The Transition from Acute to Chronic Post Surgical Pain

Abstract

All chronic pain was once acute, but not all acute pain becomes chronic. The transition of acute postoperative pain to chronic post surgical pain is a complex and poorly understood developmental process. The manuscript describes the various factors associated with the transition from acute to chronic pain. The preoperative, intraoperative and postoperative surgical, psychosocial, socio-environmental and patient-related factors and the mechanisms involved are discussed and preventive (or limitation) strategies are suggested. In future, the increasing understanding of genetic factors and the transitional mechanisms involved may reveal important clues to predict which patients will go on to develop chronic pain. This may assist the development of appropriate interventions affecting not only the individual concerned, but also ultimately the community at large.

A Review of the Literature on Multiple Factors Involved in Postoperative Pain Course and Duration

“…2,7,9,10,[12][13][14][15] It has been proposed that an increasing recognition of the contribution of these variables in the development of chronic pain may reflect a shift from a strictly biomedical model for understanding pain to a model in which pain is seen as a product of an interaction between biological and psychosocial variables. 7 For example, in a study of 70 amputees, overly solicitous behavior on the part of a significant other after an amputation (eg, excusing them from a task in response to a pain complaint) reinforced pain behaviors and was associated with diminished functioning at 2 years, whereas adequate but less solicitous social support was associated with improved functioning.…”

“…Downloaded by [Nanyang Technological University] at 07: 25 25 August 2015 Procedure-Specific Characteristics Predisposing to Chronic Pain Surgical risk factors related to the progression to chronic postoperative pain include the extent of surgery, the surgical site, and the incision type. 2,10,14 For example, pain after routine dental surgery is less likely to progress to chronic pain than pain after more complex surgeries that may carry a higher risk of trauma or nerve injury. 2,10,14 A cross-sectional, populationbased survey of 12 982 Norwegian patients who had undergone surgery $ 3 months previously found that 40.4% of respondents reported chronic postoperative pain, including 18.3% reporting pain of moderate or severe intensity.…”

“…Previous literature reviews found that postoperative pain progresses to chronic pain in 10% of patients after inguinal hernia repair or cesarean delivery, in 20% to 30% after breast surgery, in 30% to 40% after thoracotomy, and in 30% to 50% after amputation or coronary artery bypass surgery. 2,7 Pain Characteristics as a Mark of the Type of Chronic Pain Type of pain is an important determinant of whether the patient will develop chronic pain. For example, sensory abnormalities such as hyperesthesia and hypoesthesia may indicate that the patient had preexisting neuropathic pain before the procedure or developed neuropathic pain consequent to the procedure.…”

The link between acute postoperative pain and chronic pain syndromes

“…There are many risk factors for CPSP 5 , and an awareness of these provides a focus for intervention and preventive strategies. Some risk factors cannot be changed, for example age or genetic make-up, but provide avenues for research into the cause of CPSP.…”

“…Some patients are genetically less sensitive to analgesics, or are extremely fast metabolisers of analgesics [opioids and nonsteroidal anti-inflammatory drugs (NSAIDs)], and need a different dosage regimen to reach therapeutic levels. 5 Older patients tend to have a lower incidence of CPSP than younger adults, but children experience less CPSP than adults, 7 probably because of the relative immaturity of the child's nervous system. 8 Some patients are born more sensitive to pain, and are more likely to have CPSP.…”