Stephen Macres | University of California, Davis (original) (raw)

Papers by Stephen Macres

Pain is usually the natural consequence of tissue injury resulting in approximately forty million... more Pain is usually the natural consequence of tissue injury resulting in approximately forty million medical appointments per year. In general, as the healing process commences, the pain and tenderness associated with the injury will resolve. Unfortunately some individuals experience pain without an obvious injury or suffer protracted pain that persists for months or years after the initial insult. This pain condition is usually neuropathic in nature and accounts for a large number of patients presenting to pain clinics with chronic, non–malignant pain. Rather than the nervous system functioning properly to sound an alarm regarding tissue injury, in neuropathic pain the peripheral or central nervous systems are malfunctioning and become the cause of the pain.

Pain Management, 2020

Aim: To compare perioperative opioid consumption for patients undergoing mastectomy surgery with ... more Aim: To compare perioperative opioid consumption for patients undergoing mastectomy surgery with or without pectoralis nerve (PECS) plane blocks. Patients & methods: Retrospective study evaluating 152 adult females with mastectomies. Demographics, postanesthesia care unit stay duration and opioid consumption data at three time points were collected and analyzed for statistical significance. Results: 98 patients were included in the PECS block group, 54 patients were in the general anesthesia only group. Age and BMI were comparable. Total perioperative intravenous opioid consumption was less in the PECS block group (50.88 mg) compared with the general anesthesia only group (67.83 mg), p < 0.001. Conclusion: Acute pain after mastectomy is often severe. PECS plane block may decrease perioperative opioid consumption after mastectomy surgery compared with general anesthesia alone.

Seminars in Anesthesia, Perioperative Medicine and Pain, 1996

A N UNFORTUNATE but obvious tact is that where there is medical care, there are complications. Th... more A N UNFORTUNATE but obvious tact is that where there is medical care, there are complications. There are procedure-related and pharmacological complications that are discussed with the patient and made part of the informed consent. However, we may be ignoring the most common group of complications, those of the psyche. The impact of psychological complications may be just as far reaching as any physical complication resulting from a needle. In this article, we review the procedure-related and the pharmacological complications of pain management, but first we examine the often overlooked psychological complications. PSYCHOLOGICAL COMPLICATIONS Psychological complications not only are related to the performance of procedures, but are a potential risk inherent in the entire process of treating chronic pain. The concept of psychological complications is not new within the psychiatric literature. In the 1910s, Freud discussed the potentially harmful effects of countertransference. Some of the same risks of psychotherapy apply to other doctor-patient relationships in chronic illness. These risks are often critical issues in the pain clinic setting, and they include the fostering of dependency and helplessness, the reinforcing of secondary gain issues, the worsening of symptoms, and the potential triggering of hopelessness or anger. Some additional risks that are more specific (but not limited) to the pain clinic include creating or supporting narcotic addictions, rewarding malingering, and providing new areas for somatic preoccupation and anxiety.

The Clinical Journal of Pain, 2000

The objective of this study was to determine if intractable pain from erythromelalgia could be su... more The objective of this study was to determine if intractable pain from erythromelalgia could be successfully treated with intrathecal hydromorphone and clonidine. A single case of pain from erythromelalgia refractory to multiple treatment modalities was examined and treated. The setting is an outpatient pain clinic at a major university teaching hospital. Our patient is an 82-year-old woman with hypertension and peripheral vascular disease. Intrathecal opioid and an alpha2-agonist were administered. Outcome was determined by means of patient self-report during office follow-up visits. Administration of intrathecal opioid and an alpha2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.

British Journal of Anaesthesia, 1996

The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the ef... more The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg 91) of suxamethonium, vecuronium was infused to produce 75% block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg 91 , pyridostigmine 0.24 mg kg 91 or neostigmine 0.05 mg kg 91 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction. (Br.

Advances in Anesthesia, 2020

Pain is usually the natural consequence of tissue injury resulting in approximately forty million... more Pain is usually the natural consequence of tissue injury resulting in approximately forty million medical appointments per year. In general, as the healing process commences, the pain and tenderness associated with the injury will resolve. Unfortunately some individuals experience pain without an obvious injury or suffer protracted pain that persists for months or years after the initial insult. This pain condition is usually neuropathic in nature and accounts for a large number of patients presenting to pain clinics with chronic, non–malignant pain. Rather than the nervous system functioning properly to sound an alarm regarding tissue injury, in neuropathic pain the peripheral or central nervous systems are malfunctioning and become the cause of the pain.

Pain Management, 2020

Aim: To compare perioperative opioid consumption for patients undergoing mastectomy surgery with ... more Aim: To compare perioperative opioid consumption for patients undergoing mastectomy surgery with or without pectoralis nerve (PECS) plane blocks. Patients & methods: Retrospective study evaluating 152 adult females with mastectomies. Demographics, postanesthesia care unit stay duration and opioid consumption data at three time points were collected and analyzed for statistical significance. Results: 98 patients were included in the PECS block group, 54 patients were in the general anesthesia only group. Age and BMI were comparable. Total perioperative intravenous opioid consumption was less in the PECS block group (50.88 mg) compared with the general anesthesia only group (67.83 mg), p < 0.001. Conclusion: Acute pain after mastectomy is often severe. PECS plane block may decrease perioperative opioid consumption after mastectomy surgery compared with general anesthesia alone.

Seminars in Anesthesia, Perioperative Medicine and Pain, 1996

A N UNFORTUNATE but obvious tact is that where there is medical care, there are complications. Th... more A N UNFORTUNATE but obvious tact is that where there is medical care, there are complications. There are procedure-related and pharmacological complications that are discussed with the patient and made part of the informed consent. However, we may be ignoring the most common group of complications, those of the psyche. The impact of psychological complications may be just as far reaching as any physical complication resulting from a needle. In this article, we review the procedure-related and the pharmacological complications of pain management, but first we examine the often overlooked psychological complications. PSYCHOLOGICAL COMPLICATIONS Psychological complications not only are related to the performance of procedures, but are a potential risk inherent in the entire process of treating chronic pain. The concept of psychological complications is not new within the psychiatric literature. In the 1910s, Freud discussed the potentially harmful effects of countertransference. Some of the same risks of psychotherapy apply to other doctor-patient relationships in chronic illness. These risks are often critical issues in the pain clinic setting, and they include the fostering of dependency and helplessness, the reinforcing of secondary gain issues, the worsening of symptoms, and the potential triggering of hopelessness or anger. Some additional risks that are more specific (but not limited) to the pain clinic include creating or supporting narcotic addictions, rewarding malingering, and providing new areas for somatic preoccupation and anxiety.

The Clinical Journal of Pain, 2000

The objective of this study was to determine if intractable pain from erythromelalgia could be su... more The objective of this study was to determine if intractable pain from erythromelalgia could be successfully treated with intrathecal hydromorphone and clonidine. A single case of pain from erythromelalgia refractory to multiple treatment modalities was examined and treated. The setting is an outpatient pain clinic at a major university teaching hospital. Our patient is an 82-year-old woman with hypertension and peripheral vascular disease. Intrathecal opioid and an alpha2-agonist were administered. Outcome was determined by means of patient self-report during office follow-up visits. Administration of intrathecal opioid and an alpha2-agonist can be effective in the treatment of the pain of erythromelalgia and offers an alternative pain treatment modality for patients with unremitting pain refractory to more conservative therapy.

British Journal of Anaesthesia, 1996

The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the ef... more The reported effects of edrophonium on a subsequent dose of suxamethonium are variable and the effects of pyridostigmine have not been evaluated extensively. We have studied this interaction in patients anaesthetized with propofol and sufentanil. After recovery from an initial bolus (1 mg kg 91) of suxamethonium, vecuronium was infused to produce 75% block. After 30 min, the infusion was discontinued and saline 5 ml, edrophonium 0.75 mg kg 91 , pyridostigmine 0.24 mg kg 91 or neostigmine 0.05 mg kg 91 was given. Fifteen minutes later the mean durations of a second bolus of suxamethonium were: 10.5 (SD 3.9) min (saline), 10.9 (3.7) min (edrophonium), 18.7 (5.4) min (pyridostigmine) and 23.8 (7.4) min (neostigmine). Corresponding plasma cholinesterase activities (percentage of baseline) were: 91 (18), 87 (9), 21 (10) and 52 (26). When both treatment groups and individual patients were compared, the changes in duration of action did not correlate with changes in cholinesterase activity. These data suggest that other mechanisms in addition to cholinesterase inhibition may contribute to this drug interaction. (Br.

Advances in Anesthesia, 2020