Chronic postoperative pain: recent findings in understanding and management

Abstract

Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison

“…In another review of chronic postoperative pain, in addition to preoperative pain, psychological factors (e.g., anxiety, depression, catastrophizing), younger age, surgical factors (e.g., open approach, length of operation > 3 h), and intensity of pain in immediate postoperative period, female sex was also implicated in causation [26].…”

<p>Preoperative Administration of Extended-Release Dinalbuphine Sebacate Compares with Morphine for Post-Laparoscopic Cholecystectomy Pain Management: A Randomized Study</p>

“… 7 In recent years, a significant effort has been made towards the identification of optimal combinations of medications for preoperative analgesia; these are widely used to facilitate postoperative outcomes following laparoscopic procedures. 8 , 9 As one example, 8 mg of dexamethasone provided significantly better pain relief when administered preoperatively rather than postoperatively. 10 Likewise, Wilson et al demonstrated that intramuscular diclofenac after laparoscopic cholecystectomy (LC) was effective in reducing postoperative pain.…”

Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: A meta-analysis of randomized controlled trials

“…However, intolerable postoperative pain is one of the most common and frustrating complications that arise for both patients and surgeons. Previous studies have found that postoperative pain after TKA can affect the early phase of rehabilitation and also the psychological state, which can delay patient discharge and early rehabilitation, and cause a heavy economic burden (1,2). Therefore, adequate pain management is very important to reduce morbidity and promote the recovery rate after TKA (3).…”