Chronic Pain Following Abdominal Free Flap Breast Reconstruction

Abstract

Factors contributing to chronic pain continue to be elusive and understudied. Our data demonstrate the importance of screening for chronic pain, as we determined that preoperative pain is linked to increased, moderately debilitating postoperative chronic pain. Persistent chronic pain, in turn, is associated with significant morbidity, disability, and dissatisfaction. Such patients with pain issues may benefit from additional preoperative counseling and early involvement of the pain service.

Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction

“…Comparative studies on the risk of CPSP following TE/I and AFR reconstructive surgeries have produced mixed findings demonstrating greater postoperative pain with TE/I compared to breast reconstruction without implants, 14 equivocal evidence for increased pain with TE/I reconstruction, 15 more pain following AFR surgery compared to TE/I reconstruction, 12 or no differences in the severity of persistent postoperative pain between the two procedure types. 7,10,11 One explanation for this lack of agreement among previous studies may be that relative differences in postoperative pain among procedure types may evolve over time. This has been the observation in our own study population.…”

Is Enhanced Recovery the New Standard of Care in Microsurgical Breast Reconstruction?

“…The introduction of muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap and deep inferior epigastric perforator (DIEP) reconstruction has significantly contributed to improved patient outcomes. However, opioid-related adverse drug events, such as nausea and constipation, continue to be a problem in the postoperative setting for patients with breast cancer (1, 2). Recently, there has been an increased focus on using enhanced recovery pathways (ERPs) in reconstructive breast surgery to further improve outcomes, such as early mobilization, optimization of pain control, and earlier hospital discharge (3–5).…”

Chronic Postsurgical Pain Outcomes in Breast Reconstruction Patients Receiving Perioperative Transversus Abdominis Plane Catheters at the Donor Site: A Prospective Cohort Follow‐up Study

“…Nelson et al . found that development of CPSP after mastectomy and reconstruction after 4 months was associated with the incidence of preoperative pain.…”

“…found that development of CPSP after mastectomy and reconstruction after 4 months was associated with the incidence of preoperative pain. Higher preoperative pain scores, lower mental health, and poor physical health scores at baseline were associated with the development of CPSP . Other variables such as laterality, timing of procedure, or type of flap used were not significantly associated with the development of CPSP.…”