QUESTION = Could someone medically unable to feel pain have surgery done without anaethesia? GENERATION = The idea is that anesthesia is not necessarily necessary, but it can reduce the amount of pain you feel, and it can be useful in certain situations where it's not practical to anesthetize someone. For example, if you're having a tooth extraction, you're going to want to anesthetize it so that you can do the extraction without any pain. If you're having a broken bone, you're going to want to anesthetize it so that you can still be able to move around without pain. However, in the case of an emergency surgery, you want to anesthetize the patient so that they don't suffer any additional pain. In the case of an emergency surgery, you want to anesthetize the patient so that they don't suffer any additional pain. So in that case, anesthesia is necessary, but it can be useful in certain situations where it's not practical to anesthetize someone. There's a difference between anesthesia and anesthesia *treating* pain. In anesthesia, you can treat pain without anesthesia. RETRIEVAL #0 = Ankyloglossia---of those who have done so report post-operative pain. A viable alternative to surgery for children with ankyloglossia is to take a wait-and-see approach. Ruffoli "et al." report that the frenulum naturally recedes during the process of a child's growth between six months and six years of age; RETRIEVAL #1 = Congenital insensitivity to pain---analgesia in a single individual (as of 2019). The individual experienced lifelong insensitivity to pain and was oblivious to cuts and burns, did not experience pain during childbirth, did not experience pain from degeneration of a hip that required hip replacement surgery, and did not require analgesics for postoperative pain. Furthermore, the individual exhibited expedited wound healing and reduced scarring, could not sense heat from chili peppers, did not experience depression, fear, and anxiety and lacked a normal fear response to erratic and aggressive behaviour. However, the individual also experienced slight memory impairment (was prone to losing the trail of thought while speaking, and experienced some forgetfulness), and could not experience thrill ("adrenaline rush"). Developmental disabilities such as autism can include varying degrees of pain insensitivity as a sign. However, since these disorders are characterized by dysfunction of the sensory system in general, this specific condition is not in itself an indicator of any of these conditions. Section::::Treatment. The opioid antagonist naloxone allowed a woman with congenital insensitivity to pain to experience it for the first time. Similar effects were observed in Na1.7 null mice treated with naloxone. As such, opioid antagonists like naloxone and naltrexone may be effective in treating the condition. Section::::Epidemiology. RETRIEVAL #2 = Outcomes Research Consortium---from some combination of local tissue injury, inflammation, and abnormal activation of excitatory pain pathways. How to prevent, much less treat persistent pain remains unknown. About a dozen current Consortium studies address this major public health issue. Section::::Other research areas. Major ongoing initiatives for the consortium include acute and chronic pain management, fluid management, control of the surgical stress response. A recent study shows that inadequate oxygenation after surgery is surprisingly common, severe, and long-lasting. A particular interest of the group is long-term outcomes of anesthetic management. While the effects of anesthesia have traditionally been considered to dissipate within hours of surgery, there is increasing evidence that anesthetic management may alter patient outcomes weeks, months, or even years after surgery. For example, unlikely as it might seem, there is strong basic science and animal evidence suggesting the regional analgesia (such as spinal and epidural blocks, or paravertebral nerve blocks) might reduce the risk of recurrence after potentially curative cancer surgery. The Consortium is currently conducting several large randomized trials of regional analgesia and cancer recurrence. Outcomes Research statisticians routinely publish methodology articles, and their analyses set standards for statistical approaches throughout the specialty. Furthermore, the group has also developed entirely new research methods including alternating intervention studies and automat RETRIEVAL #3 = Ocular neuropathic pain---can be effective in patients that have not responded to prior treatments. For severe refractory ocular neuropathic pain cases where conservative treatments have proven ineffective, Intrathecal Targeted Drug Delivery with an implanted intrathecal pain pump has been used to successfully treat pain symptoms RETRIEVAL #4 = Unicompartmental knee arthroplasty---UKA would be compromised. The anterior cruciate ligament (ACL) should be intact, although this is debated by clinicians for people who need a medial compartment replacement. For people needing a lateral compartment replacement, the ACL should be intact and is contraindicated for people with ACL-deficient knees because the lateral component has more motion than the medial compartment. Section::::History and physical examination. A physical examination and getting the subject’s history is performed before getting surgery. A person with pain in one area of the knee may be a candidate for UKA. However, a person with pain in multiple areas of the knee may not be a good candidate for UKA. The doctor may take some radiographs (e.g., x-rays) to check for degeneration of the other knee compartments and evaluate the knee. The physical exam may also include special tests designed to test the ligaments of the knee and other anatomical structures. Most likely, the surgeon will decide to do a UKA during surgery where he/she can directly see the status of the other compartments. Section::::Surgical information. The surgeon may choose which type of incision and implant to use for the subject’s knee. During the surgery, the surgeon may align the instruments to determine the amount of bone to remove. The surgeon removes bone from the ( RETRIEVAL #5 = Pain---ability to experience pain is essential for protection from injury, and recognition of the presence of injury. Episodic analgesia may occur under special circumstances, such as in the excitement of sport or war: a soldier on the battlefield may feel no pain for many hours from a traumatic amputation or other severe injury. Although unpleasantness is an essential part of the IASP definition of pain, it is possible to induce a state described as intense pain devoid of unpleasantness in some patients, with morphine injection or psychosurgery. Such patients report that they have pain but are not bothered by it; they recognize the sensation of pain but suffer little, or not at all. Indifference to pain can also rarely be present from birth; these people have normal nerves on medical investigations, and find pain unpleasant, but do not avoid repetition of the pain stimulus. Insensitivity to pain may also result from abnormalities in the nervous system. This is usually the result of acquired damage to the nerves, such as spinal cord injury, diabetes mellitus (diabetic neuropathy), or leprosy in countries where that disease is prevalent. These individuals are at risk of tissue damage and infection due to undiscovered injuries. People with diabetes-related nerve damage, for instance, sustain poorly-healing foot ulcers as a result of decreased sensation. A much smaller number of people are insensitive to pain due to an inborn RETRIEVAL #6 = Hysteroscopy---than electrocautery, less than 0.1%. Severe Pain The English Member of Parliament, Lyn Brown (West Ham, Labour), has spoken twice in the House of Commons on behalf of constituents who have been coerced into completing unbearably painful outpatient hysteroscopies without anaesthesia. Lyn Brown cites numerous instances of women throughout England being held down by nurses in order to complete an ambulatory hysteroscopy and thus avoid the expense of safely monitored sedation or general anaesthetic. A petition to grant NHS patients full information about the risks of severe outpatient hysteroscopy pain, and the upfront choice of local anaesthetic, sedation, epidural or general anaesthetic was launched in summer 2018. 'End barbaric NHS hysteroscopies with inadequate pain-relief'. It asks the Secretary of State for Health to ensure that: 1. All NHS hysteroscopists have advanced training in pain medicine. 2. All hysteroscopy patients receive full written information before the procedure, listing the risks and benefits and explaining that local anaesthetic may be painful and ineffective against the severe pain of cervical dilation, womb distension and biopsy. 3. All hysteroscopy services are adequately funded so that BEFORE their procedures patients may choose no anaesthesia/ local anaesthesia/ safely monitored conscious sedation/ epidural/ general