[Post-surgical neuropathic pain].
The traumatic lesions during surgical interventions often turn into a persistent pain. Pain persists in the location of surgical intervention for a long time, beyond the usual course of natural healing of an acute pain and it is different from that suffered preoperatively. It is usually a chronic pain and it is associated to lesions of the central or peripheral nervous system. Pain is usually described as burning or tingling, or electric shock-like; it can be continuous or parossistic, often associated to paraesthesia, iperalgesia and allodinya. If circumstances preclude the surgical revision, the treatment of post-surgical neuropathic pain is based on drugs, according to the guidelines. The drugs of choice are the tricyclic antidepressants, the serotonin and adrenaline re-uptake selective inhibitors (SSRI), local antiepileptics of new generation (gabapentin, pregabalin) and topical anaesthetics. Drugs of second line are: opioid analgesics, tramadol; drugs of third line are: mexiletine, antagonist of NMDA receptor and capsaicine. The post-surgical neuropathic pain is often resistant to the pharmacologic treatment; for this reason the spinal cord neuromodulation can be applied only after careful selection of the patients according to the international guidelines. The incidence of post-surgical neuropathic pain in the Pain Units is approximately 20% of the patients admitted to hospital. Therefore it is necessary a greater attention for the post-surgical analgesia, adopting appropriate surgical techniques in order to avoid the onset of the post-surgical neuropathic pain.
Shaladi
Ali Muftah
AM
Servizio Terapia del dolore e Cure Palliative, Azienda ULLS n. 18, Rovigo.
Saltari
Maria Rita
MR
Crestani
Francesco
F
Piva
Bruno
B
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000929:Antidepressive Agents, Tricyclic