Guidelines for Treating Pain After Dermatologic Surgery

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The number of dermatology procedures performed in the US more than doubled from 14 million to 30 million between 1995 and 2008.
The number of dermatology procedures performed in the US more than doubled from 14 million to 30 million between 1995 and 2008.

Given the increasing number of dermatologic surgeries performed each year, pain management before, during, and after dermatologic surgery is a major concern for patients and clinicians. However, there is little consensus on or data supporting how dermatologists should treat acute postsurgical pain.

In a two-part write-up published in the Journal of the American Academy of Dermatology, Natalie Meeks, MD, from the Eastern Virginia Medical School in Norfolk, and Jonathan Glass, MD, CDR MC USN, from the Department of Dermatology at the Naval Medical Center Portsmouth, both in Virginia, and colleagues highlighted the anatomy of pain and provided an updated review of available pain treatments and their appropriate use after dermatologic surgery.

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Their goal was to provide evidence-based tools for anticipating and treating acute postsurgical pain (APSP) while reducing the use of narcotics, as well as identifying areas in pain management that need more study.

The Anatomy of Pain

The treatment for one type of pain may not work for another, the researchers emphasized. Therefore, creating individualized pain interventions based on a patient's anatomy, risk factors, and pain type is ideal for providing the best treatment.

In order to do this, clinicians need to understand the processes and cellular components that generate and transmit signals of pain. Key points for clinicians to know include:

  • Acute pain begins when a stimulus triggers an electrochemical signal in a peripheral afferent nerve that gets transmitted to the cortex
  • A patient can be primed for hyperalgesia
  • There are multiple points in the peripheral and central nervous system that can be targeted to reduce hyperalgesia and doing so can prevent complications such as chronic pain
  • Chronic pain and acute pain may require different treatments

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