Chronic pain after surgery: how common is it?
Written by:
Published: 28/09/2020
Edited by: Laura Burgess
Pain is an expected outcome of surgery. Some pain is inevitable after any surgical procedure. However, some people experience more than expected and for a longer duration. Acute pain is a predictable, physiological response to tissue damage.
Pain after surgery is considered to be chronic if it lasts for longer than three months. In some cases, however, patients undergoing common surgical procedures report of chronic post-surgical pain , or CPSP, of varying severity at one year postoperatively. This article explains more.
How is chronic post-surgical pain (CPSP) defined?
A working definition of chronic postsurgical pain (CPSP) was proposed by Macrae and subsequently refined by Werner as:
How common is chronic post-surgical pain?
The incidence in major operations is quoted as 10 to 50 per cent and severe in 2 -10 per cent. In addition to the type of surgery, risk factors include having pre-operative pain, psychological factors, demographics (e.g. female gender and younger age), surgical factors (e.g. open approach and length >3 hours), and the intensity of pain in the immediate postoperative period (i.e. first few days). The identification of high-risk individuals is important because focused interventions may be beneficial to these patient populations.
How is CPSP diagnosed?
Patients first presenting with CPSP should undergo a thorough clinical assessment to confirm the suspected diagnosis and identify underlying mechanisms of pain. It's common, as tissue and a degree of nerve damage are unavoidable in any surgical procedure. CPSP can be expressed as a combination of different clinical types of pain, such as neuropathic, nociceptive, visceral and referred.
Nociceptive pain is from tissues. Neuropathic pain originates from nerves and is described as stabbing pain, skin irritation and sensitivity, numbness, tenderness, tightness and pulling sensations. Visceral comes from the internal organs. Referred pain, where pain from one part of the body is felt in a different location, is another type of pain which might be encountered.
In addition, the typical comorbidities of chronic pain often develop, such as sleeping and mood disorders. As is the case with other chronic pain syndromes, CPSP, once entrenched, maybe multifaceted and challenging to reverse.
How is CPSP treated?
Early postoperative follow-up and management are recommended for patients presenting with the first signs of new or recurrent pain. A targeted multidisciplinary approach to CPSP management is driven by the underlying mechanisms and the comorbidity of the pain and includes:
To minimise progression to a chronic state, early intervention and referral to a multidisciplinary pain clinic are advisable.
REFERENCES
Macrae WA. Br J Anae 2008;101:77–86,
Werner MU, Br J Anae
A. Althaus, Eur J Pain 16 (2012) 901–910
Kehlet H. Lancet 2006;367(9522):1618–25.
J Bruce. Rev Pain. 2011 Sep; 5(3): 23–29.
IASP fact sheets/support messages 2017
https://fpm.ac.uk/opioids-aware
If you experience chronic post-surgical pain, book an appointment with a Top Doctors pain management specialist here.