Evaluating the Association Between Acute and Chronic Pain After Surgery

Gilron, Ian; VanDenKerkhof, Elizabeth G.; Katz, Joel; Kehlet, Henrik; Carley, Meg

doi:10.1097/ajp.0000000000000443

Cited by 61 publications

(54 citation statements)

References 36 publications

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“…Also, recall of post‐operative pain and discomfort only slightly differed between patients with and without CPSP. The relationship between acute post‐operative pain and CPSP remains difficult to understand and today no causality link has been formally established . In summary, all these observations seem to point to individuals more prone to develop pain whatever its origin and the fact that CPSP is probably more often “individual‐related” than correlated to the degree of tissue injury caused by surgery.…”

Section: Discussionsupporting

confidence: 92%

Chronic post‐surgical pain after colon surgery in patients included in an enhanced recovery program

Lois

Lavand’homme

Diller³

et al. 2019

Acta Anaesthesiol Scand

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Background: Enhanced recovery after surgery (ERAS) program improves immediate recovery. Beyond immediate benefits, long-term impact of ERAS implementation is not yet evident. This retrospective single-center cohort study investigates prevalence and characteristics of chronic post-surgical pain (CPSP) in patients who underwent colon surgery. Methods:Two hundred and ninety-seven patients enrolled prospectively in our ERAS database were contacted by mail to question the presence of CPSP. In case of CPSP, intensity, location, and type of pain, impact of pain on quality of life and treatment taken were assessed. Post-operative pain experience during hospital stay, recall of pain, and discomfort duration when back home were assessed in all patients.Comparison between patients with and without CPSP was made to approach the risk factors of CPSP in this population. Results:At 27 months after colon surgery, 25/198 patients reported CPSP (12.6%) and pain was severe in 5 patients (2.5%). CPSP had a deep abdominal component in 56% of patients and a parietal component in 20% of patients. Patients with CPSP+ differed from patients CPSP− for pre-operative pain presence (56% vs 24.8%, P = 0.004), recalled post-operative pain intensity (4 vs 3, P = 0.045), duration of discomfort after discharge (2 vs 1 weeks, P = 0.035). Pre-operative pain was found as a significant CPSP risk factor (odds ratio 1.34; 95% CI: 1.05-1.70).Conclusion: CPSP prevalence after laparoscopic colon surgery seems not much affected by ERAS context. Pre-operative presence of pain emerged as an important risk factor. These findings should be confirmed in a prospective multicenter study.

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Section: Discussionsupporting

confidence: 92%

Chronic post‐surgical pain after colon surgery in patients included in an enhanced recovery program

Lois

Lavand’homme

Diller³

et al. 2019

Acta Anaesthesiol Scand

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“…The results suggest that one reason for the variability in the observed association between acute pain and CPOP in the literature may be the method of measurement of acute pain (i.e. at rest versus after movement) 8 . The remaining recent studies on the incidence and risk factors for CPOP examine specific surgical procedures.…”

Section: Incidence and Risk Factorsmentioning

confidence: 88%

“…urology, general, plastic, and orthopedic), preoperative pain, preoperative analgesic use, acute postoperative pain, surgical fear, lack of optimism, and poor preoperative quality of life 7 . A 2017 analysis of prior studies examined the association between acute pain intensity and CPOP following a number of different surgeries 8 . The results suggest that one reason for the variability in the observed association between acute pain and CPOP in the literature may be the method of measurement of acute pain (i.e.…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Chronic postoperative pain: recent findings in understanding and management

Correll

2017

F1000Res

112

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Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

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“…Most CPSP syndromes, namely, post-thoracotomy, postamputation and postmastectomy, could be classified as belonging to model 1 of acute hyperalgesia and neuropathic involvement (pronociceptive; Eipe et al, 2015). This model of CPSP is basically related to the severity and duration of Day 7 9.7 ± 3.9 0 acute postoperative pain (pain predicts pain; Fletcher et al, 2015;Gilron, Vandenkerkhof, Katz, Kehlet, & Carley, 2017;Wang, Guyatt, & Kennedy, 2016). In the current study, pain was managed properly during the first postsurgical week (VAS <40 mm) to reduce dorsal root ganglia hyperexcitability (DRG neuroplasticity extends up to 5-6 days) (Wilder-Smith, Tassonyi, Crul, & Arendt-Nielsen, 2002).…”

Section: Discussionmentioning

confidence: 99%

The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study

Reyad

Shaker

Ghobrial

et al. 2019

European Journal of Pain

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Objective The aim of this randomized controlled trial was to evaluate U/S guided serratus anterior plane catheter block (SAPB) versus patient‐controlled analgesia (PCA) on the emergence of post‐thoracotomy pain syndrome (PTPS) after thoracotomies for thoracic tumours. Methods This trial included 89 patients with chest malignancies, scheduled for thoracotomy were randomly allocated into two groups: Group A "PCA–group N=44" receiving patient‐controlled analgesia and group B "SAPB group N=45" where analgesia was provided by SAPB. The primary outcome measure was the assessment for the possible emergence of PTPS at 12 weeks. The secondary outcome measures were pain relief measured using visual analog scale (VAS) score, Quality of life was assessed using Flanagan Quality of Life Scale (QOLS) and Activity level was assessed using Barthel Activity of daily living (ADL) score. Results At week 8, PTPS incidence was significantly (p = .037) higher in the PCA group (45%) than in the SAPB group (24%) with a relative risk of 1.38 and 95% CI (1.01–1.9) while the incidence of PTPS at week 12 was significantly (p = .035) higher in the PCA group (43%) than in the SAPB group (22%) with a relative risk of 2.38 and 95% CI (1.23–4.57). The need for pain therapy in PTPS patients was significantly lower in the SAPB group (17.7%) than the PCA group (38.6%) (p = .028) at week 12. Pain intensity: VAS‐R and VAS‐D (pain scores at rest and with activity, respectively) was comparable (p > .05) between both groups at 6, 12, 18 and 24 hr, however VAS was significantly higher in the PCA group at week 8 (p = .046) and week 12 (p = .032) . Both groups were comparable regarding ADL and QOL scores (p > .05). Conclusion Serratus anterior plane block is assumed to be a good alternative for post‐thoracotomy analgesia following thoracotomies. The current work hypothesized that SAPB for a week postoperatively, may reduce the emergence of PTPS and may reduce the demand for pain therapy in those patients. Significance statement The current work hypothesized that SAPB for a week postoperatively, is a good loco‐regional alternative for post‐thoracotomy analgesia following thoracotomies for chest malignancies, it may reduce the emergence of PTPS and the demand for pain therapy in these patients.

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Evaluating the Association Between Acute and Chronic Pain After Surgery

Cited by 61 publications

References 36 publications

Chronic post‐surgical pain after colon surgery in patients included in an enhanced recovery program

Chronic post‐surgical pain after colon surgery in patients included in an enhanced recovery program

Chronic postoperative pain: recent findings in understanding and management

The impact of ultrasound‐guided continuous serratus anterior plane block versus intravenous patient‐controlled analgesia on the incidence and severity of post‐thoracotomy pain syndrome: A randomized, controlled study

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