Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Abstract

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week.

Axotomy of tributaries of the pelvic and pudendal nerves induces changes in the neurochemistry of mouse dorsal root ganglion neurons and the spinal cord

“…This is suggested by observations in patients reporting chronic postsurgical pain after gastrointestinal surgery not only at, or near, the operative site, but also in the central or lower abdominal area (deep pain) (Bruce and Krukowski 2006). Further supporting altered visceral afferent processing, it was observed that visceral pain, but not incisional and referred pain, during the first week after laparoscopic cholecystectomy is associated with chronic unexplained pain of more than 12 months duration (Blichfeldt-Eckhardt et al 2014). Finally, neuropathic pain associated with the incisional scar, as well as visceral pain traits reflected by presence of deep abdominal and pelvic pain (often related to uterine contractions), have been suggested to develop and even coexist in patients undergoing obstetric interventions (Landau et al 2013; Lavand’homme 2013).…”

Consistency of postoperative pain assessments between nurses and patients undergoing enhanced recovery after gynaecological surgery

“…We found that the main pain areas after gynaecological laparoscopy from 4 hr after surgery to POD1 and POD2 were surgical area pain in the abdominal cavity and abdominal incision pain (Table ). Blichfeldt‐Eckhardt et al also came to the same conclusion (Blichfeldt‐Eckhardt, Ording, Andersen, Licht, & Toft, ). They assessed the pain of 100 laparoscopic cholecystectomy patients during the first postoperative week, and the results indicated abdominal incision pain and surgical area pain in the abdominal cavity were most reported pain areas.…”

Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition

“…Hyperalgesia in the postoperative period is likely to be expressed as increased pain experience, which we found for both VAS at rest and on movement. A significant relationship between early postoperative pain and persistent pain has previously been reported for breast cancer surgery [13] and other interventions including cholecystectomy [8, 9], groin hernia repair [10] and thoracic surgery [12]. …”