Não existe nenhuma medicação nem estudo de medicação para uso especico em DCPO. As melhores perspectivas estão voltadas para o uso de medicamentos que atuem em processos especícos da reação inamatória para prevenção da sua
ação nos nervos (como o fator neurotróco derivado de linhagem de células da glia – GNDF, que poderia prevenir alterações transcricionais nos neurônios sensitivos) ou para prevenir ativação da glia, como a minociclina15 e outras substâncias em estudo.
O bloqueio de canais iônicos especícos também é estudado, assim como drogas que aumentam a inibição descendente, como o uso de duloxetina. O uso de inibidores do receptor de serotonina (5-HT3) tem sido estudado como medida ecaz para redu- ção do drive facilitatório descendente no corno dorsal da medula20.
A anestesia regional prolongada continua a ser fator importante, cujo uso deve ser intensicado e otimizado no pós-operatório, inclusive após a alta hospitalar.
Estudos mais aprofundados e com melhores desenhos são necessários para escla- recimento da siopatologia, medidas preventivas e tratamento da patologia, tomando como base o fator procedimento especico e a necessidade de individualização da terapia44. Nesse campo, a questão genética se revela importante, dada a grande varia-
bilidade das respostas individuais. Já se colocou a necessidade de coletar amostras individuais de sangue e estocagem para futuros estudos genéticos24.
Em conclusão, a DCPO existe, mas é subestimada. Seu diagnóstico é complexo e deve ser feito precocemente para possibilitar uma intervenção efetiva para prevenir a incapacidade do paciente. Estudos com melhor desenho e com amostra adequada de- vem ser realizados, especialmente visando a determinação dos fatores que possibili- tam a evolução da dor aguda para crônica e sua persistência. Possivelmente a resposta está na elucidação dos fatores genéticos envolvidos na siopatologia da dor.
Referências
1. International Association for the Study of Pain. IASP taxonomy: pain terms. Disponível em: https:// www.iasp-pain.org/Taxonomy#Pain.
2. International Association for the Study of Pain. 2017 global year against pain after surgery. Dis- ponível em: https://www.iasp-pain.org/GlobalYear?navItemNumber=580. Acesso em: 27 set 2017. 3. WA M, HTO D. Chronic postsurgical pain. In: Crombie IK, Croft PR, Linton SJ et al. (Ed.). Epidemi-
ology of pain. Seattle: IASP Press; 1999. p. 125–42.
4. Brennan TJ. Pathophysiology of postoperative pain. Pain, 2011;152:S33-40.
5. Werner MU, Kongsgaard UE. I. Dening persistent post-surgical pain: is an update required? Br J Anaesth, 2014: 113:1-4.
6. Steyaert A, Lavand’homme P. Acute and chronic neuropathic pain after surgery: still a lot to learn. Eur J Anaesthesiol, 2017;34:650-1.
7. Sommer M, de Rijke JM, van Kleef M et al. The prevalence of postoperative pain in a sample of 1490 surgical inpatients. Eur J Anaesthesiol, 2008;25:267-74.
8. Walther-Larsen S, Pedersen MT, Friis SM et al. Pain prevalence in hospitalized children: a pro- spective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand, 2017;61:328-37.
9. Rabbitts JA, Fisher E, Rosenbloom BN et al. Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain, 2017;18:605-14.
10. Schug SA, Pogatzki-Zahn EM. Chronic pain after surgery or injury. Pain Clin Updates, 2011; 19:1-5. 11. Schug SA, Palmer GM, Scott DA et al. Acute pain management: scientic evidence, fourth edition,
2015. Med J Aust, 2016;204:315-7.
12. Ip HY, Abrishami A, Peng PW et al. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology, 2009;111:657-77.
13. Lirk P, Fiegl H, Weber NC et al. Epigenetics in the perioperative period. Br J Pharmacol, 2015;172:2748-55.
14. Buchheit T, Van de Ven T, Shaw A. Epigenetics and the transition from acute to chronic pain. Pain Med, 2012;13:1474-90.
15. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet, 2006;367:1618-25.
16. Clark AJ, Spanswick CC. Why anesthesiologists need to care about the way chronic pain is managed. Can J Anaesth, 2014;61:95-100.
17. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology, 2006;104:570-87.
18. McGreevy K, Bottros MM, Raja SN. Preventing chronic pain following acute pain: risk factors, pre- ventive strategies, and their ecacy. Eur J Pain Suppl, 2011;5:365-72.
19. Kraychete DC, Sakata RK, Lannes Lde O et al. Dor crônica persistente pós-operatória: o que sabe- mos sobre prevenção, fatores de risco e tratamento?. Rev Bras Anestesiol, 2016;66:505-12.
20. Voscopoulos C, Lema M. When does acute pain become chronic? Br J Anaesth, 2010;105:i69-85. 21. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective
factors. Expert Rev Neurother, 2009;9:723-44.
22. D’Mello R, Dickenson AH. Spinal cord mechanisms of pain. Br J Anaesth, 2008;101:8-16.
23. Ji RR, Berta T, Nedergaard M. Glia and pain: is chronic pain a gliopathy? Pain, 2013;154:S10-28. 24. Kehlet H, Rathmell JP. Persistent postsurgical pain: the path forward through better design of clini-
cal studies. Anesthesiology, 2010;112:514-5.
25. Haroutiunian S, Nikolajsen L, Finnerup NB et al. The neuropathic component in persistent postsur- gical pain: a systematic literature review. Pain, 2013;154:95-102.
26. Beloeil H, Sion B, Rousseau C et al. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol, 2017;34:652-7.
27. Granot M. Can we predict persistent postoperative pain by testing preoperative experimental pain? Curr Opin Anaesthesiol, 2009;22:425-30.
28. Yarnitsky D, Crispel Y, Eisenberg E et al. Prediction of chronic post-operative pain: pre-operative DNIC testing identies patients at risk. Pain, 2008;138:22-8.
29. Rivat C, Bollag L, Richebe P. Mechanisms of regional anaesthesia protection against hyperalgesia and pain chronicization. Curr Opin Anaesthesiol, 2013;26:621-5.
30. Wong K, Phelan R, Kalso E et al. A ntidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions. Anesthesiology, 2014; 121:591-608.
31. Wang CF, Russell G, Wang SY et al. R-duloxetine and N-methyl duloxetine as novel analgesics against experimental postincisional pain. Anesth Analg, 2016;122:719-29.
32. Straube S, Derry S, Moore RA et al. Single dose oral gabapentin for established acute postoperative pain in adults. Cochrane Database Syst Rev, 2010:CD008183.
33. Fabritius ML, Geisler A, Petersen PL et al. Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand, 2016;60:1188-208.
34. Wien PJ, Derry S, Bell RF et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev, 2017;6:CD007938.
35. Eipe N, Penning J, Yazdi F et al. Perioperative use of pregabalin for acute pain-a systematic review and meta-analysis. Pain, 2015;156:1284-300.
36. Martinez V, Pichard X, Fletcher D. Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials. Pain, 2017;158:775-83.
37. Moyse DW, Kaye AD, Diaz JH et al. Perioperative ketamine administration for thoracotomy pain. Pain Physician, 2017;20:173-84.
38. Chaparro LE, Smith SA, Moore RA eet al. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev, 2013:CD008307.
39. Oliveira Jr GS, Castro-Alves L J, Khan JH et al. Perioperative systemic m agnesium to mini- mize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology, 2013;119:178-90.
40. Sanchez Munoz MC, De Kock M, Forget P. What is the place of clonidine in anesthesia? Systematic review and meta-analyses of randomized controlled trials. J Clin A nesth, 2017;38:140-53.
41. Dunn LK, Durieux ME. Perioperative use of intravenous lidocaine. Anesthesiology, 2017;126:729-37. 42. Tiippana E, Hamunen K, Heiskanen T et al. New approach for treatment of prolonged postoperative
pain: APS Out-Patient Clinic. Scand J Pain, 2016;12:19-24.
43. Katz J, Weinrib A, Fashler SR et al. The Toronto General Hospital Transitional Pain Service: devel- opment and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res, 2015;8:695-702.
44. Scholz J, Yaksh TL. Preclinical research on persistent postsurgical pain: what we don’t know, but should start studying. Anesthesiology, 2010;112:511-3.