Document Detail


Surgically induced neuropathic pain: understanding the perioperative process.
MedLine Citation:
PMID:  23059501     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Nerve damage takes place during surgery. As a consequence, significant numbers (10%-40%) of patients experience chronic neuropathic pain termed surgically induced neuropathic pain (SNPP). The initiating surgery and nerve damage set off a cascade of events that includes both pain and an inflammatory response, resulting in "peripheral and central sensitization," with the latter resulting from repeated barrages of neural activity from nociceptors. In affected patients, these initial events produce chemical, structural, and functional changes in the peripheral and central nervous systems (CNS). The maladaptive changes in damaged nerves lead to peripheral manifestations of the neuropathic state-allodynia, sensory loss, shooting pains, etc, that can manifest long after the effects of the surgical injury have resolved. The CNS manifestations that occur are termed "centralization of pain" and affect sensory, emotional, and other (eg, cognitive) systems as well as contributing to some of the manifestations of the chronic pain syndrome (eg, depression). Currently there are no objective measures of nociception and pain in the perioperative period. As such, intermittent or continuous pain may take place during and after surgery. New technologies including direct measures of specific brain function of nociception and new insights into preoperative evaluation of patients including genetic predisposition, appear to provide initial opportunities for decreasing the burden of SNPP, until treatments with high efficacy and low adverse effects that either prevent or treat pain are discovered.
Authors:
David Borsook; Barry D Kussman; Edward George; Lino R Becerra; Dennis W Burke
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Annals of surgery     Volume:  257     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-06     Completed Date:  2013-04-02     Revised Date:  2014-03-09    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  403-12     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Brain / physiopathology*
Humans
Neuralgia / complications,  physiopathology*
Nociceptors / physiology*
Pain, Postoperative / etiology,  physiopathology*
Grant Support
ID/Acronym/Agency:
K24 NS064050/NS/NINDS NIH HHS; K24 NS064050/NS/NINDS NIH HHS
Comments/Corrections

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