A Prospective Study of Chronic Postsurgical Pain in Elderly Patients: Prevalence, Characteristics and Risk factors

Abstract

Background Considering 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 prevalence, 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). ResultsA total of 1165 elderly patients were followed up for 6 postoperative months and included in final analysis. At 3 and 6 months after operation, the prevalence of CPSP was 35.6% and 21.5 %, respectively. CPSP cause negative impacts on patient’s ADL and most particularly on mood. Neuropathic pain was 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, preoperative depression, orthopedic surgery, higher pain severity on movement within postoperative 24 h predicted CPSP independently at both 3 and 6 months after surgery. Conclusions CPSP is a common postoperative complication in elderly surgical patients. Predictors for CPSP in the elderly included preoperative anxiety and depression, orthopedic surgery, and greater intensity of acute postoperative pain on movement.

Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges

“…Recently, the postoperative occurrence of pruritus in the painful area as well as cold hypersensitivity 14 days after surgery were shown to be associated with the development of CPSP [47 ▪▪ ]. The role of these neuropathic pain features assessed after surgery in the prognostication of CPSP emphasizes the role of surgery-induced neuropathic mechanisms [62,63]. Similar, assessment of a neuropathic pain questionnaire, the DN4 early after surgery was associated with the development of neuropathic CPSP [64].…”

Prolonged Opioid Use Is Associated With Poor Pain Alleviation After Orthopaedic Surgery

“…CPSP may result from the accumulation of inflammatory cytokines during surgery and after surgery in the setting of PPA, thereby sensitizing the peripheral and central nervous systems. 10,11 Although the current study was not designed to identify methods of avoiding PPA, the strong relationship that was identified between PPA and COU suggests that the management of acute postsurgical pain should be a continued research focus and a clinical priority. This study identified demographic factors associated with COU.…”

“…The relationship between PPA and CPSP, leading to COU, is well documented. 1,3,4,9,10 Previous studies have suggested mechanistic explanations of the relationship between PPA and CPSP. CPSP may result from the accumulation of inflammatory cytokines during surgery and after surgery in the setting of PPA, thereby sensitizing the peripheral and central nervous systems.…”

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.…”