Predictors and Patterns of Chronic Pain Three Months after Cardiac Surgery in Taiwan

Abstract

Patients reporting a pattern of increasing pain starting about 10 days after surgery and holding negative beliefs about opioid use are at risk of developing chronic pain and may require more careful monitoring and pain treatment. The possible benefits of interventions that minimize pain during the weeks after surgery and that alter negative beliefs about opioid use should be examined in future research.

Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study

“…As reported in previous studies, 9,17,19,21,25,35 we found no significant association between the type of surgery (CABG or valve replacement, or both) and persistent postoperative pain. However, we found that the longer the surgery lasted, the less likely patients were to report any persistent postoperative pain.…”

“…Results at earlier follow-up points are consistent with those reported in several prospective studies of shorter duration among cardiac surgery patients. 9,13,14,20,21,25 These prevalence rates are not negligible given that more than 400 000 patients undergo CABG annually in the United States 4 and that persistent postoperative pain affects patients' health-related quality of life. [7][8][9]19 The risk of persistent postoperative pain should be discussed with patients during preoperative counselling and perhaps included in informed consent for surgery.…”

“…13,14,21,22,25 All of the above studies were carried out in a single hospital and included relatively small samples. None of the studies examined the contribution of psychological factors such as levels of anxiety and depression before cardiac surgery, although these factors have been shown to influence acute or persistent postoperative pain in other types of surgery.…”

“…Also, the follow-up was 24 months after surgery, as compared with 12 months or less in earlier studies. 9,14,25 Detailed neurophysiological examinations and quantitative sensory testing were not performed to assess the presence of sensory abnormalities in the area of surgery (e.g., hyperesthesia, hypoesthesia) in the pre-and postoperative periods. Therefore, we were unable to evaluate the potential role of altered pain processing due to intraoperative nerve injury or to some general predispositional factors in the development of persistent postoperative pain.…”

“…[1][2][3]24 Few prospective cohort studies have examined the exact time course of persistent postoperative pain after cardiac surgery, and follow-up has always been limited to a year or less. 9,14,25 Factors that put patients at risk of this type of problem are poorly understood. 26 Studies have reported inconsistent results regarding the contribution of age, sex, body mass index, preoperative angina, surgical technique, grafting site, postoperative complications or level of opioid consumption after surgery.…”