Management Of Chronic Pain Patients Research Articles

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with and without Triamcinolone Acetonide in the Management of Chronic Pain in Post-Operative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Role of Injection Lidocaine with Triamcinolone Acetonide versus Lidocaine Alone in the Management of Chronic Pain in Postoperative Inguinal Hernioplasty

Background: Inguinal hernioplasty, also called Lichtenstein repair, is a common surgical procedure for inguinal hernia which can lead to chronic groin pain. Local anesthetic blocks combined with corticosteroids like lidocaine and triamcinolone have been used for post-operative pain management. This study aimed to compare the efficacy of lidocaine with triamcinolone acetonide versus lidocaine alone for chronic pain management in patients who underwent inguinal hernioplasty. Methods: A randomized control trial study was conducted at the Department of Surgery, Kulsoom Bai Valika Hospital, Karachi, Pakistan, from June 2022 to June 2023. The study included patients undergoing inguinal hernioplasty who were over 18 years of age. Group 1 (n=75) received a combination of lidocaine with triamcinolone acetonide, while group 2 (n=75) received lidocaine alone. Pain levels were assessed using the visual analog scale (VAS) during 1st week, 1st month, and 3rd month after the surgery. Results: In group 1, the incidence of pain in the 1st week was 25%, significantly lower than the 41.3% in group 2 (p=0.024). The risk ratio (RR) was 0.65 (95% CI=0.43-0.97, p=0.037). In the 1st month, group 1 had a 13.3% incidence of pain compared to 29.3% in group 2 (p=0.017), with an RR of 0.56 (95% CI=0.33-0.97). Similarly, in the 3rd month, group 1 had a 9.3% incidence of pain compared to 22.7% in group 2 (p=0.026), with an RR of 0.48 (95% CI=0.23-0.97). Conclusion: Lidocaine with triamcinolone acetonide is an effective approach for managing chronic postoperative pain in inguinal hernioplasty.

Opioids for acute and chronic pain when receiving psychiatric medications.

People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.

Association of pain neurophysiology knowledge and application amongst UK chiropractic students: A cross-sectional study.

To investigate if chiropractic placement students in the United Kingdom are aware of current pain evidence and how they relate this to the management of chronic pain patients. Moreover, to gain an understanding of how this can lead to improved pain education planning and engagement in the future. The revised Neurophysiology of Pain Questionnaire and the researchers' own questionnaire were administered online to chiropractic placement students. The aggregated total number of correct responses and the individual mean scores were calculated. Statistical analysis included tests of normality and difference using the Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Χ2 tests. There was an overall response rate of 21.6% (n = 50). The mean score achieved on the revised neurophysiology of pain questionnaire was 37.8%. A significant difference between individual mean scores on the revised Neurophysiology of Pain Questionnaire was observed between male and female participants. No differences in mean score were observed between age, number of chronic pain patients seen, and previous qualifications. For the study-specific questionnaire, statistically significant differences were found in mean score for previous qualifications, number of patients seen, and sex. Chiropractic placement students in the United Kingdom appear to have a lower level of pain knowledge than other health care professionals and education institutions may wish to consider how to best address this within their curricula.

Nursing consultations in pain assessment and treatment facilities

The concept of nursing consultation takes on its full meaning with people suffering from chronic pain. The Société française d'étude et de traitement de la douleur (French Society for the Study and Treatment of Pain), and more specifically its professional nursing commission, has drawn up a reference framework of consultation activities on which pain resource nurses (PRNs) can draw. This describes the various stages in the management of chronic pain patients. In view of the needs and expectations expressed by the population in terms of care, the PRN function is likely to evolve towards that of advanced practice nurse.

Development and Validation of the Dystonia-Pain Classification System: A Multicenter Study.

Dystonia is associated with disabling nonmotor symptoms like chronic pain (CP), which is prevalent in dystonia and significantly impacts the quality of life (QoL). There is no validated tool for assessing CP in dystonia, which substantially hampers pain management. The aim was to develop a CP classification and scoring system for dystonia. A multidisciplinary group was established to develop the Dystonia-Pain Classification System (Dystonia-PCS). The classification of CP as related or unrelated to dystonia was followed by the assessment of pain severity score, encompassing pain intensity, frequency, and impact on daily living. Then, consecutive patients with inherited/idiopathic dystonia of different spatial distribution were recruited in a cross-sectional multicenter validation study. Dystonia-PCS was compared to validated pain, mood, QoL, and dystonia scales (Brief Pain Inventory, Douleur Neuropathique-4 questionnaire, European QoL-5 Dimensions-3 Level Version, and Burke-Fahn-Marsden Dystonia Rating Scale). CP was present in 81 of 123 recruited patients, being directly related to dystonia in 82.7%, aggravated by dystonia in 8.8%, and nonrelated to dystonia in 7.5%. Dystonia-PCS had excellent intra-rater (Intraclass Correlation Coefficient - ICC: 0.941) and inter-rater (ICC: 0.867) reliability. In addition, pain severity score correlated with European QoL-5 Dimensions-3 Level Version's pain subscore (r = 0.635, P < 0.001) and the Brief Pain Inventory's severity and interference scores (r = 0.553, P < 0.001 and r = 0.609, P < 0.001, respectively). Dystonia-PCS is a reliable tool to categorize and quantify CP impact in dystonia and will help improve clinical trial design and management of CP in patients affected by this disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Videothoracoscopic splanchnicectomy as a method of treatment of the chronic pain syndromes in pancreatic cancer and chronic pancreatitis

Background: Chronic pain is a serious problem occurring in patients suffering from pancreatic cancer or chronic pancreatitis. It often contributes to anorexia and significantly deteriorates the quality of life, including the possibility of shortening the survival of such patients. Thoracoscopic splanchnicectomy is a surgical procedure consisted of the excision of the major thoracic visceral nerve or its branches, which attend the transmission of pain stimuli from the abdominal viscera. &#x0D; Aim of the study: The study aim is to indicate benefits of videothoracoscopic splanchnicectomy as a procedure performed in chronic pain management in patients suffering from pancreatic cancer and chronic pancreatitis. &#x0D; Material and methods: The literature available in the databases such as PubMed, Google Scholar and polish scientific journals was reviewed, using the following keywords: videothoracoscopic splanchnicectomy, pancreatic cancer, chronic pancreatitis.&#x0D; Results and conclusions: Videothoracoscopic splanchnicectomy is a minimally invasive yet highly effective surgical procedure, which allows to avoid traumatizing procedures such as thoracotomy or laparotomy in patients suffering from a severe chronic pain associated with pancreatic cancer, chronic pancreatitis and other conditions. Moreover it contributes to a statistically significant decrease in pain intensity and considerably improves the quality of patients’ lives.

Acute and chronic pain management in patients with sickle cell disease in the modern era: a comprehensive review

Sickle cell disease (SCD) is the most common inherited red blood cell (RBC) disorder worldwide, resulting in chronic hemolytic anemia, vaso-occlusion, tissue hypoxia, and ultimately end organ damage. The hallmark of the disease is manifested by vaso-occlusive crisis (VOC) resulting in acute on chronic pain, and the most common cause for presentation to the emergency department and hospital admission. The management of pain for patients with SCD in the U.S. has historically been socially and politically complex with most patients experiencing pain on a daily basis but not seeking immediate medical attention. The pathophysiology of acute and chronic pain in SCD is multifactorial and complex. Here, we describe factors contributing to acute and chronic pain in SCD and management strategies.

Pain treatment in patients with cirrhosis

Chronic pain is reported by 40% -79% of patients with cirrhosis, which is one of the most neglected symptoms among this population. Chronic pain management in patients with cirrhosis remains a difficult clinical issue since a significant number of analgesics are metabolized in the liver and potential side effects are more frequent and involve significant clinical risk. The aim of this review is to draw attention to the available pain management options in patients with cirrhosis based on an analysis of published articles. The following article is based on the literature found in the pubmed database. There are still no precise pain management guidelines in this group of patients. Treatment should include pharmacological, non-pharmacological methods and treatment of comorbidities and patients require careful observation. More research is needed in this area.

Role of Buprenophine in Chronic Pain Management in Covid-19

The suitable Management of chronic pain COVID-19 pandemic is the most demanding process, particularly with developing evidence that COVID-19 Infection analogous to pain,muscle ache, extended neuropathic pain. This review provides the relavant management of chronic pain patients during the COVID-19 pandemic.Buprenorphine is a schedule third semisynthetic opioid analgesic show distinctive pharmacokinetic &amp; pharmacodynamic properties, &amp; involves vital role in chronic pain management in COVID-19.Transdermal formulation of buprenorphine provide controlled delivery for sustained analgesic effectiveness. It's matrix system permitts for slow release of baprenorphine &amp; damage does not construct dose dumping i.e provides predictable serum buprenorphine level over a prolonged period. Also, Buprenorphine show minimal level of adverse effects compared to other opioids like morphine, fentanyl involves respiratory depression, addiction, euphoria, etc.&amp; show good patient acceptance.

Sex-Dependent Prescription Patterns and Clinical Outcomes Associated With the Use of Two Oral Cannabis Formulations in the Multimodal Management of Chronic Pain Patients in Colombia.

To date, the therapeutic use of cannabinoids in chronic pain management remains controversial owing to the limited clinical evidence found in randomized clinical trials (RCTs), the heterogeneous nature of the clinical indication, and the broad range of cannabis-based medicinal products (CBMPs) used in both experimental and observational clinical studies. Here we evaluate patient-reported clinical outcomes (PROMS) in a cohort of adult patients, diagnosed with chronic pain of diverse etiology, who received adjuvant treatment with oral, cannabis-based, magistral formulations between May and September 2021 at the Latin American Institute of Neurology and Nervous System (ILANS-Zerenia) in Bogotá, Colombia. During this period, 2,112 patients completed a PROMS questionnaire aimed at capturing the degree of clinical improvement of their primary symptom and any potential side effects. Most participants were female (76.1%) with an average age of 58.7 years old, and 92.5% (1,955 patients) reported some improvement in their primary symptom (p < 0.001). Two monovarietal, full-spectrum, cannabis formulations containing either cannabidiol (CBD 30 mg/mL; THC <2 mg/mL) or a balanced composition (THC 12 mg/mL; CBD 14 mg/mL) accounted for more than 99% of all prescriptions (59.5 and 39.8%, respectively). The degree of improvement was similar between both formulations, although males reported less effectiveness in the first 4 weeks of treatment. Sex-specific differences were also found in prescription patterns, with male patients increasing the intake of the balanced chemotype overtime. For many patients (71.7%) there were no adverse side effects associated to the treatment and those most reported were mild, such as somnolence (13.0%), dizziness (8.1%) and dry mouth (4.2%), which also appeared to fade over time. Our results constitute the first real-world evidence on the clinical use of medicinal cannabis in Colombia and suggest that cannabis-based oral magistral formulations represent a safe and efficacious adjuvant therapeutic option in the management of chronic pain.

Prospects and Challenges of the Drug Delivery Systems in Endometriosis Pain Management: Experimental and Theoretical Aspects.

Endometriosis is considered a serious public health issue because of the large number of females affected by this illness. Chronic pain management in patients with endometriosis demands new strategies to increase the life quality of these patients. The development of drug delivery systems represents a new approach in pain treatment among endometriosis patients. Diclofenac sodium, one of the most utilized nonsteroidal anti-inflammatory drugs (NSAID), has its own limitations when being used in formulas such as oral, parental, or local applications. In this paper, a series of four drug release formulations based on chitosan, 2-hydroxy-5-nitrobenzaldehyde, and diclofenac sodium salt were prepared in view of the investigation of the drug release ability. The formulations were analyzed from a morphological and supramolecular point of view by scanning electron microscopy and polarized light microscopy. The in vitro drug release ability was investigated by mimicking a physiologic environment. A mathematical model, using the fractal paradigm of motion, is utilized to explain the behaviors of the drug delivery system presented in this paper. These results suggest a great potential of the proposed drug delivery system, based on chitosan and 2-hydroxy-5-nitrobenzaldehyde to improve the diclofenac sodium salt bioavailability, and it may represent a future treatment formula for endometriosis pain.

Opioids for chronic pain management in patients with dialysis-dependent kidney failure.

Chronic pain is highly prevalent among adults treated with maintenance haemodialysis (HD) and has profound negative effects. Over four decades, research has demonstrated that 50-80% of adult patients treated with HD report having pain. Half of patients with HD-dependent kidney failure (HDKF) have chronic moderate-to-severe pain, which is similar to the burden of pain in patients with cancer. However, pain management in patients with HDKF is often ineffective as most patients report that their pain is inadequately treated. Opioid analgesics are prescribed more frequently for patients receiving HD than for individuals in the general population with chronic pain, and are associated with increased morbidity, mortality and health-care resource use. Furthermore, current opioid prescribing patterns are frequently inconsistent with guideline-recommended care. Evidence for the effectiveness of opioids in pain management in general, and in patients with HDKF specifically, is lacking. Nonetheless, long-term opioid therapy has a role in the treatment of some patients when used selectively, carefully and combined with an ongoing assessment of risks and benefits. Here, we provide a comprehensive overview of the use of opioid therapy in patients with HDKF and chronic pain, including a discussion of buprenorphine, which has potential as an analgesic option for patients receiving HD owing to its unique pharmacological properties.

Conceptualizing breakthrough pain

The concept of breakthrough pain (BTP) is examined through the development of a conceptual model with a long-term goal of positively impacting the management of chronic pain patients who experience BTP when hospitalized. The model is based on a 2008 Health Economic Model of Breakthrough Pain developed by Abernethy, Wheeler, and Fortner, which will be referred to as the parent model. The conceptual model of BTP, titled, Novel Conceptual Model of Breakthrough Pain (NCMBP) shares a similar structure in regards to the relationships of major constructs. Like the parent model, the NCMBP is based on three major constructs which are analyzed and explained further with associated concepts. The NCMBP is primarily concerned with the importance of a pain management plan and the endpoint result of patient-perceived analgesia. The NCMBP is viewed as a necessary foundation for continuing safe and effective pain management in the setting of a current opioid overdose epidemic in the United States. The structure and conceptual relationships of the NCMBP are preliminary and will continue to undergo revision as conduction of research is attempted to test the model.

Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain.

Musculoskeletal pain is a challenging condition for both patients and physicians. Many adults have experienced one or more episodes of musculoskeletal pain at some time of their lives, regardless of age, gender, or economic status. It affects approximately 47% of the general population. Of those, about 39–45% have long-lasting problems that require medical consultation. Inadequately managed musculoskeletal pain can adversely affect quality of life and impose significant socioeconomic problems. This manuscript presents a comprehensive review of the management of chronic musculoskeletal pain. It briefly explores the background, classifications, patient assessments, and different tools for management according to the recently available evidence. Multimodal analgesia and multidisciplinary approaches are fundamental elements of effective management of musculoskeletal pain. Both pharmacological, non-pharmacological, as well as interventional pain therapy are important to enhance patient’s recovery, well-being, and improve quality of life. Accordingly, recent guidelines recommend the implementation of preventative strategies and physical tools first to minimize the use of medications. In patients who have had an inadequate response to pharmacotherapy, the proper use of interventional pain therapy and the other alternative techniques are vital for safe and effective management of chronic pain patients.

Qualitative assessment of chronic pain management in patients undergoing computed tomography-guided procedures

BackgroundTo study the qualitative efficacy and safety of percutaneous pain management under CT guidance. The success rate of medical management for chronic pain in long term is very less. This study aids in evaluating the clinical success rate in each CT-guided pain management procedure we have done.ResultsAmong the 60 patients, 39 (65%) were male patients and 21 (35%) were female patients. We did 40 celiac plexus neurolysis (66.7%), 13 radiofrequency ablations (21.6%), 4 stellate ganglion neurolysis (6.7%), and 3 trigeminal nerve neurolysis (5%). The average pre-procedural pain score in all the procedures was 7 which was significantly reduced to 1 in 24 h and 1 and 3 months.ConclusionPercutaneous pain management under CT guidance by virtue of its precise needle placement offers effective pain relief. It has a lower rate of complications, reduces the need for repeat procedures, and ultimately increases the quality of life.

Effects of the COVID-19 pandemic on chronic pain in Spain: a scoping review.

The COVID-19 outbreak has been a great challenge in the management of chronic pain patients. We have conducted a rapid scoping review to assess the impact of the pandemic (and the associated public health measures) on the health status and management practices of chronic pain patients in Spain. To this end, we performed a bibliographic search in LitCOVID and PubMed, and reviewed official websites and documents, and expert reports. The review showed that (1) the studies consistently indicate that the pandemic has had a very negative impact on the physical and psychological health of chronic pain patients; (2) there are scarce data on how the pandemic affected pain unit consultations and a lack of protocols to organize health care in the face of future waves of contagion, with little implementation of telehealth. We make proposals to improve management of chronic pain patients in pandemic situations, which should pivot around 3 axes: (1) a coordinated response of all the relevant stakeholders to define a future roadmap and research priorities, (2) a biopsychosocial approach in pain management, and (3) development and implementation of novel telemedicine solutions.

The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Background:Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD.Objectives:To determine the prevalence and severity of chronic pain in patients with CKD.Design:Systematic review and meta-analysis.Setting:Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity.Patients:Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis.Measurements:Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain.Methods:Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported.Results:Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates.Limitations:Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain.Conclusions:Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided.Trial registration:PROSPERO Registration number CRD42020166965

Acute Pain Management of Chronic Pain Patients in Ambulatory Surgery Centers.

With the widespread growth of ambulatory surgery centers (ASCs), the number and diversity of operations performed in the outpatient setting continue to increase. In parallel, there is an increase in the proportion of patients with a history of chronic opioid use and misuse undergoing elective surgery. Patients with such opioid tolerance present a unique challenge in the ambulatory setting, given their increased requirement for postoperative opioids. Guidelines for managing perioperative pain, anticipating postoperative opioid requirements and a discharge plan to wean off of opioids, are therefore needed. Expert guidelines suggest using multimodal analgesia including non-opioid analgesics and regional/neuraxial anesthesia whenever possible. However, there exists variability in care, resulting in challenges in perioperative pain management. In a recent study of same-day admission patients, anesthesiologists correctly identified most opioid-tolerant patients, but used non-opioid analgesics only half the time. The concept of a focused ambulatory pain specialist on site at each ASC has been suggested, who in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized. This review focuses on perioperative pain management in three subsets of patients who exhibit opioid tolerance: those on large doses of opioids (including abuse-deterrent formulations) for chronic non-malignant or malignant pain; those who have ongoing opioid misuse; and those who were prior addicts and are now on methadone/suboxone maintenance. We also discuss perioperative pain management for patients who have implanted devices such as spinal cord stimulators and intrathecal pain pumps.