Name: an experimental paradigm for the prediction of post-operative pain (ppop)
Uploaded: 2010-01-27T16:25:00
Duration: 14 min 56 s
Description: Watch this Scientific Journal Video about An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP at JoVE.com

UWMC एनेस्थिसियोलॉजी विभाग और चिकित्सा दर्द

<ol>
	<li>Eisenach, J. C., Pan, P. H., Smiley, R., Lavand'homme, P., Landau, R., Houle, T. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Severity+of+acute+pain+after+childbirth,+but+not+type+of+delivery,+predicts+persistent+pain+and+postpartum.">Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum.</a> Pain. 140, 87-94 (2008).</li><li>Kehlet, H., Jensen, T. S., Woolf, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Persistent+postsurgical+pain:+risk+factors+and+prevention.">Persistent postsurgical pain: risk factors and prevention.</a> Lancet. 367, 1618-1625 (2006).</li><li>Ecker, J. L., Frigoletto, F. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cesarean+delivery+and+the+risk-benefit+calculus.">Cesarean delivery and the risk-benefit calculus.</a> N Engl J Med. 356, 885-888 (2007).</li><li>Carvalho, B., Cohen, S. E., Lipman, S. S., Fuller, A., Mathusamy, A. D., Macario, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+preferences+for+anesthesia+outcomes+associated+with+cesarean+delivery.">Patient preferences for anesthesia outcomes associated with cesarean delivery.</a> Anesth Analg. 101, 1182-1187 (2005).</li><li>Yarnitsky, D., Crispel, Y., Eisenberg, E., Granovsky, Y., Ben-Nun, A., Sprecher, E., Best, L. A., Granot, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prediction+of+chronic+post-operative+pain:+pre-operative+DNIC+testing+identifies+patients+at+risk.">Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.</a> Pain. 138, 22-28 (2008).</li></ol>

प्रारंभिक आंकड़ों से पता चलता है कि टन और DNIC अधिक hyperalgesia - सीजेरियन के बाद के साथ सहसंबद्ध किया जा सकता है. यदि पूर्व ऑपरेटिव टन DNIC, आनुवंशिक परीक्षण और psychosocial प्रश्नावली व्यक्तिगत संवेदनशीलता की भविष्यवाणी करने के लिए गंभीर पोस्ट ऑपरेटिव दर्द और लगातार दर्द को विकसित कर सकते हैं, रोगियों को अलग जोखिम वाले समूहों के लिए स्तरीकृत हो सकता है. बदले में रोगियों के प्रत्येक सबसेट में, रिक्तिपूर्व बहुविध analgesia सहित विभिन्न उपचार अलग परिणामों में हो सकता है. <img src="/files/ftp_upload/1671/1671fig1.jpg" alt="चित्रा 3" /> चित्रा 3 पोस्ट ऑपरेटिव दर्द (PPOP परियोजना) की भविष्यवाणी.

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<td>Pathway - Pain and Sensory Evaluation System</td>
<td>&nbsp;</td>
<td>Medoc Advanced Medical Systems, Durham, North Carolina</td>
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<td>Boekel 14L Hot Tub</td>
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<td>180g Touch-Test Sensory Evaluator</td>
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<td>Electronic von Frey</td>
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an experimental paradigm for the prediction of post-operative pain (ppop)

Many women undergo cesarean delivery without problems, however some experience significant pain after cesarean section. Pain is associated with negative short-term and long-term effects on the mother. Prior to women undergoing surgery, can we predict who is at risk for developing significant postoperative pain and potentially prevent or minimize its negative consequences? These are the fundamental questions that a team from the University of Washington, Stanford University, the Catholic University in Brussels, Belgium, Santa Joana Women's Hospital in S&atilde;o Paulo, Brazil, and Rambam Medical Center in Israel is currently evaluating in an international research collaboration. The ultimate goal of this project is to provide optimal pain relief during and after cesarean section by offering individualized anesthetic care to women who appear to be more 'susceptible' to pain after surgery.
A significant number of women experience moderate or severe acute post-partum pain after vaginal and cesarean deliveries. 1 Furthermore, 10-15% of women suffer chronic persistent pain after cesarean section. 2 With constant increase in cesarean rates in the US 3 and the already high rate in Brazil, this is bound to create a significant public health problem. When questioning women's fears and expectations from cesarean section, pain during and after it is their greatest concern. 4 Individual variability in severity of pain after vaginal or operative delivery is influenced by multiple factors including sensitivity to pain, psychological factors, age, and genetics. The unique birth experience leads to unpredictable requirements for analgesics, from 'none at all' to 'very high' doses of pain medication. Pain after cesarean section is an excellent model to study post-operative pain because it is performed on otherwise young and healthy women. Therefore, it is recommended to attenuate the pain during the acute phase because this may lead to chronic pain disorders. The impact of developing persistent pain is immense, since it may impair not only the ability of women to care for their child in the immediate postpartum period, but also their own well being for a long period of time.
In a series of projects, an international research network is currently investigating the effect of pregnancy on pain modulation and ways to predict who will suffer acute severe pain and potentially chronic pain, by using simple pain tests and questionnaires in combination with genetic analysis. A relatively recent approach to investigate pain modulation is via the psychophysical measure of Diffuse Noxious Inhibitory Control (DNIC). This pain-modulating process is the neurophysiological basis for the well-known phenomenon of 'pain inhibits pain' from remote areas of the body. The DNIC paradigm has evolved recently into a clinical tool and simple test and has been shown to be a predictor of post-operative pain.5 Since pregnancy is associated with decreased pain sensitivity and/or enhanced processes of pain modulation, using tests that investigate pain modulation should provide a better understanding of the pathways involved with pregnancy-induced analgesia and may help predict pain outcomes during labor and delivery. For those women delivering by cesarean section, a DNIC test performed prior to surgery along with psychosocial questionnaires and genetic tests should enable one to identify women prone to suffer severe post-cesarean pain and persistent pain. These clinical tests should allow anesthesiologists to offer not only personalized medicine to women with the promise to improve well-being and satisfaction, but also a reduction in the overall cost of perioperative and long term care due to pain and suffering. On a larger scale, these tests that explore pain modulation may become bedside screening tests to predict the development of pain disorders following surgery.

Watch this Scientific Journal Video about An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP at JoVE.com

An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP

विसरित हानिकारक निरोधात्मक नियंत्रण, अस्थायी योग और घाव hyperalgesia परीक्षण प्रसूति रोगी में प्रदर्शन कर रहे हैं. इन परीक्षणों दर्द प्रसंस्करण के निरोधात्मक और उत्तेजक तंत्र का मूल्यांकन और यहाँ अलग अलग समय बिंदुओं पर गर्भावस्था और लगातार दर्द के लिए व्यक्ति के जोखिम को प्रकट करने में मदद peripartum अवधि के दौरान अंतर्जात analgesia का मूल्यांकन का उपयोग.

पोस्ट ऑपरेटिव दर्द की भविष्यवाणी के लिए एक प्रायोगिक प्रतिमान (PPOP)

Many women undergo cesarean delivery without problems, however some experience significant pain after cesarean section. Pain is associated with negative ...

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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)

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