{"title":"Implantable technology for pain management","authors":"G Baranidharan, Naresh Rajasekar","doi":"10.1016/j.mpaic.2025.04.002","DOIUrl":"10.1016/j.mpaic.2025.04.002","url":null,"abstract":"<div><div>Neuropathic pain is a well-recognized chronic pain condition. This can have a significant impact on patients’ quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral nerve field. Pharmacological modulation is achieved by directly infusing drugs to the central nervous system. Although neuromodulation has become increasing popular, it is still currently believed to be underused in treating neuropathic pain. This modality has provided us with a non-pharmacological approach to manage patients with neuropathic pain. Patients should have been assessed by a multidisciplinary team before undergoing neuromodulation. This review highlights the present and future management of patients with chronic intractable pain using neuromodulation.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 438-445"},"PeriodicalIF":0.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.05.001","DOIUrl":"10.1016/j.mpaic.2025.05.001","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 452-453"},"PeriodicalIF":0.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paediatric chronic pain","authors":"William Shankey-Smith","doi":"10.1016/j.mpaic.2025.04.013","DOIUrl":"10.1016/j.mpaic.2025.04.013","url":null,"abstract":"<div><div>Chronic pain in children significantly impacts their physical, emotional, and social well-being, making its management complex and multifaceted. This review explores the intricacies of paediatric chronic pain, focusing on its prevalence, physiology, pathophysiology, assessment, and multidisciplinary management strategies. It discusses the development of pain pathways in children and highlights the mechanisms underlying peripheral and central sensitization in the development of chronic pain. Emphasis is placed on a comprehensive assessment approach using the biopsychosocial model, including history taking, physical examination, and age-appropriate pain assessment tools. This article also explores various management strategies, including pharmacological, physical, and psychological therapies. It emphasizes the importance of pain education and self-management techniques in empowering patients and families. By adopting a holistic approach that integrates biological, psychological, and social factors, healthcare professionals can optimize the quality of life and function of children living with chronic pain. This article aims to provide anaesthetists and pain specialists with a thorough understanding of paediatric chronic pain and effective management strategies to improve patient outcomes.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 395-399"},"PeriodicalIF":0.2,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delivering an acute pain service","authors":"E Baird, B Patrick","doi":"10.1016/j.mpaic.2025.04.012","DOIUrl":"10.1016/j.mpaic.2025.04.012","url":null,"abstract":"<div><div>Traditionally it has been the inpatient pain team's role to treat patients in hospital during an acute admission. The remit of the inpatient pain team is now extending to the whole patient's journey including surgical patients pre operatively and post discharge. The treatment of a patient's pain is primarily an ethical and humanitarian obligation, but effective pain management may also improve clinical outcomes. The treatment of pain from surgery or trauma reduces complication rates for example by improving mobilization and a patient's ability to take deep breaths and cough. When patients mobilize early they reduce their risk of venous thromboembolism, pulmonary embolism and pressure sores. A patient that cannot adequately cough or take deep breaths due to pain is at higher risk of pneumonia and respiratory compromise. From a health economics perspective patients who mobilize earlier and have fewer complications spend less time in hospital and therefore cost less. Untreated severe pain may also predispose patients to develop chronic pain or to take opioid pain medication for prolonged periods of time.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 391-394"},"PeriodicalIF":0.2,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemkumar Pushparaj, Manish Gupta, Manohar L. Sharma
{"title":"Neuroablative interventions for cancer-related pain","authors":"Hemkumar Pushparaj, Manish Gupta, Manohar L. Sharma","doi":"10.1016/j.mpaic.2025.04.005","DOIUrl":"10.1016/j.mpaic.2025.04.005","url":null,"abstract":"<div><div>Cancer treatment continues to improve survival rate in cancer patients. This also increases cancer-related pain prevalence. Thus, with advances in cancer treatment, there is an ever-increasing unmet need in cancer pain management. Opioids and adjuvant pain killers help to manage significant numbers. Still significant numbers suffer from intractable treatment resistant pain and thus need other modalities. Neuroablative techniques, although technically more demanding, provide good pain control especially in these patients with limited prognosis. Neuroablative procedures are indicated in cancer patients who have limited life expectancy with severe, opioid-resistant pain. The goal would be to improve the quality of life, reduce analgesic side effects, improve patients’ ability to function, socialize, and to reduce the amount of time spent in contact with healthcare providers. When successful, these interventions allow significant reduction in the need for clinic visits. Percutaneous procedures are preferred over open procedures for their lower morbidity. This review provides a brief description of commonly used neurolytic interventions for cancer-related pain in our multidisciplinary set-up. Neuroablative procedures, especially percutaneous cervical cordotomy, require considerable skill of the physician performing the procedure.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 406-414"},"PeriodicalIF":0.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Visceral pain","authors":"Iain Mactier, Tammar Al-Ani","doi":"10.1016/j.mpaic.2025.04.001","DOIUrl":"10.1016/j.mpaic.2025.04.001","url":null,"abstract":"<div><div>Visceral pain is a complex and multifaceted experience, distinct from somatic pain due to its diffuse localisation, autonomic involvement, and strong affective components. It arises from internal organs and follows unique neurophysiological pathways, encompassing transduction, transmission, perception, modulation, and amplification. Visceral nociception is transmitted via autonomic afferents and ascends through the spinothalamic, spinoreticular, spinomesencephalic, and dorsal column pathways. The extensive convergence of visceral and somatic afferents contributes to referred pain and poses diagnostic challenges. Acute visceral pain is primarily nociceptive, triggered by inflammation, ischaemia, or distension, whereas chronic visceral pain involves central sensitisation, dysfunction of descending modulation, and neuroimmune activation, leading to persistent pain and visceral hypersensitivity. While simple analgesics, opioids, and regional anaesthesia techniques incorporating sympathetic blockade remain cornerstones of acute visceral pain treatment, chronic visceral pain management is more complex. It relies on a multidisciplinary approach, integrating pharmacotherapy, interventional techniques, physiotherapy, psychotherapy, lifestyle modifications, and patient education to support self-management, improve symptom control, and enhance function and quality of life.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 420-425"},"PeriodicalIF":0.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radiofrequency techniques in chronic pain management","authors":"Peter Paisley, Anne Devine","doi":"10.1016/j.mpaic.2025.04.006","DOIUrl":"10.1016/j.mpaic.2025.04.006","url":null,"abstract":"<div><div>Radiofrequency ablation is the use of radio waves to create a thermal lesion or isotherm. This process can be used to treat a variety of chronic pain conditions such as facet joint pain, shoulder and knee pain, and trigeminal neuralgia, by targeting the responsible sensory nerve and disrupting pain transmission. It can be performed by continuous, pulsed or cooled application. The technique is performed under fluoroscopy or ultrasound guidance to identify the correct target before the current is applied, making it a minimally invasive procedure that is well tolerated. In appropriately selected candidates it can significantly improve pain, function and result in a better quality of life.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 7","pages":"Pages 434-437"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Challenges in healthcare delivery in low- and middle-income countries","authors":"Hannah Phelan, Victoria Yates, Emma Lillie","doi":"10.1016/j.mpaic.2025.02.010","DOIUrl":"10.1016/j.mpaic.2025.02.010","url":null,"abstract":"<div><div>The Lancet Commission outlines a vision of universal access to safe emergency and essential surgery. Global disparities in perioperative outcomes are recognized, with resource-poor environments and a workforce crisis particularly challenging low- and middle-income countries (LMICs) to provide safe surgical and anaesthesia care. The coronavirus disease (COVID-19) pandemic placed an even greater strain on under-resourced and over-stretched healthcare systems. Bridging the gap to achieve universal access is a substantial undertaking and requires collaboration with high-income countries. Global partnerships are abundant and mutually beneficial, aiming to alleviate the workforce crisis, provide education, training and expertise and raise standards of care in host LMICs. Clinical, leadership and management experience gained in low-resource settings is valued by healthcare systems in high-income countries, acknowledged by curriculum for ‘developing world anaesthesia’. Further challenges to healthcare delivery, training and implementation of change are influence by government policy, cultural traditions, expectations and work ethic. During the COVID-19 pandemic many partnerships were required to move online. The necessity of providing remote support has created its own set of challenges, while also providing novel opportunities for education and collaboration with the global health community. This article describes challenges through reflection on personal experience in Zambia.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 385-388"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obstetric haemorrhage","authors":"Sarah Lambert, Louise England","doi":"10.1016/j.mpaic.2025.02.016","DOIUrl":"10.1016/j.mpaic.2025.02.016","url":null,"abstract":"<div><div>Obstetric haemorrhage is a major cause of maternal morbidity and mortality globally. Identifying risk factors, implementing early risk stratification, and engaging in multidisciplinary team planning can help mitigate its impact. Effective haemorrhage management requires prompt recognition and a rapid, coordinated, multidisciplinary approach. The use of protocols reinforced through targeted drills enhances team vigilance, familiarity, and competency in managing haemorrhage which can lead to improved patient outcomes. This article reviews the management of obstetric haemorrhage including pharmacological interventions, transfusion strategies and surgical techniques.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 6","pages":"Pages 327-333"},"PeriodicalIF":0.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144139525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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