Chinese Association for the Study of Pain: Expert consensus on chronic postsurgical pain

Abstract

Chronic postsurgical pain is a common surgical complication that severely reduces a patient’s quality of life. Many perioperative interventions and management strategies have been developed for reducing and managing chronic postsurgical pain. Under the leadership of the Chinese Association for the Study of Pain, an editorial committee was formed for chronic postsurgical pain diagnosis and treatment by experts in relevant fields. The editorial committee composed the main content and framework of this consensus and established a working group. The working group conducted literature review (1989-2020) using key words such as “surgery”, “post-surgical”, “post-operative”, “pain”, “chronic”, and “persistent” in different databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews. Only publications in the English language were included. The types of literature included systematic reviews, randomized controlled studies, cohort studies and case reports. This consensus was written based on clinical practice combined with literature evidence. The first draft of the consensus was rigorously reviewed and edited by all the editorial committee experts before being finalized. The level of evidence was assessed by methodological experts based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The strength of recommendation was evaluated by all editorial committee experts, and the opinions of most experts were adopted as the final decision. The recommendation level “strong” generally refers to recommendations based on high-level evidence and consistency between clinical behavior and expected results. The recommendation level “weak” generally refers to the uncertainty between clinical behavior and expected results based on low-level evidence.

Development and validation of a nomogram to predict chronic postoperative pain in elderly orthopedic patients

“…According to the strength of action, we found that the risk factors for increasing CPSP in elderly orthopedic surgery patients were as follows: APSP (OR 8.151), preoperative pain at non-surgical site (OR 3.987), limb surgery (OR 3.260), preoperative pain at surgical site (OR (27)(28)(29); APSP occurring immediately after surgery is an important risk factor for the development of chronic pain and a key target of intervention measures to reduce the risk of CPSP (28). Buvanendran et al (29) found that APSP was still a risk factor for CPSP after total knee arthroplasty (TKA), even after adjusting for confounding variables such as pain mutation, anxiety, depression, and functional status.…”

Evaluation of the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for chronic pain after lower abdominal surgery

“…A mixture of local anesthetics and glucocorticoids is commonly used. Nerve blocks can stop the transmission of pain signals, inhibit neuroinflammation, and promote the recovery of neural functions (12).…”

Effect of Bilateral Quadratus Lumborum Block Type I on Patient Satisfaction and Incidence of Chronic Postsurgical Pain Following Cesarean Section-A Randomized Controlled Trial

“…The definition of CPSP involves postsurgical pain of more than 3-months duration that is new when compared to the preoperative status, and the cause is not secondary to an identifiable reason such as infection [28]. The most important risk factors for developing CPSP in parturients undergoing cesarean section are female gender, young adult age, and the severity and duration of acute postoperative pain [29]. The exact mechanism of CPSP is still under debate and no targeted treatment is available at this time [30].…”