With the advent of new pain assessment standards and guidelines and advances in the development of analgesic agents, it is timely to discuss current and future approaches to the management of acute pain in orthopaedic practice. With the percentage of elderly patients increasing in the general population, orthopaedic specialists will see an unprecedented number of patients who not only are burdened by pain from acute musculoskeletal conditions but who also expect to stay active longer than did previous generations.
It is increasingly acknowledged that acute postoperative pain from ambulatory surgery is undertreated and that the consequences of this add to the already huge burden of pain management on patients and society1-3. Recent advances in the elucidation of the biologic mechanisms underlying the development of both acute and chronic pain suggest that inadequately treated acute pain can result in the sensitization of the peripheral and central nervous system, which may ultimately lead to the development of chronic pain4-6.
Look for this and other related articles in Instructional Course Lectures, Volume 54, which will be published by the American Academy of Orthopaedic Surgeons in February 2005:
• “Complex Regional Pain Syndrome,” by L. Andrew Koman, MD, Beth Paterson Smith, PhD, Evan Ekman, MD, and Thomas L. Smith, PhD
The most common musculoskeletal injuries are those involving the back or spine, followed by sprains, dislocations, and fractures—the sum of which account for almost one-half of all musculoskeletal injuries7. Ankle injuries are the most common sports and recreational injuries, accounting for 38% to 45% of those injuries8,9. In 2001, 2.6 million people in North America were seen for foot and ankle injuries10. More than 40% of ankle sprains can progress to chronic problems11. Knee injuries …
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