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Special Issue on Plasticity in Postoperative Pain: Select Reports from the Journal-sponsored Symposium

Raja, Srinivasa N. M.D.*; Brennan, Timothy J. M.D., Ph.D.†

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IN this issue of the Journal, we present the third annual special issue. This special issue includes select peer-reviewed manuscripts of studies presented as poster abstracts at the 14th Anesthesiology-sponsored symposium at the annual meeting of the American Society of Anesthesiologists, October 2005. We feature six original research reports and a Clinical Concepts and Commentary article related to the topic of the symposium, “Plasticity in Postoperative Pain.” The Journal Editorial Board considered this topic to be timely because we are in the midst of the Decade of Pain Control and Research. This “decade,” declared by the U.S. Congress in the fall of 2000, is aimed at stimulating further progress in research, education, and clinical management of pain in the new millennium. This is only the second congressionally declared medical decade and follows the Decade of the Brain in the 1990s.
Webster’s defines plasticity as “the capability of being molded.” In neuroscience, plasticity is the term used to denote the dynamic functional and/or anatomical changes occurring in the nervous system as a result of an injury or disease. Plasticity occurs not only in the neural pathways damaged directly, but also in undamaged pathways in the peripheral and central nervous systems1,2 as part of a compensatory reorganization. With regard to postoperative pain, the relevant mechanisms are processes whereby tissue injury increases the responsiveness of the sensory system so that subsequent stimuli have an enhanced effect—a phenomenon termed sensitization. The Journal symposium examined the advances in our understanding of the plastic changes that occur in the peripheral and central nervous systems as a result of surgery, how these mechanisms may contribute to postoperative pain, and how anesthesia and acute perioperative pain management may influence this plasticity.
The major goals in optimizing postoperative pain management include achieving a pain-free state with minimal drug-related adverse effects, facilitating early rehabilitation and discharge from the hospital, identifying patients likely to develop chronic pain states, and establishing effective preventative therapies for this population. We now recognize that postoperative pain is not just a transient uncomfortable experience to the patient, but can have far-reaching long-term sequelae.3 The development of animal models of incisional pain4 has helped considerably in understanding the pathophysiological mechanisms of postoperative pain. A better understanding of these neural changes and their regulation is important in designing strategies to hasten and improve functional recovery in our patients and to minimize the development of chronic pain states after surgery.5,6
Challenges in the pain field include translation from animal models to identification of novel targets for drug development for humans and developing strategies that lead to improvements in patient care. Toward this goal, the symposium featured presentations that reviewed advances in the basic science and clinical arenas. Timothy Brennan, Ph.D., M.D. (Associate Professor of Anesthesia and Pharmacology, University of Iowa, Iowa City, Iowa), discussed the “Peripheral and Central Plasticity in an Animal Model of Incisional Pain” and Gary Strichartz, Ph.D. (Professor of Anesthesia, Pharmacology and Biophysics, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts), reviewed “Pharmacological Studies on Preventing or Modulating the Plastic Changes in Experimental Models of Incisional Pain.” Additional presentations on “Clinical Evidence for Neural Plasticity in the Postoperative Period: Its Relevance and Modulation” and “Persistent Pain following Surgery: Neurobiological Mechanisms” were made by Troels Jensen, M.D., Ph.D. (Professor of Neurology, Aarhus University and Danish Pain Research Center, Aarhus, Denmark), and Henrik Kehlet, M.D., Ph.D. (Professor of Surgery, The Juliane Marie Center, Rigshospitalet, Copenhagen, Denmark), respectively. Dr. Brennan discussed the 11 poster abstracts selected for presentation at the symposium. All of these speakers graciously agreed to be recorded and to provide their slides, and we are pleased to offer their presentations as a Web Enhancement to this month’s issue.
Authors of abstracts submitted to the symposium were encouraged to submit a manuscript for consideration in the special issue. Six of the submitted articles were selected for publication. The published articles describe factors predicting postoperative pain in patients, the sites of action and roles of cyclooxygenase products, and the synaptic physiology of incisions. A Clinical Concepts and Commentary on postthoracotomy pain was solicited. We deeply appreciate the help of our panel of reviewers for their expedited reviews of the manuscripts submitted for this special issue. We also thank Barbara Bewyer (Managing Editor, Anesthesiology) and her editorial staff, who not only played a significant role in the planning and organizing of the Journal symposium, but also in the timely publication of this issue.
The topic of the next Journal symposium at the annual meeting of the Society at Chicago in October 2006 will be “Postoperative Cognitive Dysfunction,” organized by Michael M. Todd, M.D. (Editor-in-Chief, Anesthesiology; Head, Department of Anesthesia, The University of Iowa, Iowa City, Iowa), and Mervyn Maze, M.B., Ch.B. (Editor, Anesthesiology; Professor, Sir Ivan Magill Department of Anesthetics, Chelsea and Westminster Hospital, London, England, United Kingdom). We invite you all to participate in the symposium and to submit your work related to the topic to be considered for inclusion in the symposium at the next annual meeting of the American Society of Anesthesiologists. The Journal hopes to continue this tradition of publishing a special issue dedicated to the subject of the symposium.
Srinivasa N. Raja, M.D.,*
Timothy J. Brennan, M.D., Ph.D.†
Dr. Raja is Editor, Anesthesiology, and Dr. Brennan is Assistant Editor-in-Chief, Anesthesiology. *Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland. †Departments of Anesthesia and Pharmacology, The University of Iowa, Iowa City, Iowa. sraja@jhmi.edu
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References

1. Ji RR, Woolf CJ: Neuronal plasticity and signal transduction in nociceptive neurons: Implications for the initiation and maintenance of pathological pain. Neurobiol Dis 2001; 8:1–10

2. Petersen-Felix S, Curatolo M: Neuroplasticity—An important factor in acute and chronic pain. Swiss Med Wkly 2002; 132:273–8

3. Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000; 93:1123–33

4. Brennan TJ, Zahn PK, Pogatzki-Zahn EM: Mechanisms of incisional pain. Anesthesiol Clin North Am 2005; 23:1–20

5. Brennan TJ, Kehlet H: Preventive analgesia to reduce wound hyperalgesia and persistent postsurgical pain: Not an easy path. Anesthesiology 2005; 103:681–3

6. Woolf CJ: Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004; 140:441–51

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