Dr. Kissin’s interests are centered on the pharmacology of anesthetics and analgesics. They have led to studies on preemptive analgesia.
Preemptive analgesia is a treatment that prevents establishment of the altered sensory processing that amplifies post-operative pain. The treatment should cover the entire duration of high-intensity noxious stimulation that can lead to establishment of central (and peripheral) sensitization caused by incisional or inflammatory injuries (during surgery and the initial postoperative period). Two approaches have been used to reveal preemptive analgesia. One of them is to demonstrate a reduction in pain intensity and/or in analgesic use beyond the drug presence in the biophase.This approach is based on a study design comparing preoperative treatment and nontreatment groups (PRE versus NO). The other approach is to prove that a treatment applied before surgery is more effective than the same treatment provided at the end of surgery (PRE versus POST). The present direction of his investigations is to prove that full potential of preemptive analgesia can be revealed only with PRE versus NO approach. The other important condition to have the full effect of preemption is the completeness of interventions suppressing C and A beta fibers central input.
One of Dr. Kissin’s projects is based on the idea to use vanilloid agonists for the blockade of peripheral nerves. Vanilloids bind to the transient receptor potential type channels (TRPV1) and cause nerve desensitization. He has shown that vanilloids can provide selective (C fibers and AÎ´ fibers) and long-lasting (days) neural blockade. Extension of the traditional local anesthetic blockade into the postoperative period presents a problem for early mobilization (rehabilitation) after surgery and when protective sensation is required. Vanilloid agonists have an advantage in this regard. They do not affect non-painful sensations to touch and pressure or motor function. Dr. Kissin’s experiments demonstrated that perineural resiniferatoxin (vanilliod agonist) prevents hyperalgesia in a rat model of postoperative pain.vHis electron microscopy study in rats demonstrated that resiniferatoxin-induced sciatic nerve blockade may lead to morphological changes in C fibers but to a much smaller degree than those with the use of local anesthetics. This result may indicate a new direction in the treatment of pain – conduction analgesia.
The other area of Dr. Kissin’s investigations is the effect of peripheral nerve blocks in chronic pain. The working hypothesis regarding this effect is that a temporary nerve block can restore the normal afferent processing in the CNS following block resolution. Since 2010 Dr. Kissin has also been developing a new scientometric indicator that can determine the probability of a drug’s success – Top Journal Selectivity Index.
Igor Kissin, M.D., Ph.D. is a Professor of Anaesthesia at Harvard Medical School.
- Kissin I, Gelman S. “Chronic postsurgical pain: Still a neglected topic?” J Pain Res 2012;5:1-17.
- Kissin I, Bradley EL Jr. “Top Journal Selectivity Index and ‘me-too’ drugs.” Scientometrics 2012;91:131-42.
- Kissin I. “Can a bibliometric indicator predict the success of an analgesic?” Scientometrics 2011;86:785-95.
- Vlassakov KV, Narang S, Kissin I. “Cutaneous anesthesia in neuropathic pain: systematic analysis.” J Anesth Clin Res 2012;3:199; D01:10.4172/2155-6148. 1000199
- Vlassakov KV, Narang S, Kissin I. “Local anesthetic blockade of peripheral nerves for treatment of neuralgias: systematic analysis.” Anesth Analg 2011;112:1487-93.