A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

Abstract

Background Due to the continued growth of surgical procedures in older adults and the significant impact of chronic postsurgical pain (CPSP), it is crucial to improve our understanding of the occurrence of CPSP as well as the appropriate prevention and treatment. We therefore conducted this study to determine the incidence, characteristics and risk factors of CPSP in elderly patients at both 3 and 6 months after surgery. Methods Elderly patients (aged ≥ 60 years) undergoing elective surgery in our institution between April 2018 and March 2020 were prospectively enrolled in this study. Data on demographics, preoperative psychological well-being, intraoperative surgical and anesthesia management, and acute postoperative pain intensity were collected. At 3 and 6 months after surgery, patients received telephone interview and completed the questionnaires regarding chronic pain characteristics, analgesic consumption, and interference of the pain with activities of daily living (ADL). Results A total of 1065 elderly patients were followed up for 6 postoperative months and included in final analysis. At 3 and 6 months after operation, the incidence of CPSP was 35.6% [95% confidence interval (95% CI) 32.7 − 38.8%] and 21.5% (95% CI 19.0% − 23.9%), respectively. CPSP cause negative impacts on patient’s ADL and most particularly on mood. Neuropathic features were found in 45.1% of the patients with CPSP at 3 months. At 6 months, 31.0% of those with CPSP reported that the pain had neuropathic features. Preoperative anxiety [3 months: Odds ratio (OR) 2.244, 95% CI 1.693 to 2.973; 6 months: OR 2.397, 95% CI 1.745 to 3.294], preoperative depression (3 months: OR 1.709, 95% CI 1.292 to 2.261; 6 months: OR 1.565, 95% CI 1.136–2.156), orthopedic surgery (3 months: OR 1.927, 95% CI 1.112 to 3.341; 6 months: OR 2.484, 95% CI 1.220 to 5.061), higher pain severity on movement within postoperative 24 h (3 months: OR 1.317, 95% CI 1.191 to 1.457; 6 months: OR 1.317, 95% CI 1.177 to 1.475) were associated with a higher risk for CPSP independently at both 3 and 6 months after surgery. Conclusions CPSP is a common postoperative complication in elderly surgical patients. Preoperative anxiety and depression, orthopedic surgery, and greater intensity of acute postoperative pain on movement are associated with an increased risk for CPSP. It should be kept in mind that developing psychological interventions to reduce anxiety and depression and optimizing the management of acute postoperative pain will be effective in reducing the development of CPSP in this population.

Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors

“…Typical and easy-to-assess patient-related prognostic and risk factors for CPSP are young (adult) age, female sex, and high BMI (see Table 2). While young (adult) age is a well-described associated factor for the development of acute and (not as strong) for CPSP ( 6,95,100▪▪ ; see Tables 1 and 2), elderly patients present particular susceptibility associated with comorbidities, but also more prevalent central sensitization and changes in the descending modulating systems 101,102 . Thus, the role of age for CPSP needs further exploitation.…”

Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument

“…At the level of a single comorbid diagnosis, some diagnoses are known to be both highly prevalent and impactful in choosing therapies for older adults with pain ( 31 , 32 ). Depression, for example, has a complex relation to pain, potentially increasing risks for and being increased by pain, as well as impacting compliance with pain therapies ( 25 , 33 – 35 ). Heart disease, cerebrovascular disease, dementia, renal failure, and hepatic failure can all impact medication safety ( 36 ).…”

The role of neuroinflammation in the transition of acute to chronic pain and the opioid-induced hyperalgesia and tolerance

“…The incidence of pain persisting beyond the period of wound healing after surgery is approximately 10%-85%, depending on the type of surgery. This has been typified as CPSP, with 5%-10% of cases rating the pain as severe, affecting patients quality of life and creating a significant economic burden for the health systems (Kehlet et al, 2006;Johansen et al, 2012;Jin et al, 2021;Jin et al, 2023). The most recent revision of the International Classification of Diseases (ICD-11) defines CPSP as "pain developing or increasing in intensity after a surgical procedure, in the area of the surgery, persisting beyond the healing process (i.e., at least 3 months) and not better explained by another cause such as infection, malignancy or a pre-existing pain condition".…”