Preventing and treating chronic disabling pain after surgery

ABSTRACT

Chronic postoperative pain (CPP) is an important health problem. This is a narrative review of etiologies, mechanisms, risk factors, means of reducing the risk, and treatment of chronic postoperative pain. Methods: This is a topical review based on a focused literature review and personal clinical experience and research efforts on chronic pain after surgical interventions. Results: CPP is defined as new pain in the area of surgery that lasts more than 3-6 months after the operation, is clearly related to tissue and nerve injuries during the operation and cannot be explained by other etiologies. The overall prevalence is that 20-40 percent have some pain and discomfort for a few weeks, 10 percent have moderate pain that cannot be neglected for a few months, about 1 percent develop debilitating CPP. CPP is caused by nerve and tissue injury and abnormal reactions to such injury. Only those who have pre and peri-operative risk factors determined in part by genetic makeup, reinforced by abnormal pain modulating mechanisms, having chronic pain in other part(s) of the body, having psychological stress factors andc atastrophizing thoughts and anxiety, having severe acute pain during and immediately after surgery, chemotherapy or radiation after cancer surgery, and being younger rather than elderly. Risks of CPP can be estimated by a simple scoring system with approximate risk prediction determined by the number and degree of preoperative risk factors. A number of procedures and drugs can ameliorate these risk factors Regional and local anesthetic techniques when appropriate, anti-hyperalgesic drugs with nitrous Introduction Long-lasting new pain after an operation is a common, sometimes a debilitating consequence of surgery. We know some factors that increase the risk of developing chronic postoperative pain (CPP). The patients’ GP, surgeon, and anesthesiologist must focus on these risks and prioritize efforts to reduce their effects...