OBJECTIVES To explore current literature on chronic pain syndromes and develop ED recommendations for the management and minimalization of chronic non-cancer pain. METHODS A focused literature review. RESULTS Chronic pain is a common presentation to the ED but is poorly understood and managed. Research into the psychophysiology of chronic pain shows that there are definite changes in the re...

DESPITE recent advances in our understanding of the physiology of acute pain, the development of new opioid and nonopioid analgesics and novel methods of drug delivery, and more widespread use of pain-reducing minimally invasive surgical techniques, pain after surgical procedures remains a challenge for many practitioners. Not surprisingly, recent surveys in the United States and Europe have em...

Management of acute postoperative pain remains suboptimal: nearly 80% of patients report moderate to extreme pain following surgery. New pain management paradigms incorporate multimodal analgesia, using a combination of analgesics throughout the perioperative period to control nociceptive and centrally-stimulated pain. Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) have a role in po...

The goals for ambulatory surgery are rapid recovery with minimal side effects, adequate postoperative pain control, rapid patient discharge and overall cost containment. The addition of regional anaesthetic techniques has been shown to decrease nausea, postoperative pain scores and the need for post-anaesthesia care unit monitoring. The use of regional anaesthesia is increasing as studies confi...

The high incidence of hip fracture, together with considerable associated morbidity, mortality, and cost of care, makes this injury a major clinical challenge. Of particular importance is the pain associated with hip fracture, which can have potentially severe consequences and may lead to delayed recovery. The prevailing opioid-dependent model of analgesia, however, presents multiple drawbacks ...

The efficacy of a multimodal analgesic approach for ligation excision haemorrhoidectomy was evaluated in a prospective series of 62 patients. Opioid was given as intravenous fentanyl intra-operatively, as part of a standardised general anaesthetic technique, followed by post-operative parenteral fentanyl or oral oxycodone as required. Pre-emptive local anaesthesia was provided via ischiorectal ...

Low back pain is the most frequent musculoskeletal complaint worldwide and leading cause of chronic disability. In this review we discuss knowledge about the role of management of non-invasive, conservative therapy for the nonspecific low back pain. Initial therapy includes modification of activity, pharmacological analgesic therapy and education of patients. In patients with sub acute or chron...

Pain is a prevalent symptom affecting as many as 50% of community-dwelling older adults. Pain affects quality of life, functional status, cognition, mood, sleep, and well-being. A multimodal approach to pain management consists of both non-pharmacologic and pharmacologic interventions. Prescribing analgesics is safe and effective in older persons if done judiciously by starting low and titratin...

Optimizing postoperative pain control is the key to further advancement in the field of ambulatory anesthesia. The current situation in postoperative pain management indicates room for improvement, especially in the area of patient education and the development of individualized discharge analgesic packages. Multimodal analgesia provides superior analgesia with a lower side-effect profile. Preo...