Update for nurse anesthetists--pt 4. Itching, the "little" big problem as an orphan symptom.

The phenomenon of itching has received surprisingly little scientific scrutiny despite its commonality--hence its designation as a kind of neglected, "orphan symptom." Recent research and clinical understanding has shed light on itching, helping to illuminate its previously shaded landscape. This course reviews the nature of itching, its physiology, major triggers of particular interest to anesthetists (especially when using neuraxial agents), and interventions directed at its resolution. A variety of chemical mediators and modulators have important roles in the genesis and experience of itching. Although many medical comorbidities can cause itch, the ubiquitous use of neuraxial opioids in the perioperative care of patients has been attended by a dramatic increase in the number of patients experiencing, and complaining of, itching as a consequence of our management. Patient satisfaction inventories have placed the sensation of refractory itch among the most distressing, non-life-threatening complications that are experienced. Intractable itch can be so incapacitating that it deserves the same degree of clinical attention as pain.