Acute and Chronic Pain Management: Focused Ultrasound for Peripheral Neuromodulation
Poorly controlled acute and chronic pain are common and significant sources of patient morbidity. Inadequate control of postoperative pain is a risk factor for worsened patient outcomes, and 5% to 80% of patients will develop chronic pain after surgery. Novel, safe, and effective methods to improve and prevent acute and chronic pain are needed.
Focused ultrasound (FUS) can modulate central and peripheral nervous system structures. Most FUS research is concentrated on its utility for transcranial modulation of neural structures and ablation of tissues. However, there is evidence that it can also alter peripheral nerve conduction, including compound action potential depression in a manner similar to local anesthetics. However, no work has yet been published assessing its effects on acute or chronic pain, nor whether it is able to differentially modulate different classes of nerve fibers.
We are interested in the potential of focused ultrasound to modulate peripheral nerves and improve both acute and chronic pain.
Pediatric Perioperative Outcomes
Chronic opioid use is a public health concern in the United States and a growing number of countries. It is a complicated socioeconomic problem, not entirely related to the healthcare system, but it is a staggeringly important one. Those who use opioids chronically are more likely to have worsened health and require more medical care. Opioid-naïve adult patients who undergo surgery are at increased risk of becoming chronic opioid users. A number of retrospective and prospective studies have examined longitudinal opioid use in adult surgical patients. However, only a single study has examined this risk in pediatric patients. This study examined a limited, older pediatric patient population, but the results suggest that chronic opioid use in pediatric patients after surgery may be as high as 5%. As more than five million inpatient and outpatient pediatric surgical procedures take place in the U.S. each year, it is imperative to understand the risk of chronic opioid use in this vulnerable and understudied population and to design and investigate interventions to decrease this risk.
We are working with a large national healthcare dataset assessing the risk of persistent opioid use after surgery in children. We are also investigating the use of regional anesthesia, opioid use, and opioid-sparing analgesic use in pediatric patients who undergo surgery at the Lucile Packard Children’s Hospital at Stanford. Our goal is to understand how various perioperative pain management strategies affect outcomes in children who undergo surgery.