Davina Wildemeersch

Background: Chronic pain is a major global health problem for which current treatments often provide insufficient relief. Tissue hypoxia and redox imbalance may contribute to its pathophysiology, prompting interest in hyperbaric oxygen therapy (HBOT) as a potential adjunctive treatment. This review evaluates the therapeutic effects of HBOT in adults with chronic pain syndromes. Methods: A PRISMA-guided systematic review was conducted (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials; January 2000 - August 2025). Randomized controlled trials (RCTs) evaluating HBOT in adults with chronic pain were included. Primary outcomes were pain measures (intensity, distribution and sensitivity). Secondary outcomes included multidimensional pain-related outcomes (quality of life, functioning and psychological well-being), analgesic use, neuroimaging findings, and adverse events. Risk of bias was assessed using the Cochrane RoB 2 tool. Due to study heterogeneity, results were synthesized narratively. Results: Eleven RCTs (480 participants) were included, predominantly involving fibromyalgia (n=8), with additional studies in complex regional pain syndrome (CRPS) (n=1), idiopathic trigeminal neuralgia (n=1) and radiation-induced brachial neuropathy (n=1). Sample sizes ranged from 17 to 71 participants. Most trials showed some concerns or high risk of bias, mainly due to subjective outcomes and lack of blinding. In fibromyalgia, HBOT showed consistent within-group improvements in pain, functioning, and quality of life, with some studies demonstrating between-group benefits. Limited evidence in CRPS and trigeminal neuralgia suggested possible benefit, whereas the trial in radiation-induced brachial plexopathy showed no meaningful improvement. HBOT was generally well tolerated, with mostly mild adverse events. Conclusion: HBOT shows potential as an adjunctive intervention for selected chronic pain syndromes, particularly fibromyalgia. However, condition-specific effects, inconsistent superiority over controls, methodological limitations, protocol heterogeneity, and limited long-term follow-up constrain the strength of evidence. Larger, standardized trials with extended follow-up are needed before routine clinical implementation can be recommended.

Introduction: Chronic pain is a frequent and disabling complication following major trauma. Despite its high prevalence, it remains under-recognised and inconsistently managed. To review current evidence on the prevalence, risk factors and predictive models for chronic pain following major trauma, with comparison between musculoskeletal trauma, thoracic trauma, and spinal cord injury. Methods: This narrative review follows PRISMA 2020 guidelines. Studies published between 2015 and March 2025 were included if they examined adults with major trauma and chronic pain. Thematic synthesis was performed and stratified by trauma sub-type. Results: Chronic pain occurs in 30–70% of trauma survivors, with prevalence varying by injury type. Key risk factors include female sex, younger age, pre-existing pain, psychological distress, and social disadvantage. Validated prediction models are available for musculoskeletal trauma, while preventive strategies remain inconsistently applied across trauma sub-types. Conclusion: Chronic pain after major trauma is common. A trauma-informed, proactive approach is needed to improve outcomes.

Background: Despite extensive research efforts into risk factors and management strategies, the prevalence of chronic post-surgical pain (CPSP) remains high. Additionally, the treatment of chronic pain is often complex, with outcomes frequently falling short of expectations. As chronic pain continues to be a significant global problem affecting medical, psychological and socioeconomic aspects, and with the growing number of surgeries performed, there is a pressing need for an early, comprehensive model to predict CPSP. Various models have been created in recent years to predict postsurgical pain. However, to date, no generalizable CPSP risk stratification model independent for type of surgery is extensively applied. This study aims to create a simple and effective model to predict presurgically the likelihood of CPSP occurring three months after elective surgery. Methods: An observational, single center, pragmatic, pilot cohort study [PERISCOPE] in adult elective surgery patients was conducted at the Antwerp University Hospital, Belgium, between December 2022 and September 2023. More than 40 different types of surgeries in 11 disciplines were included. CPSP was defined as persistent pain in the surgical area, reported by the patient three months after surgery on a 11-level numeric rating scale. Biopsychosocial candidate variables, including health-related quality of life and psychosocial concerns, were identified based on clinical knowledge and literature review. Results: The final study population at our tertiary hospital included 415 patients of which 19.3% reported CPSP. Four predictors: preoperative pain intensity, education level, type of surgery and concerns about the planned surgery were identified leading to the best predictive model (P⁴-Prevoque™) in terms of area under the curve (0.81; 95% confidence interval [0.76, 0.87]) and significance. Conclusion: The P⁴-Prevoque™ questionnaire is able to identify presurgically a major part of CPSP patients with a sensitivity of 74%, and specificity of 77%. Using four straightforward and readily available questions, the proposed user-friendly prediction model has the strength to be easily implemented in daily practice. Future research should focus on its further validation. Trial Registration: ClinicalTrials.gov NCT05526976, Ethics Committee B3002022000112.

Background: The rise in global cannabis use has led anaesthetists to encounter an increasing number of patients on cannabis and cannabinoids. With cannabis influencing the perioperative period, anaesthetists will face associated challenges managing these patients. Objective: This review aims to summarise this literature on perioperative care for patients with long-term cannabis consumption or cannabis use disorder. Methods: This review was conducted based on the PRISMA 2020 statement. A literature search was performed using Medline and Cochrane library databases to identify relevant reports published from 2003 to 2023. This search yielded 209 records. After screening, 17 articles were included. Results: Preoperative screening of patients for chronic cannabis use or cannabis use disorder can be valuable, due to the increased risk of postoperative myocardial infarction, more postoperative pain and opioid use. Moreover, regarding respiratory management, anaesthetists should prepare to manage bronchospasm and consider adjustments in ventilation. During the perioperative period, attention should be paid to potential interactions between anticoagulant medications and cannabinoids.

Background: The global incidence of persistent pain after surgery is approximately 10%, with considerable clinical and socioeconomic impacts. Despite identifying many risk factors in its development and the challenging management of the often neuropathic pain complaints, preoperative recognition of high-risk patients in various surgical populations using a standardized risk factor assessment questionnaire is lacking. This study evaluates the predictive value of a short holistic risk factor screening questionnaire as a first step in preventing and treating persistent pain in adults undergoing elective surgery. Methods: This prospective observational pragmatic trial will include 560 adults undergoing elective surgery. The primary endpoint is the evaluation of the predictive value of the screening questionnaire, including the optimal cut-off determination in terms of sensitivity and specificity for inclusion in a perioperative high-vigilance program. Secondary endpoints are postoperative pain (intensity and characterization using the NRS and DN4), postoperative analgesic usage, and well-being using the EQ-5D-5 L. To assess the performance of the designed screening questionnaire in the identification of psychosocial pain aspects, HADs, and STAI-trait are being surveyed. Additionally, the multidimensional pain inventory (MPI, part 1) is being used to assess the impact of pain on daily life in patients. Discussion: This pragmatic clinical trial will evaluate a short preoperative screening questionnaire to predict persistent postoperative pain after elective surgery in adults. Suppose high-risk patients could be identified earlier using this short preoperative holistic screening questionnaire. In that case, it might contribute to a more widespread implementation of standardized preoperative assessment and awareness for preventing persistent postoperative pain. Trial Registration: Local ethics committee: B3002022000112. ClinicalTrials.gov identifier: NCT05526976. Registered on: 02 September 2022. Start of recruitment: 22 December 2022. Trial Status: This paper is based on protocol version 4.0. The first patient was assigned to the research project on the 22 of December 2022. We anticipate including the last patient in October 2023 and plan to finalize the study by January 2024.

Monkeypox (MPX) is a zoonotic infection caused by an orthopoxvirus that is endemic to Central and Western Africa. The MPX virus is a part of the same family of viruses as the variola virus, which causes smallpox. Since May 2022, there has been a global increase in the incidence of MPX infections in multiple countries where the illness is not usually prevalent. A growing number of publications have emphasized on the need for increased awareness among all health professionals for the rapid recognition and diagnosis of this disease and for proper public health measures. However, atypical presentations and occurrence of uncommon symptoms receive less than the desired attention. More specifically, MPX infection related nociceptive symptoms are currently underexposed. Nevertheless, reports from the current outbreak have revealed that (severe) pain is one of the major causes for distress and even hospitalization in these patients. As for all serious pain conditions, an integrated, multidisciplinary, and holistic approach is indicated. This approach should be multimodal and include non-pharmacological therapies alongside pharmacological approaches. Health care professionals should be aware of available alternatives when first choice analgesic therapies fail. Protocols for identification of pain type and prolonged monitoring of clinical status should be implemented to improve patient well-being during acute infection, but also prevent chronic nociceptive syndromes.

Background: The use of neostigmine after neuromuscular blockade (NMB) has been associated with postoperative respiratory complications. In previous studies, we found lower diaphragmatic activity after neostigmine reversal of NMB, compared to sugammadex. It is still unclear whether the adequate use of neostigmine guarantees normal respiratory muscle function after NMB. In this study, we wanted to assess the effect of commonly used degrees of NMB and their possible reversal strategies on respiratory muscle activity after the return of normal neuromuscular transmission. Methods: This is a randomized, controlled, parallel-group, single-centre, double-blind study in patients scheduled for intracranial surgery at a tertiary academic hospital in Belgium. All participants received target controlled propofol/remifentanil anesthesia and were randomized into one of five groups, receiving either a shallow NMB with no reversal (shallow/saline), a shallow NMB with sugammadex reversal (shallow/sugammadex), a moderate NMB with neostigmine reversal (moderate/neostigmine), a moderate NMB with sugammadex reversal (moderate/sugammadex), or a deep NMB with sugammadex reversal (deep/sugammadex). Primary and secondary outcome parameters were diaphragm and intercostal electromyographic (EMG) activity at the moment of resumed spontaneous breathing activity, defined as a maximal interval of 10 min after the first spontaneous breath. Results: For the five groups, a total of 55 patients could be included in the final analysis. Median time of spontaneous breathing analyzed was 5 min (IQR 3–9.5 min). Both the moderate/sugammadex and the moderate/neostigmine groups had lower levels of diaphragm EMG compared to the shallow/sugammadex group. The moderate/neostigmine group had lower levels of intercostal EMG activity compared to the shallow/saline group. Conclusions: In this study, the depth of neuromuscular blockade and type of reversal strategy impacts respiratory muscle activity at the moment of resumed spontaneous breathing and recovery of neuromuscular blockade. Both groups that received moderate NMB had lower levels of diaphragm EMG, compared to the shallow NMB group with sugammadex reversal. Compared to the shallow NMB group with no reversal, the moderate NMB with neostigmine reversal group had lower intercostal EMG activity. Trial registration: Clinicaltrials.gov NCT01962298 on October 9, 2013 and EudraCT 2013–001926-25 on October 10, 2013.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet