotion may decrease pain intensity in chronic pain populations. More research is needed to fully understand the influence of sleep-targeting interventions on pain control.
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| 9. |
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| 10. |
- Andersson, Ingemar
(author)
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Långvarig smärta - en introduktion
- 2010
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In: Smärta och smärtbehandling. - Stockholm : Liber. ; :2, s. 387-400
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Book chapter (other academic/artistic)
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| 11. |
- Andersson, Ingemar
(author)
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Rehabilitering vid långvarig smärta
- 2010
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In: Smärta och smärtbehandling. - Stockholm : Liber. ; :2, s. 401-409
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Book chapter (other academic/artistic)
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| 12. |
- Asghar, Mohammad Sohail, et al.
(author)
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Secondary Hyperalgesia Phenotypes Exhibit Differences in Brain Activation during Noxious Stimulation.
- 2015
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:1
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Journal article (peer-reviewed)abstract
- Noxious stimulation of the skin with either chemical, electrical or heat stimuli leads to the development of primary hyperalgesia at the site of injury, and to secondary hyperalgesia in normal skin surrounding the injury. Secondary hyperalgesia is inducible in most individuals and is attributed to central neuronal sensitization. Some individuals develop large areas of secondary hyperalgesia (high-sensitization responders), while others develop small areas (low-sensitization responders). The magnitude of each area is reproducible within individuals, and can be regarded as a phenotypic characteristic. To study differences in the propensity to develop central sensitization we examined differences in brain activity and anatomy according to individual phenotypical expression of secondary hyperalgesia by magnetic resonance imaging. Forty healthy volunteers received a first-degree burn-injury (47°C, 7 min, 9 cm2) on the non-dominant lower-leg. Areas of secondary hyperalgesia were assessed 100 min after the injury. We measured neuronal activation by recording blood-oxygen-level-dependent-signals (BOLD-signals) during mechanical noxious stimulation before burn injury and in both primary and secondary hyperalgesia areas after burn-injury. In addition, T1-weighted images were used to measure differences in gray-matter density in cortical and subcortical regions of the brain. We found significant differences in neuronal activity between high- and low-sensitization responders at baseline (before application of the burn-injury) (p < 0.05). After the burn-injury, we found significant differences between responders during noxious stimulation of both primary (p < 0.01) and secondary hyperalgesia (p ≤ 0.04) skin areas. A decreased volume of the right (p = 0.001) and left caudate nucleus (p = 0.01) was detected in high-sensitization responders in comparison to low-sensitization responders. These findings suggest that brain-structure and neuronal activation to noxious stimulation differs according to secondary hyperalgesia phenotype. This indicates differences in central sensitization according to phenotype, which may have predictive value on the susceptibility to development of high-intensity acute and persistent pain.
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| 13. |
- Bache, Iben, et al.
(author)
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An excess of chromosome 1 breakpoints in male infertility.
- 2004
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In: European Journal of Human Genetics. - : Springer Science and Business Media LLC. - 1476-5438 .- 1018-4813. ; 12:12, s. 993-1000
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Journal article (peer-reviewed)abstract
- In a search for potential infertility loci, which might be revealed by clustering of chromosomal breakpoints, we compiled 464 infertile males with a balanced rearrangement from Mendelian Cytogenetics Network database (MCNdb) and compared their karyotypes with those of a Danish nation-wide cohort. We excluded Robertsonian translocations, rearrangements involving sex chromosomes and common variants. We identified 10 autosomal bands, five of which were on chromosome 1, with a large excess of breakpoints in the infertility group. Some of these could potentially harbour a male-specific infertility locus. However, a general excess of breakpoints almost everywhere on chromosome 1 was observed among the infertile males: 26.5 versus 14.5% in the cohort. This excess was observed both for translocation and inversion carriers, especially pericentric inversions, both for published and unpublished cases, and was significantly associated with azoospermia. The largest number of breakpoints was reported in 1q21; FISH mapping of four of these breakpoints revealed that they did not involve the same region at the molecular level. We suggest that chromosome 1 harbours a critical domain whose integrity is essential for male fertility.
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| 14. |
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| 15. |
- Bäckryd, Emmanuel, 1974-
(author)
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The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects
- 2015
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Doctoral thesis (other academic/artistic)abstract
- The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain.In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question.In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor.In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses.
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| 16. |
- Degerfält, Jan, et al.
(author)
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E-learning programs in oncology : a nationwide experience from 2005 to 2014
- 2017
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In: BMC Research Notes. - : BioMed Central (BMC). - 1756-0500. ; 10:1
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Journal article (peer-reviewed)abstract
- Background: E-learning is an established concept in oncological education and training. However, there seems to be a scarcity of long-term assessments of E-learning programs in oncology vis-á-vis their structural management and didactic value. This study presents descriptive, nationwide data from 2005 to 2014. E-learning oncology programs in chemotherapy, general oncology, pain management, palliative care, psycho-social-oncology, and radiotherapy, were reviewed from our databases. Questionnaires of self-perceived didactic value of the programs were examined 2008-2014.Results: The total number of trainees were 4693, allocated to 3889 individuals. The trainees included medical doctors (MDs; n = 759), registered nurses (RNs; n = 2359), radiation therapy technologists (n = 642), and, social and health care assistants (SHCAs; n = 933). The E-learning covered 29 different program classifications, comprising 731 recorded presentations, and covering 438 themes. A total of 490 programs were completed by the trainees. The European Credit Transfer and Accumulation System (ECTS; 1 ECTS point equals 0.60 US College Credit Hours) points varied across the educational programs from 0.7 to 30.0, corresponding to a duration of full-time studies ranging between 15 to 900 h (0.4-24 weeks) per program. The total number of ECTS points for the trainee cohort, was 20,000 corresponding to 530,000 full-time academic hours or 324.0 standard academic working years. The overall drop-out rate, across professions and programs, was 10.6% (499/4693). The lowest drop-out rate was seen for RNs (4.3%; P < 0.0001). Self-reported evaluation questionnaires (2008-2014) were completed by 72.1% (2642/3666) of the trainees. The programs were overall rated, on a 5-categorical scale (5 = excellent; 1 = very inferior), as excellent by 68.6% (MDs: 64.9%; RNs: 66.8%; SHCAs: 77.7%) and as good by 30.6% (MDs: 34.5%; RNs: 32.4%; SHCAs: 21.5%) of the responders.Conclusions: This descriptive study, performed in a lengthy timeframe, presents high-volume data from multi-professional, oncological E-learning programs. While the E-learning paradigm, across professions, seems to have been well received, it is imperative that prospective studies, benchmarking against traditional training methods, are carried out, examining the hypothesized didactic value of our E-programs.
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| 17. |
- Dubayev, Akhmedkhan, et al.
(author)
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Quantitative somatosensory assessments in patients with persistent pain following groin hernia repair : A systematic review with a meta-analytical approach
- 2024
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 19:1
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Research review (peer-reviewed)abstract
- ObjectivesQuantitative sensory testing (QST) provides an assessment of cutaneous and deep tissue sensitivity and pain perception under normal and pathological settings. Approximately 2–4% of individuals undergoing groin hernia repair (GHR) develop severe persistent postsurgical pain (PPSP). The aims of this systematic review of PPSP-patients were (1) to retrieve and methodologically characterize the available QST literature and (2) to explore the role of QST in understanding mechanisms underlying PPSP following GHR.MethodsA systematic literature search was conducted from JAN-1992 to SEP-2022 in PubMed, EMBASE, and Google Scholar. For inclusion, studies had to report at least one QST-modality in patients with PPSP. Risk of bias assessment of the studies was conducted utilizing the Newcastle Ottawa Scale and Cochrane’s Risk of Bias assessment tool 2.0. The review provided both a qualitative and quantitative analysis of the results. A random effects model was used for meta-analysis.ResultsTwenty-five studies were included (5 randomized controlled trials, 20 non-randomized controlled trials). Overall, risk of bias was low. Compared with the contralateral side or controls, there were significant alterations in somatosensory function of the surgical site in PPSP-patients. Following thresholds were significantly increased: mechanical detection thresholds for punctate stimuli (mean difference (95% CI) 3.3 (1.6, 6.9) mN (P = 0.002)), warmth detection thresholds (3.2 (1.6, 4.7) °C (P = 0.0001)), cool detection thresholds (-3.2 (-4.9, -1.6) °C (P = 0.0001)), and heat pain thresholds (1.9 (1.1, 2.7) °C (P = 0.00001)). However, the pressure pain thresholds were significantly decreased (-76 (-123, -30) kPa (P = 0.001)).ConclusionOur review demonstrates a plethora of methods used regarding outcome assessments, data processing, and data interpretation. From a pathophysiological perspective, the most consistent findings were postsurgical cutaneous deafferentation and development of a pain generator in deeper connective tissues.
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| 18. |
- Jensen, Elisabeth Kjær, et al.
(author)
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A national center for persistent severe pain after groin hernia repair : Five-year prospective data
- 2019
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In: Medicine. - 0025-7974. ; 98:33
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Journal article (peer-reviewed)abstract
- Severe persistent pain after groin hernia repair impairs quality-of-life. Prospective, consecutive cohort study including patients with pain-related impairment of physical and social life. Relevant surgical records were obtained, and examinations were by standardized clinical and neurophysiological tests. Patients demonstrating pain sensitivity to pressure algometry in the operated groin underwent re-surgery, while patients with neuropathic pain received pharmacotherapy. Questionnaires at baseline (Q0) and at the 5-year time point (Q5Y) were used in outcome analyses of pain intensity (numeric rating scale [NRS] 0-10) and pain-related effect on the activity-of-daily-living (Activities Assessment Scale [AAS]). Data are mean (95% CI).Analyses were made in 172/204 (84%) eligible patients. In 54/172 (31%) patients re-surgery (meshectomy/selective neurectomy) was performed, while the remaining 118/172 (69%) patients received pharmacotherapy. In the re-surgery group, activity-related, and average NRS-scores at Q0 were 6.6 (5.6-7.9) and 5.9 (5.6-5.9), respectively. Correspondingly, NRS-scores at Q5Y was 4.1 (3.3-5.1) and 3.1 (2.3-4.0; Q0 vs. Q5Y: P < .0005), respectively. Although both groups experienced a significant improvement in AAS-scores comparing Q0 vs. Q5Y (re-surgery group: 28% (4-43%; P < .0001); pharmacotherapy group: 5% (0-11%; P = .005)) the improvement was significantly larger in the re-surgery group (P = .02).This 5-year cohort study in patients with severe persistent pain after groin hernia repair signals that selection to re-surgery or pharmacotherapy, based on examination of pain sensitivity, is associated with significant improvement in outcome. Analyzing composite endpoints, combining pain and physical function, are novel in exploring interventional effects.ClinicalTrials.gov Identifier NCT03713047.
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| 19. |
- Jensen, Elisabeth Kjær, et al.
(author)
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Somatosensory Outcomes Following Re-Surgery in Persistent Severe Pain After Groin Hernia Repair : A Prospective Observational Study
- 2023
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In: Journal of Pain Research. - 1178-7090. ; 16, s. 943-959
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Journal article (peer-reviewed)abstract
- Purpose: After groin hernia repair (globally more than 20 million/year) 2–4% will develop persistent severe pain (PSPG). Pain management is challenging and may require multimodal interventions, including re-surgery. Quantitative somatosensory testing (QST) is an investigational psychophysiological tool with the potential to uncover the pathophysiological mechanisms behind the pain, ie, revealing neuropathic or inflammatory components. The primary objective was to examine and describe the underlying pathophysiological changes in the groin areas by QST before and after re-surgery with mesh removal and selective neurectomy. Patients and Methods: Sixty patients with PSPG scheduled for re-surgery and with an inflammatory “component” indicated by blunt pressure algometry were examined in median (95% CI) 7.9 (5.8–11.5) months before and 4.0 (3.5–4.6) months after re-surgery. The QST-analyses included standardized assessments of cutaneous mechanical/thermal detection and pain thresholds. Suprathreshold heat stimuli were applied. Deep tissue sensitivity was tested by pressure algometry. Testing sites were the groin areas and the lower arm. Before/after QST data were z-transformed. Results: Re-surgery resulted in median changes in rest, average, and maximal pain intensity scores of −2.0, −2.5, and −2.0 NRS (0/ 10) units, respectively (P = 0.0001), and proportional increases in various standardized functional scores (P = 0.0001). Compared with the control sites, the cutaneous somatosensory detection thresholds of the painful groin were increased before re-surgery and increased further after re-surgery (median difference: 1.28 z-values; P = 0.001), indicating a successive post-surgical loss of nerve fiber function (“deafferentation”). Pressure algometry thresholds increased after re-surgery (median difference: 0.30 z-values; P = 0.001). Conclusion: In this subset of patients with PSPG who underwent re-surgery, the procedure was associated with improved pain and functional outcomes. While the increase in somatosensory detection thresholds mirrors the surgery-induced cutaneous deafferentation, the increase in pressure algometry thresholds mirrors the removal of the deep “pain generator”. The QST-analyses are useful adjuncts in mechanism-based somatosensory research.
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| 20. |
- Jensen, Elisabeth Kjaer, et al.
(author)
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Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis
- 2021
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In: Scandinavian Journal of Pain. - : WALTER DE GRUYTER GMBH. - 1877-8860 .- 1877-8879. ; 21:1, s. 70-80
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Journal article (peer-reviewed)abstract
- Objectives: Severe persistent post-surgical pain (PPSP) remains a significant healthcare problem. In the third most common surgical procedure in the U.K., groin hernia repair, including 85,000 surgeries, estimated 1,500-3,000 patients will annually develop severe PPSP. While the trajectory of PPSP is generally considered a continuation of the acute post-surgery pain, recent data suggest the condition may develop with a delayed onset. This study evaluated pain-trajectories in a consecutive cohort referred from groin hernia repair-surgeons to a tertiary PPSP-center. Potential explanatory variables based on individual psychometric, sensory, and surgical profiles were analyzed. Methods: Patients completed graphs on pain trajectories and questionnaires on neuropathic pain, pain-related functional assessments, and psychometrics. Surgical records and quantitative sensory testing profiles were obtained. Pain trajectories were normalized, and pre- and post-surgical segments were analyzed by a normalized area-under-the-curve (AUC) technique. Principal component analysis (PCA) was applied to the explanatory variables. Significant PCA-components were further examined using multiple logistic regression models. Results: In 95 patients, the AUC identified groups of post-surgical pain trajectories (p<0.0001): group I (n=48), acute high-intensity pain progressing to PPSP; group II (n=28), delayed onset of PPSP; group III (n=7), repeat-surgery gradually inducing PPSP. Data from groups IV (n=3) and V (n=9) were not included in the statistical analysis due to small sample size and data heterogeneity, respectively. The PCA/logistic analyses indicated that neuropathic pain scores, composite pain scores, and pain-related functional assessments were explanatory variables for groups I and II. Conclusions: Pain trajectories in PPSP after groin hernia repair are heterogeneous but can be classified into meaningful groups. Examination of pain trajectories, mirroring the transition from acute to severe persistent post-surgical pain, has the potential of uncovering clinically relevant pathophysiological mechanisms.
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| 21. |
- Jørgensen, Johanne Villars, et al.
(author)
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Assessment of somatosensory profiles by quantitative sensory testing in children and adolescents with and without cerebral palsy and chronic pain
- 2024
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In: European Journal of Paediatric Neurology. - 1090-3798. ; 51, s. 32-40
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Journal article (peer-reviewed)abstract
- Objective: We investigated differences in somatosensory profiles (SSPs) assessed by quantitative sensory testing in children and adolescents with cerebral palsy (CCP) with and without chronic pain and compared these differences to those in a group of typically developed children and adolescents (TDC) with and without chronic pain. Method: All included subjects were consecutively recruited from and tested at the same outpatient orthopedic clinic by the same investigator. The subjects had their reaction times tested. The SSP consisted of the following tests: warmth (WDT), cool (CDT), mechanical (MDT), and vibration (VDT) detection thresholds; heat (HPT), pressure (PPT), and mechanical (MPT) pain thresholds; wind-up ratio (WUR); dynamic mechanical allodynia (DMA) and cold pressor test (CPT) using a conditioned pain modulation (CPM) paradigm. Results: We included 25 CCP and 26 TDC. TDC without chronic pain served as controls. In TDC with chronic pain, WDT, HPT, HPT intensity, and PPT were higher than in controls. No differences in SSPs between CCP with and without chronic pain were observed. In CCP, the MDT, WDT, CDT, and HPT intensity were higher than in controls. CCP had longer reaction times than TDC. There were no differences regarding the remaining variables. Discussion: In CCP, the SSPs were independent of pain status and findings on MR images. In all CCP the SSPs resembled TDC with chronic pain, compared to TDC without chronic pain. This suggests that CCP do not have the normal neuroplastic adaptive processes that activate and elicit functional changes in the central and peripheral nervous systems.
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| 22. |
- Ljungman, Gustaf, et al.
(author)
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Cancerrelaterad smärta hos barn
- 2010. - 2:a uppl.
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In: Smärta och smärtbehandling. - Stockholm : Liber. - 9789147084135 ; , s. 374-384
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Book chapter (other academic/artistic)
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| 23. |
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Långvarig smärta: smärtmedicin vol. 2
- 2021. - 1
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Editorial collection (other academic/artistic)abstract
- Boken ger läsaren en solid kunskapsbas om smärtmedicinens komplexa natur, från såväl ett vetenskapligt som ett mänskligt perspektiv.Långvarig smärta – smärtmedicin (vol. 2) är ett nytt gediget verk med ett omfattande referensmaterial baserat på den senaste evidensen och klinisk praxis och kan läsas som fördjupningslitteratur eller uppslagsverk. Boken kan användas på utbildningar för läkare, sjuksköterskor och fysioterapeuter samt övriga professioner som i sitt yrke möter människor med smärta.DEL I ger en smärtmedicinsk grund med bland annat fysiologi samt psykologiska, humanistiska och åldersmässiga aspekter av smärta. DEL II behandlar den långvariga smärtans patofysiologi och behandlingsmetoder samt farmakologi. DEL III beskriver olika smärttillstånd såsom muskuloskeletala, neuropatiska, ischemiska och viscerala tillstånd samt ett kapitel om långvarig smärta hos barn.Långvarig smärta (vol. 2) kompletteras av Akut och cancerrelaterad smärta (vol. 1). Böckerna bygger på den välrenommerade boken Smärta och smärtbehandling och har extensivt utökats i omfång och djup tack vare den senaste forskningen inom området. Tillsammans utgör de båda volymerna den i särklass mest heltäckande läroboken om smärta på svenska.
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| 24. |
- Madsen, Signe Sloth, et al.
(author)
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Neuroplasticity induced by general anaesthesia : study protocol for a randomised cross-over clinical trial exploring the effects of sevoflurane and propofol on the brain - A 3-T magnetic resonance imaging study of healthy volunteers
- 2020
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In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 21:1
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Journal article (peer-reviewed)abstract
- Background: Although used extensively worldwide, the effects of general anaesthesia on the human brain remain largely elusive. Moreover, general anaesthesia may contribute to serious conditions or adverse events such as postoperative cognitive dysfunction and delirium. To understand the basic mechanisms of general anaesthesia, this project aims to study and compare possible de novo neuroplastic changes induced by two commonly used types of general anaesthesia, i.e. inhalation anaesthesia by sevoflurane and intravenously administered anaesthesia by propofol. In addition, we wish to to explore possible associations between neuroplastic changes, neuropsychological adverse effects and subjective changes in fatigue and well-being. Methods: This is a randomised, participant- and assessor-blinded, cross-over clinical trial. Thirty healthy volunteers (male:female ratio 1:1) will be randomised to general anaesthesia by either sevoflurane or propofol. Multimodal magnetic resonance imaging (MRI) of the brain will be performed before and after general anaesthesia and repeated after 1 and 8 days. Each magnetic resonance imaging session will be accompanied by cognitive testing and questionnaires on fatigue and well-being. After a wash-out period of 4 weeks, the volunteers will receive the other type of anaesthetic (sevoflurane or propofol), followed by the same series of tests. Primary outcomes: changes in T1-weighted 3D anatomy and diffusion tensor imaging. Secondary outcomes: changes in resting-state functional magnetic resonance imaging, fatigue, well-being, cognitive function, correlations between magnetic resonance imaging findings and the clinical outcomes (questionnaires and cognitive function). Exploratory outcomes: changes in cerebral perfusion and oxygen metabolism, lactate, and response to visual stimuli. Discussion: To the best of our knowledge, this is the most extensive and advanced series of studies with head-to-head comparison of two widely used methods for general anaesthesia. Recruitment was initiated in September 2019. Trial registration: Approved by the Research Ethics Committee in the Capital Region of Denmark, ref. H-18028925 (6 September 2018). EudraCT and Danish Medicines Agency: 2018-001252-35 (23 March 2018). www.clinicaltrials.gov, ID: NCT04125121. Retrospectively registered on 10 October 2019.
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| 25. |
- Mikkelsen, T, et al.
(author)
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Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy
- 2004
-
In: Anesthesia and Analgesia. - 1526-7598. ; 99:1, s. 146-151
-
Journal article (peer-reviewed)abstract
- Inguinal hernia repair is associated with a 5%-30% incidence of chronic pain, but the pathogenesis remains unknown. We therefore evaluated pain and sensory dysfunction by quantitative sensory testing 6-12 mo after open herniorrhaphy. Before sensory testing, all patients (n = 72) completed a short-form McGill Pain Questionnaire and a functional impairment questionnaire. Sensory dysfunction in the incisional area was evaluated by quantification of thermal and mechanical thresholds, by mechanical pain responses (von Frey/pressure algometry), and by areas of pinprick hypoesthesia and tactile allodynia. The incidence of chronic pain was 28% (20 of 72). Quantitative sensory testing and pressure algometry did not demonstrate differences between the pain and nonpain groups, except for a small but significant increase in pain response to von Frey hair and brush stimulation in the pain group. Hypoesthesia, or tactile allodynia, in the incisional area was observed in 51% (37 of 72) of the patients, but the incidence did not differ significantly between the pain group and the nonpain group (14 of 20 versus 23 of 52; P > 0.3). We concluded that cutaneous hypoesthesia, or tactile allodynia, is common after inguinal herniotomy but has a low specificity for chronic postherniotomy pain. Factors other than nerve damage maybe involved in the development of chronic postherniotomy pain.
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| 26. |
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| 27. |
- Papathanasiou, Theodoros, et al.
(author)
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High-dose naloxone, an experimental tool uncovering latent sensitisation : pharmacokinetics in humans
- 2019
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In: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912. ; 123:2, s. 204-214
-
Journal article (peer-reviewed)abstract
- Background: Naloxone, an opioid receptor antagonist, is used as a pharmacological tool to detect tonic endogenous activation of opioid receptors in experimental pain models. We describe a pharmacokinetic model linking naloxone pharmacokinetics to its main metabolite after high-dose naloxone infusion. Methods: Eight healthy volunteers received a three-stage stepwise high-dose i.v. naloxone infusion (total dose 3.25 mg kg−1). Naloxone and naloxone-3-glucuronide (N3G) plasma concentrations were sampled from infusion onset to 334 min after infusion discontinuation. Pharmacokinetic analysis was performed using non-linear mixed effect models (NONMEM). The predictive performances of Dowling's and Yassen's models were evaluated, and target-controlled infusion simulations were performed. Results: Three- and two-compartment disposition models with linear elimination kinetics described the naloxone and N3G concentration time-courses, respectively. Two covariate models were developed: simple (weight proportional) and complex (with the shallow peripheral volume of distribution linearly increasing with body weight). The median prediction error (MDPE) and wobble for Dowling's model were –32.5% and 33.4%, respectively. For Yassen's model, the MDPE and wobble were 1.2% and 19.9%, respectively. Conclusions: A parent–metabolite pharmacokinetic model was developed for naloxone and N3G after high-dose naloxone infusion. No saturable pharmacokinetics were observed. Whereas Dowling's model was inaccurate and over-predicted naloxone concentrations, Yassen's model accurately predicted naloxone pharmacokinetics. The newly developed covariate models may be used for high-dose TCI-naloxone for experimental and clinical practice. Clinical trials registration: NCT01992146.
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| 28. |
- Rotboll Nielsen, P, et al.
(author)
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Prediction of postoperative pain
- 2007
-
In: Current Anaesthesia and Critical Care. - : Elsevier BV. - 0953-7112. ; 18:3, s. 157-165
-
Journal article (peer-reviewed)abstract
- Pain is a complex subjective experience with sensory-discriminative, emotional-affective and cognitive-evaluative components. Postoperative pain is associated with considerable psychological and physiological distress that may impede postoperative recovery and lead to increased morbidity and development of persistent post-surgical pain. There seems to be a considerable individual variability in postoperative pain perception even following standardized surgical procedures. Implementation of clinically relevant preoperative screening methods may facilitate more aggressive pain therapies specifically targeted at high-risk individuals, a strategy that may improve postoperative rehabilitation and morbidity. This article reviews data on the predictive potential in postoperative pain of the surgical procedure, preoperative pain, age, gender, anxiety, depression, neuroticism, psycho-physiological assessments, catastrophizing, genetics and pharmacogenetics, and acute opioid tolerance.
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| 29. |
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| 30. |
- Rudin, Åsa, et al.
(author)
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Morphine metabolism after major liver surgery
- 2007
-
In: Anesthesia and Analgesia. - : Ovid Technologies (Wolters Kluwer Health). - 0003-2999 .- 1526-7598. ; 104:6, s. 1409-1414
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Impaired metabolism of morphine may lead to an increase in sedation and respiratory depression. METHODS: In the present study we investigated morphine pharmacokinetics in patients who had undergone liver resection (n = 15) compared to a control group undergoing colon resection (n = 15). Morphine was administered IV by patient-controlled analgesia. Plasma concentrations of morphine, morphine-6-glucuronide, and morphine-3-glucuronide were measured 2-3 times daily for the first two postoperative days. Pain intensity scores were assessed three times daily and respiratory rate and sedation scores every third hour. RESULTS: There were no differences in morphine requirements 1.1 (0.8-2.5 [median, interquartile range]) mg/h (liver resection) and 1.5 (1.1-1.7) mg/h (colon resection) [P = 0.84]) or in pain intensity scores (P > 0.3) between the groups. Plasma morphine concentrations were higher in patients undergoing liver resection than in the control group (P < 0.01) reflecting a lower rate of morphine metabolism. Plasma morphine concentrations were correlated with the volume of liver resection (P < 0.02). However, plasma concentrations of morphine-6-glucuronide and morphine-3-glucuronide did not differ between the groups (P = 0.62 and P = 0.48, respectively). There was a higher incidence of sedation (P = 0.02), but not respiratory depression (P = 0.48), after liver resection. CONCLUSION: The study demonstrates that plasma concentrations of morphine are higher in patients undergoing liver resection compared with patients undergoing colon resection. Sedation scores were higher in patients undergoing liver resection. Caution is therefore recommended when administering morphine to this patient group.
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| 31. |
- Rudin, Åsa, et al.
(author)
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Prediction of post-operative pain after a laparoscopic tubal ligation procedure.
- 2008
-
In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 52:7, s. 938-945
-
Journal article (peer-reviewed)abstract
- Background: Pre-operative identification of reliable predictors of post-operative pain may lead to improved pain management strategies. We investigated the correlation between pre-operative pain, psychometric variables, response to heat stimuli and post-operative pain following a laparoscopic tubal ligation procedure. Methods: Assessments of anxiety, mood, psychological vulnerability and pre-operative pain were made before surgery using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety Depression Scale (HADS), a psychological vulnerability test and the Short-Form McGill Pain Questionnaire (SF-MPQ), respectively. Pre-operative assessments of thermal thresholds and pain response to randomized series of heat stimuli (1 s, 44-48 degrees C) were made with quantitative sensory testing technique. Post-operative pain intensity was evaluated daily by a visual analogue scale during rest and during standardized dynamic conditions for 10 days following surgery. Univariate and multivariate regression analyses were used to construct prediction models. Results: Fifty-nine patients completed the study. Post-operative pain was significantly correlated with pre-operative pain (SF-MPQ), heat pain perception, psychological vulnerability, STAI and HADS. In the multiple regression model pre-operative pain and heat pain perception were significant predictive factors (R=0.537-0.609). Conclusion: The study indicates that pre-surgical pain and heat pain sensitivity are important pre-operative indicators of post-operative pain intensity, while psychological factors like vulnerability and anxiety seem to contribute to a lesser degree after laparoscopic tubal ligation. The prediction model accounted for 29-43% of the total variance in post-operative movement-related pain.
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| 32. |
- Rudin, Åsa, et al.
(author)
-
Prediction of Postoperative Pain After Mandibular Third Molar Surgery
- 2010
-
In: Journal of Orofacial Pain. - : Quintessence Publishing Co. - 1064-6655 .- 1945-3396. ; 24:2, s. 189-196
-
Journal article (peer-reviewed)abstract
- Aims: To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS). Methods: Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44 degrees C to 48 degrees C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery. Results: Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (>30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28138) during eating. In a multiple regression model, the combination of psychological vulnerability and beat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to.001).Conclusion: Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery. J OROFAC PAIN 2010;24:189-196
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| 33. |
- Springborg, Anders Deichmann, et al.
(author)
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Methodology and applicability of the human contact burn injury model : A systematic review
- 2021
-
In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:7 July
-
Research review (peer-reviewed)abstract
- The contact burn injury model is an experimental contact thermode-based physiological pain model primarily applied in research of drug efficacy in humans. The employment of the contact burn injury model across studies has been inconsistent regarding essential methodological variables, challenging the validity of the model. This systematic review analyzes methodologies, outcomes, and research applications of the contact burn injury model. Based on these results, we propose an improved contact burn injury testing paradigm. A literature search was conducted (15-JUL-2020) using PubMed, EMBASE, Web of Science, and Google Scholar. Sixty-four studies were included. The contact burn injury model induced consistent levels of primary and secondary hyperalgesia. However, the analyses revealed variations in the methodology of the contact burn injury heating paradigm and the post-burn application of test stimuli. The contact burn injury model had limited testing sensitivity in demonstrating analgesic efficacy. There was a weak correlation between experimental and clinical pain intensity variables. The data analysis was limited by the methodological heterogenicity of the different studies and a high risk of bias across the studies. In conclusion, although the contact burn injury model provides robust hyperalgesia, it has limited efficacy in testing analgesic drug response. Recommendations for future use of the model are being provided, but further research is needed to improve the sensitivity of the contact burn injury method. The protocol for this review has been published in PROSPERO (ID: CRD42019133734).
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| 34. |
- Storgaard, Ida Klitzing, et al.
(author)
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Population pharmacokinetic–pharmacodynamic model of subcutaneous bupivacaine in a novel extended-release microparticle formulation
-
In: Basic and Clinical Pharmacology and Toxicology. - 1742-7835.
-
Journal article (peer-reviewed)abstract
- The objective of this study was to develop a population pharmacokinetic–pharmacodynamic model of subcutaneously administered bupivacaine in a novel extended-release microparticle formulation for postoperative pain management. Bupivacaine was administered subcutaneously in the lower leg to 28 healthy male subjects in doses from 150 to 600 mg in a phase 1 randomized, placebo-controlled, double-blind, dose-ascending study with two different microparticle formulations, LIQ865A and LIQ865B. Warmth detection threshold was used as a surrogate pharmacodynamic endpoint. Population pharmacokinetic–pharmacodynamic models were fitted to plasma concentration-effect-time data using non-linear mixed-effects modelling. The pharmacokinetics were best described by a two-compartment model with biphasic absorption as two parallel absorption processes: a fast, zero-order process and a slower, first-order process with two transit compartments. The slow absorption process was found to be dose-dependent and rate-limiting for elimination at higher doses. Apparent bupivacaine clearance and the transit rate constant describing the slow absorption process both appeared to decrease with increasing doses following a power function with a shared covariate effect. The pharmacokinetic–pharmacodynamic relationship between plasma concentrations and effect was best described by a linear function. This model gives new insight into the pharmacokinetics and pharmacodynamics of microparticle formulations of bupivacaine and the biphasic absorption seen for several local anaesthetics.
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| 35. |
- Werner, Mads, et al.
(author)
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Arthroscopic knee surgery does not modify hyperalgesic responses to heat injury
- 2003
-
In: Anesthesiology. - 1528-1175. ; 99:5, s. 1152-1157
-
Journal article (peer-reviewed)abstract
- Background: Experimental studies suggest that surgical injury may up- or down-regulate nociceptive function. Therefore, the aim of this clinical study was to evaluate the effect of elective arthroscopically assisted knee surgery on nociceptive responses to a heat injury. Methods: Seventeen patients scheduled to undergo repair of the anterior cruciate ligament and 16 healthy controls were studied. The first burn injury was induced 6 days before surgery, and the second burn was induced I day after surgery with a contact thermode (12.5 cm(2), 47degreesC for 7 min) placed on the medial aspect of the calf contralateral to the surgical side. Ibuprofen and acetaminophen were given for 2 days before the first burn injury and again from the time of surgery. in the controls, the two burn injuries were separated by 7 days. Sensory variables included cumulated pain score during induction of the burn (visual analog scale), secondary hyperalgesia area, and mechanical and thermal pain perception and pain thresholds assessed before and I h after the burn injury. Results: The heat injuries induced significant increases in pain perception (P < 0.001) and decreases in pain thresholds (P < 0.02). Baseline heat pain thresholds were higher during the second burn injury in patients (P < 0.001) and controls (P < 0.01). However, there were no significant differences in pain to heat injury (P > 0.8), secondary hyperalgesia areas (P > 0.1), mechanical and thermal pain perception (P > 0.1), or mechanical and thermal pain thresholds (P > 0.08) in the burn area before surgery compared to after surgery. Conclusion: Arthroscopic knee surgery did not modify nociceptive responses to a contralaterally applied experimental burn injury.
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| 36. |
- Werner, Mads, et al.
(author)
-
Prediction of postoperative pain by preoperative nociceptive reponses to heat stimulation
- 2004
-
In: Anesthesiology. - 1528-1175. ; 100:1, s. 115-119
-
Journal article (peer-reviewed)abstract
- Background: Despite major advances in the understanding of the neurobiologic mechanisms of pain, the wide variation in acute pain experience has not been well explained. Therefore, the authors investigated the potential of a preoperatively induced heat injury to predict subsequent postoperative pain ratings in patients undergoing knee surgery. Methods: Twenty patients were studied. The burn injury was induced 6 days before surgery with a contact thermode (12.5 cm(2), 47degreesC for 7 min). The sensory testing, before and 1 h after the injury, included pain score during induction of the burn, secondary hyperalgesta area, thermal and mechanical pain perception, and pain thresholds. Postoperative analgesia consisted of ibuprofen and acetaminophen. Pain ratings (visual analog scale) at rest and during limb movement were followed for 10 days after surgery. Results: The burn injury was associated with development of significant hyperalgesia. There was a significant correlation between preoperative pain ratings during the burn injury and early (0-2 days, area under the curve) and late (3-10 days, area under the curve) postoperative dynamic pain ratings during limb movement. Conclusion: The results of this study suggest that the pain response to a preoperative heat injury may be useful in research in predicting the intensity of postoperative pain. These findings may have important implications to identify patients at risk for development of chronic pain and to stratify individuals for investigations of new analgesics.
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| 37. |
- Werner, Mads, et al.
(author)
-
The acute pain service – roles and challenges.
- 2007
-
In: Current Anaesthesia & Critical Care. - : Elsevier BV. - 0953-7112. ; 18:3, s. 135-139
-
Journal article (peer-reviewed)abstract
- cute pain services were introduced more than 20 years ago as an organizational attempt to meet shortcomings in postoperative pain management. The acute pain service concept received immediate and strong support from a large number of medical and health-care organizations around the world. Literature reviews indicate that 30–70% of North-American and European hospitals, depending on size and academic affiliation, have an acute pain service. The advantages of a multiprofessional team approach in postoperative pain management seem obvious, but has the acute pain service demonstrated its value? Recent reviews indicate disappointingly that inadequate pain relief continues to be a clinically significant and major problem. Though implementation of an acute pain service has been associated with a significant improvement in patients’ postoperative pain ratings and satisfaction scores, there are no conclusive data available in regard to side effects, adverse events or postoperative morbidity. Future strategies should focus on outcome analyses of pain management, including estimates of cost-effectiveness, and the acute pain service should be an integrated part of clinical pathways directed at early postoperative rehabilitation leading to an improvement in postoperative outcome. The lack of relevant outcome data, however, may pose a threat in an increasingly cost-conscious public health-care sector.
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| 38. |
- Werner, Mads U., et al.
(author)
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The Harald Breivik lecture 2022. Pathophysiology in persistent severe pain after groin hernia repair
- 2022
-
In: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 22:4, s. 686-689
-
Journal article (peer-reviewed)abstract
- The transition from a healthy to a persistent severe pain state following otherwise successful elective surgery is a feared complication. Groin hernia repair, previously considered minor surgery, is a standard surgical procedure annually performed on 2,000 individuals per one million residents. A trajectory into persistent severe pain is, unfortunately, seen in 2-4%, severely impeding physical and psychosocial daily functions.
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| 39. |
-
- 2019
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Journal article (peer-reviewed)
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