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Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Michael M. H. Yang, Jay Riva-Cambrin, Jonathan Cunningham, Nathalie Jetté, Tolulope T. Sajobi, Alex Soroceanu, Peter Lewkonia, W. Bradley Jacobs and Steven Casha

stay. 3 In addition, poor pain control has been associated with complications such as the development of chronic pain syndromes, thromboembolic diseases, and delirium in the elderly. 3 , 4 It is estimated that the economic burden of treating chronic pain that develops following acute pain in a 30-year-old individual over a lifetime is as much as $1 million (USD). 5 Thus, prevention and effective relief of acute pain may improve clinical outcomes, save healthcare resources, and improve quality of life. Several efforts have been made to improve postoperative pain

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W. Lee Titsworth, Justine Abram, Peggy Guin, Mary A. Herman, Jennifer West, Nicolle W. Davis, Jennifer Bushwitz, Robert W. Hurley and Christoph N. Seubert

U ncontrolled postoperative pain is associated with an increased risk for pulmonary and cardiovascular complications, is the most common cause for delayed discharge and unexpected readmissions after ambulatory surgery, and is responsible for prolonged convalescence after surgery. 3 , 20 , 25 , 39 , 42 , 44 Additionally, high levels of postoperative pain are associated with an increased risk of chronic pain. 25 , 42 Recently, patients' perceptions of postoperative pain and analgesia have become critical components of health care evaluations, and these

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James W. Leiphart, Prasanna P. Vasudevan, Samer R. Rajjoub, Luis W. Dominguez and Jason Chang

L ittle has been done in the analysis of weight gain or loss in patients with neuropathic pain. The studies addressing body weight or patient appetite in relation to pain have been self-report studies. Studies of postoperative pain markers in children have found that parents reliably report a loss of appetite in their children. 10 Postoperatively, parents have reported that their children refuse to eat or eat less than usual when in pain. 2 Results from these studies suggest that acute pain is associated with behaviors that could lead to weight loss

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Kitti Jirarattanaphochai and Surachai Jung

S ystematic reviews of RCTs have demonstrated the benefits of NSAIDs in reducing postoperative pain, analgesic requirement, and morphine side effects. 26 , 33 , 44 , 48 However, the efficacy and safety of NSAIDs evaluated in patients who underwent lumbar spine surgery yielded contrasting results for both nonselective NSAIDs 1 , 11 , 23 , 25 , 27 , 31 , 35 , 39 , 40 , 49 , 50 and selective COX-2 NSAIDs. 3 , 17 , 21 , 37 , 38 , 41 , 42 We conducted a meta-analysis to evaluate the effect of NSAIDs on postoperative pain control in patients undergoing

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Linda S. Aglio, Muhammad M. Abd-El-Barr, Vwaire Orhurhu, Grace Y. Kim, Jie Zhou, Laverne D. Gugino, Lisa J. Crossley, James L. Gosnell, John H. Chi and Michael W. Groff

T here have been many studies that suggest that any noxious stimulus, including a surgical incision, may induce prolonged changes in the central nervous function. These changes may contribute to postoperative pain. Various methods have been used to decrease postoperative pain, which has been shown to decrease patient satisfaction and decrease hospitalization stays and complications. 20 Preemptive analgesia, which is defined as the preoperative administration of analgesia prior to the painful stimulus, has shown promise in spine surgery, with various methods and

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Scott Y. Rahimi, Cargill H. Alleyne Jr., Eric Vernier, Mark R. Witcher and John R. Vender

L ike surgeons in many other specialties, neurosurgeons continually confront postoperative pain management issues. Traditionally several classes of analgesics have been used for the treatment of postoperative pain. These include opioids, NSAIDs, cox-2 inhibitors that are a subset of NSAIDs, and a miscellaneous category including acetaminophen and tramadol. Neurosurgical patients requiring craniotomies have historically been treated exclusively with narcotic pain medications and acetaminophen. Although these medications are very effective for pain, they cause

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Kunal S. Patel, Azim N. Laiwalla, Jasmine A. T. DiCesare, Matthew C. Garrett and Anthony C. Wang

Postoperatively, pain levels were assessed every hour by using the FACES Pain Rating Scale ( https://wongbakerfaces.org/ ) ( Fig. 1A ). 8 , 9 This previously validated score is commonly used in both the pediatric and adult settings. The score ranges from 0 (no pain) to 10 (highest amount of pain). In patients who could not use the FACES Pain Rating Scale (e.g., young pediatric patients), the FLACC (Face, Legs, Activity, Cry, Consolability) pain scale was used. 22–24 , 26 This is a previously validated observational pain assessment tool used in patients who are unable to

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James B. Chadduck, J. Robert Sneyd and Louis H. Pobereskin

using standardized anesthesia techniques and postoperative pain relief. Clinical Material and Methods Approval for this study was obtained from the South and West Devon Health Authority Ethics Committee. Patient Population All patients admitted to the Department of Neurosurgery at Derriford Hospital, Plymouth, England, who were expected to undergo operations for benign conditions of the lumbar spine were asked to participate in this trial. Patients who were younger than the age of 18 years, pregnant, or in whom it was expected the dura would be opened were

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Padraic O'Neill, Christine Knickenberg, Senarath Bogahalanda and Anthony E. Booth

extradural catheter as proposed by others, 16, 18 and thereby diminish the potentially increased risk of postoperative infection caused by an indwelling catheter. We are therefore reporting our experience with the use of intrathecal morphine for postoperative pain relief following lumbar spine surgery in a double-blind trial in 24 patients. Clinical Material and Methods The investigation was approved by the ethics committee of Walsgrave Hospital, and the patient's informed consent was obtained in the preoperative period. All patients undergoing lumbar spine

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Zoher Ghogawala

T he importance of achieving pain control after spinal surgery has been emphasized by many. Adequate postoperative pain control is associated with improved patient satisfaction, reduced postoperative opioid dependence, shorter hospital length of stay, and lower costs. 1 In the current issue of the Journal of Neurosurgery: Spine , Yang et al. use data from the Canadian Spine Outcomes and Research Network (CSORN) to develop a predictive model for identifying patients who had a high or extremely high risk of having inadequate pain control after spinal surgery. 2