Top Tweets for #Pronociception
@NarouzeMD @DrAndrewHuang @_Anesthesiology @harshamd5 @ASRA_Society @DProvenzanoMD @KalagaraHari @Ropivacaine @drchadb @SreeHPraveenKO1 @KohanLynn @ShaliniShahMD @nelkassabany Why worry about acute #Hyperalgesia?
Is this not just the hallmark of *opioid resistant pain,
but also a harbinger of *chronic pain?
HT: #Pronociception
https://t.co/ZlB1p5BaWo
@NarouzeMD @DrAndrewHuang @_Anesthesiology @harshamd5 @ASRA_Society @DProvenzanoMD @KalagaraHari @Ropivacaine @drchadb @SreeHPraveenKO1 @KohanLynn @ShaliniShahMD @nelkassabany Also acute pain disproportionate to incision or injury #hyperalgesia should alert the presence of #AcNeuP #pronociception!
While opioid*free anesthesia not essential,
opioid**sparing analgesia may be the way forward? #pragmatic #practical #KISS
https://t.co/MNqniPCjNK
@Jopo_dr Finger cuts & burns help us explain how #pronociception aka hyperalgesia makes acute pain disproportionate to injury! #AcNeuP
In acute/postop pain, need to watch for this (#DN4) and add appropriate anti-hyperalgesics-
opioids alone are ineffective & can worsen the pain!
@Jopo_dr Finger cuts & burns help us explain how #pronociception aka hyperalgesia makes acute pain disproportionate to injury! #AcNeuP
In acute/postop pain, need to watch for this (#DN4) and add appropriate anti-hyperalgesics-
opioids alone are ineffective & can worsen the pain!
@rsatyak @JanBoublikMDPhD @ketaminh Another interesting ketamine use- “opioid resistant pain”
aka #pronociception #hyperalgesia
@HusniTweet @GLSilvermanMD A former @OttawaHospital APS Fellow described ketamine use & is credited with coining term 'Opioid Resistant' Pain @NAPS_UK @BritishPainSoc
@maffygirl @MaplesonF @morefluids Yes!
Consider acetaminophen & NSAIDs #Foundational- most/all pts. should get them #FirstOnLastOff & #roundtheclock
Then for #nociceptive pain, add #weakopioids or low-dose #strongopioids
If #pronociception present, #antihyperalgesics needed- #theotherside
#NewOttawaPainLadder
@colinjmccartney @doccigar @DavidJuurlink @brownpa79 @glbryson @euroanaesthesia @ESA_HQ @Drhaclarke @EMARIANOMD @cpaolag @amit_pawa Dr Penning calls this #Pronociception which presents as Hyperlgesia, the 3rd Dimension of Pain!
Opioids are not only ineffective, they can paradoxically make this kind of pain worse!
Finally, persistent Hyperalgesia May predict #CPSP?
@James22kim @EMARIANOMD @nelkassabany @stanfordanes @PennAnesthesia @dr_tgro @VeenaGraffMD #Pronociception that manifests as Hyperalgesia in the postoperative period may be the #missinglink between acute and chronic postsurgical pain #CPSP?
Identify with DN4 & treat with appropriate antihyperalgesics!
#NewOttawaLadder
#FourDimensions
@GongGasGirl @SLBaldry #StepLadder provides a #StableFramework for reducing pain, opioids and side effects, especially when #Pronociception is sought & Rx with #AntiHyperalgesics
https://t.co/naknKJvbr2
@pritanand @dr_rajgupta Exactly why pregabalin preferred- allows for better dose titration, especially in the perioperative period.
Also these #AntiHyperalgesics need to be used when there is #Pronociception, where the #DN4 allows for better decision making!
@painfreeED Acute Pain Crises in #SickleCell predominantly #ProNociception -opioids ineffective.
Anti Hyperalgesics- ketamine, #IVLido (or Dexmed) may work well.
HT:
PubMed - NCBI https://t.co/eVS8aBvyhF
@garyschwartzmd @Neuro_Kellie @ankeetudani @ASRA_Society @EMARIANOMD @jonhagedornmd @DrMStiegler @amit_pawa @DrJeniMD @ESchwenkMD @DoctorSivaMD @docroland @AmyPearsonMD @DanWarrenMD @PainDocGoel @dr_rajgupta @chadptmd @nelkassabany @paulhting Probably important to identify & treat acute hyperalgesia aggressively?
Anti Hyperlagesics (Pregabalin, Lidocaine & Ketamine etc.) improve both acute pain Mx & prevent development of chronic pain.
Using DN4 may diagnose #ProNociception
@cpaolag @colinjmccartney
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