Prevention and Treatment of Chronic Postsurgical Pain: A Narrative Review

Abstract

Chronic postsurgical pain affects between 5 and 75% of patients, often with an adverse impact on quality of life. While the transition of acute to chronic pain is a complex process-involving multiple mechanisms at different levels-the current strategies for prevention have primarily been restricted to perioperative pharmacological interventions. In the present paper, we first present an up-to-date narrative literature review of these interventions. In the second section, we develop several ways by which we could overcome the limitations of the current approaches and enhance the outcome of our surgical patients, including the better identification of individual risk factors, tailoring treatment to individual patients, and improved acute and subacute pain evaluation and management. The third and final section covers the treatment of established CPSP. Given that evidence for the current therapeutic options is limited, we need high-quality trials studying multimodal interventions matched to pain characteristics.

Multimodal Anesthesia via Opioid-Free Analgesia and Erector Spinae Plane Block

“…Opioid-free analgesia (OFA) has evolved in the last two decades [24,25], with the highest rates of use in patient groups with high rates of or higher risk of opioid side effects. ese patient groups may include patients with morbid obesity, sleep apnea syndrome, history of hyperalgesia, complex pain, or fibromyalgia syndromes or patients with opioid addiction [4,[26][27][28]. However, OFA use beyond laparoscopic surgery remains limited in our practice.…”

Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service

“…Type of surgery has long been recognized as a major risk factor for CPSP, with surgeries that involve deliberate or inadvertent damage to nerves showing the highest prevalence, 17,19 though not all CPSP is neuropathic. 30 The most robust risk factor for CPSP is pain itself. 19,31 The data clearly show that the presence 32 and intensity of preoperative chronic pain, 6,[33][34][35] the intensity of acute postoperative pain, 6,23,32,33,36 the time spent in severe pain after surgery, 6 pain intensity in the weeks after surgery, 35,37,38 and pain in other body parts 32,34,39 reliably predict CPSP across a range of surgical procedures.…”

Chronic pain and central sensitization in immuno-inflammatory rheumatic diseases: pathogenesis, clinical manifestations, the possibility of using targeted disease modifying antirheumatic drugs

“…Обсуждая факторы, влияющие на развитие ЦС при РА и ПсА, нельзя не уделить внимание малоизученному вопросу индивидуального восприятия боли. Боль -весьма субъективное ощущение, оценка которого зависит не только от степени повреждения ткани, но и от психоэмоциональных особенностей человека, вариантов болевой чувствительности (которая, в частности, связана с наличием отдельных вариантов и выраженности экспрессии генов, отвечающих за синтез и метаболизм нейромедиаторов), воспитания, а также своевременности и качества обезболивания на ранних стадиях заболевания [73,74]. Так, J. Clark и соавт.…”