Developmental mechanisms of CPSP: Clinical observations and translational laboratory evaluations

Abstract

Understanding mechanisms that underly the transition from acute to chronic pain and identifying potential targets for preventing or minimizing this progression have specific relevance for chronic postsurgical pain (CPSP). Though it is clear that multiple psychosocial, family, and environmental factors may influence CPSP, this review will focus on parallels between clinical observations and translational laboratory studies investigating the acute and long-term effects of surgical injury on nociceptive pathways. This includes data related to alterations in sensitivity at different points along nociceptive pathways from the periphery to the brain; age- and sex-dependent mechanisms underlying the transition from acute to persistent pain; potential targets for preventive interventions; and the impact of prior surgical injury. Ongoing preclinical studies evaluating age- and sex-dependent mechanisms will also inform comparative efficacy and preclinical safety assessments of potential preventive pharmacological interventions aimed at reducing the risk of CPSP. In future clinical studies, more detailed and longitudinal peri-operative phenotyping with patient- and parent-reported chronic pain core outcomes, alongside more specialized evaluations of somatosensory function, modulation, and circuitry, may enhance understanding of individual variability in postsurgical pain trajectories and improve recognition and management of CPSP.

Efficacy of paracetamol and mannitol injection in managing chronic post-thoracotomy pain following lung cancer surgery: Study protocol for a single center, prospective, randomized, double-blind, and controlled trial

“…Some scholars have reported that the probability of CPSP at 3 and 6 months after traditional open thoracic surgery is about 57% and 47%, respectively, and although minimally invasive surgery can reduce the surgical incision and relieve postoperative acute pain, CPSP is still one of the most signi cant complications [23,24]. The onset of CPSP may be related to a series of anatomical, physiological, and biochemical changes but the exact mechanism is still unclear [25]. The de nition of CPSP is based on the healing time of normal tissues (3 months), but this time frame is somewhat random, likely because the time of tissue healing varies greatly among different individuals and is affected by various systemic and local factors, surgical procedures, and anesthesia.…”

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

“…Understanding the proposed mechanisms that underly the transition from acute to chronic pain states is necessary to identify potential targets to prevent or minimize persistent pain. 30,31 There are a number of relevant publications that • Anxiety sensitivity 9,[18][19][20][21][22] • Perception of pain unpleasantness 17,19,21 • Fear of pain 23 • Fear of re-injury 23 • Poor coping strategies 24 • Depressive symptoms 15,25 • Tendency to catastrophize 3,16,[18][19][20]24,26 • Sleep quality 15,23…”

“…• Surgery Type a. General Orthopedic 3,11,15,28 (2-54% prevalence) b. Spinal Fusion 9,18 (11-54% prevalence) c. Thoracotomy 29,30 (2-28% prevalence) d. Inguinal Hernia 28,31 (2-9% prevalence) e. Urologic 28…”

“…describe the known pathophysiology associated with persistent postoperative pain and the transition from acute to chronic pain after surgery (Figure 1). 28,31,36 However, as we review in this section, there are substantial knowledge deficits in our mechanistic understanding of CPSP in children. Proteins: There is increasing evidence that chronic pain is a neuroinflammatory disorder with pathophysiology involving a complex interplay between the nervous and immune systems.…”

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

“…For an overview over the latest studies describing associations of factors and development of CPSP, refer to Tables 1 and 2. Additionally to these recently published studies, the bio-molecular mechanisms of the transition from acute to CPSP are described in three comprehensive reviews 6,95,96▪▪ . This review focuses on adults; for comprehensive reviews on children and adolescents, see refs 96▪▪–99▪ .…”