Pathogenesis and treatment of pain in patients with chronic wounds.
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Pain must be managed during treatment of a patient with a chronic wound. Failure to do so will impair the patient's ability to heal significantly. Understanding the wound's etiology is essential for designing the wound-healing protocol and implementing its pain management regimen, of which a critical part is the chronic-wound patient's self-assessed scores of pain and functionality. In this report we present a paradigm for treating all chronic wounds, which was subsequently applied to 32 consecutive patients. Our integrated-team approach to managing the treatment of wounds includes accurate evaluation of the progression of patients' pain. Directors of the pain-management team and wound team have jointly managed hundreds of patients--either hospitalized or seen in both outpatient clinical practices. The three general categories for etiologies of the 10 most common types of chronic wounds are: ischemia, neuropathy, and direct tissue damage (e.g. pressure ulcers and venous stasis ulcers). Each of these are treated with unique analgesic regimens focused on surgical/medical management of the wound: oral and parenteral medications in combinations designed to facilitate specific additive analgesic effects and nerve blocks and implantable devices for correcting underlying wound pathophysiology. Successful treatment of pain generally results in increased functional independence and improvement of the patient's quality of life. We integrated wound-care pain-management team established guidelines that delineate the causes of chronic wounds and categorize treatment options for practical clinical use. The expectation is that all pain should be resolved in all patients if both the wound-healing and pain-healthcare providers use current technologies and drugs.Keywords:
Etiology
Wound care
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Abstract Background Indications for negative-pressure wound therapy (NPWT) in vascular surgical patients are expanding. The aim of this review was to outline the evidence for NPWT on open and closed wounds. Methods A PubMed, EMBASE and Cochrane Library search from 2007 to June 2016 was performed combining the medical subject headings terms ‘wound infection’, ‘abdominal aortic aneurysm (AAA)’, ‘fasciotomy’, ‘vascular surgery’ and ‘NPWT’ or ‘VAC’. Results NPWT of open infected groin wounds was associated with shorter duration of wound healing by 47 days, and was more cost-effective than alginate dressings in one RCT. In one RCT and six observational studies, NPWT-related major bleeding and graft preservation rates were 0–10 and 83–100 per cent respectively. One retrospective comparative study showed greater wound size reduction per day, fewer dressing changes, quicker wound closure and shorter hospital stay with NPWT compared with gauze dressings for lower leg fasciotomy. NPWT and mesh-mediated fascial traction after AAA repair and open abdomen was associated with high primary fascial closure rates (96–100 per cent) and low risk of graft infection (0–7 per cent). One retrospective comparative study showed a significant reduction in surgical-site infection, from 30 per cent with standard wound care to 6 per cent with closed incisional NPWT. Conclusion NPWT has a central role in open and infected wounds after vascular surgery; the results of prophylactic care of closed incisions are promising.
Negative-pressure wound therapy
Groin
Wound care
Wound dehiscence
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Purpose: Laparoscopic totally extraperitoneal herniorrhaphy (TEP) was developed as an alternative treatment of inguinal hernias to open hernia repair. This study evaluated 92 cases of laparoscopic surgery to determine the effectiveness and safety of laparoscopic TEP. Methods: Laparoscopic TEP was performed on 92 patients with inguinal hernias from January 2008 to December 2010. Through a retrospective study of these patients, information om TEP repair was collected including the patients’ characteristics, operation time, hospital stay, analgesic use and related complications. Results: Laparoscopic herniorrhaphy were performed on a total of 92 patients (85 men and 7 women, age ranging from 16 to 83 years, with a mean of 56 years). The mean operation time for a unilateral inguinal hernia and bilateral inguinal hernia was 58.7 and 84.2 min, respectively. The mean postoperative hospital stay was 4.0 days (range, 2∼9 days). Thirty nine patients were discharged without an analgesic injection, whereas 36 patients were injected with analgesic on the day of surgery. Of these 92 procedures, 10 complications were recorded; one granuloma complication, two patients with operation site discomfort, five with urinary retention issues, one patient with a scrotal seroma, and one patient with scrotal edema. Conclusion: TEP repairs have minimal morbidity and are more effective with less pain than the open procedure. TEP repair can be considered a favorable procedure for patients who request minimally invasive procedures for inguinal hernia repairs.
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The burden of chronic/persistent pain is substantial for the patient and society as a whole. Although a variety of pharmacologic treatments are available, chronic/persistent pain remains inadequately treated. Many pharmacologic treatment options provide analgesic efficacy for 4 to 6 hours, requiring multiple doses for continuous pain relief. The inconvenience of multiple doses may prevent many patients from achieving adequate pain relief. Other limitations to the current pharmacologic treatment options include gastrointestinal effects, cardiovascular effects, and organ toxicity, as well as fear of abuse or addiction. The purpose of this review is to highlight the burden of chronic/persistent pain in today's society and discuss the limitations of short-acting pharmacologic therapies used in the treatment of chronic/persistent pain.
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Objective To compare endoscopic and open surgical thyroidectomy clinical results.Methods A retrospective analysis of our hospital from January 2009 to August 2011,25 cases of endoscopic thyroid surgery(laparoscopic group) and open the same period 25 cases of thyroid surgery(open group) and clinical data.We compared operative time,blood loss,intraoperative drainage and other indicators of intraoperative and postoperative consumption of time,recovery activities time,number of doses of analgesic drug application,length of stay and other indicators.Results Endoscopic group blood loss was significantly less than the open group(t=9.16,P0.05);Two groups of operative time and intraoperative drainage were no significant difference(t=1.22,P0.05);Laparoscopic group after feeding time,recovery time activities,the number of analgesic use and postoperative hospital stay and other indicators than the control group(t=7.43,t=8.28,χ2=10.09,t=7.79,P0.05).Conclusion Endoscopic thyroidectomy is superior to the clinical efficacy of open surgery,the patient's pain,quick recovery,should be widely applied.
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OBJECTIVE: To determine the quality of life of elderly patients with osteoarthritis (OA) compared with that of their peers with no chronic illnesses and to investigate the associations between analgesic use and quality of life. SUBJECTS: Patients >65 years of age with OA taking analgesics with (n = 33) and without (n = 26) comorbidities, and control patients with no chronic illness and not taking analgesics (n = 37). METHODS: Quality of life was assessed by the SF-36 and level of pain was measured by a visual analog scale. Multiple regression analysis was used to determine the medication characteristics and additional patient factors significantly associated with SF-36 scores. RESULTS: OA patients had significantly (p < 0.05) lower scores than control patients in all quality-of-life domains. OA patient scores were lowest for the domains of role-physical, bodily pain, and physical functioning. OA patients with comorbidities also had poorer general and mental health. Pain- and analgesic-related factors were significantly (p < 0.05) associated with physical health status, reduced vitality, general health, and social functioning. A better quality of life was associated with noncompliance, fewer visits to the physician, and taking oral nonsteroidal antiinflammatory agents. Presence of adverse drug reactions and sleep disturbance did not influence SF-36 scores significantly. CONCLUSIONS: Quality of life of elderly OA patients with and without additional comorbidities was significantly poorer than that of their healthy peers, particularly in the domains associated with physical status, but also affecting vitality, social functioning, and general health. Level of pain suffered and perceived effectiveness of analgesic medication in pain control were important factors associated with quality of life.
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Conservative measures were instituted as the primary treatment of 39 consecutive patients with high output fistulas of the gastrointestinal tract and related organs. Nutritional status was maintained by an intravenous feeding regimen, using peripheral vein infusion sites and supplying 60% of the calorie intake by a fat emulsion. This regimen had no serious complications. These patients died during treatment. The fistulas healed spontaneously in 35 of the remaining 36 patients. None of these patients had obstruction distally or other factors tending to prevent spontaneous closure. Under these circumstances, nonoperative treatment is safest and best. Surgical closure was necessary in one patient after two months of conservative treatment and was successful.
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Negative-pressure wound therapy
Wound care
Compression Therapy
Venous leg ulcer
Standard of care
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The authors of the 2014 article "Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: A crossover, randomised, double-blinded, placebo-controlled study" wish to retract the article as Dr Kozek-Langenecker did not consent to its submission and publication.
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