Adolescents’ home pain management after laparoscopic appendectomy: unexpected findings

Translating the Human Genome to Manage Pediatric Postoperative Pain

“…Well known to clinicians is the tremendous variability of patients' experiences of pain. For example, our clinical research provides evidence of this variability in subjective reports of pain intensity among adolescents experiencing postoperative pain (Figure 1; Karamessinis et al, 2013;Manworren et al, 2014Manworren et al, , 2013Manworren, Paulos, & Pop, 2004). However, knowledge of patient characteristics and variables that increase risk for more severe postoperative pain is limited.…”

“…In our studies of analgesic needs to treat postoperative pain, we found tremendous variation in pediatric patients’ analgesic requirements to achieve optimal pain relief (Karamessinis, Cooper, & Manworren, 2013; Manworren et al., 2014; Manworren, Karamessinis, & Cooper, 2013; Pop et al, 2007). Deficiencies in current knowledge of analgesic efficacy in pediatrics have been identified (Berde et al, 2012; Gregoire & Finley, 2007).…”

“…Variability in pain sensitivity, pain tolerance, and responses to analgesics is only partially explained by the personal and sociocultural context in which the pain is experienced, interpreted, and expressed (Fillingim, King, Ribeiro-Dasilva, Rahim-Williams, & Riley, 2009;Logan & Rose, 2005;Manworren et al, 2013;Mogil, 2004;Pinto et al, 2013). When considering modifiable psychological characteristics associated with increased postoperative pain intensity and analgesic use, some researchers conclude that adolescents' postoperative pain may be interpreted as a self-fulfilling prophecy (Logan & Rose, 2005).…”

“…For example, we currently cannot predict which patients are at the greatest risk for pain or persistent post-surgical pain, which patients are at greatest risk for adverse analgesic effects, or which patients are at greatest risk for opioid addiction. Instead, pain medications are prescribed based on patient weight, perceived seriousness of illness and invasiveness of surgical procedure, with little regard for individual patient genetic suitability (Diatchenko et al, 2006; Filligim et al, 2009; Kim et al, 2004; Logan & Rose, 2005; Karamessinis, Cooper, & Manworren, 2013; Manworren, Karamessinis, & Cooper, 2013; Mogil, 2004; Pinto et al, 2013; Rakvag et al, 2005). …”