Risk Factors for Acute Postsurgical Pain: A Narrative Review

Abstract

Acute postsurgical pain (APSP) has received growing attention as a surgical outcome. When poorly controlled, APSP can affect short-and long-term outcomes in patients. Despite the steady increase in awareness about postoperative pain and standardization of pain prevention and treatment strategies, moderate-to-severe APSP is frequently reported in clinical practice. This is possibly because pain varies widely among individuals and is influenced by distinct factors, such as demographic, perioperative, psychological, and genetic factors. This review investigates the risk factors for APSP, including gender, age, obesity, smoking history, preoperative pain history, pain sensitivity, preoperative anxiety, depression, pain catastrophizing, expected postoperative pain, surgical fear, and genetic polymorphisms. By identifying patients having an increased risk of moderate-to-severe APSP at an early stage, clinicians can more effectively manage individualized analgesic treatment protocols with a combination of pharmacological and nonpharmacological interventions. This would alleviate the transition from APSP to chronic pain and reduce the severity of APSPinduced chronic physical disability and social psychological distress. Keywords: acute postoperative pain, acute postsurgical pain, risk factors, predictors which 86% reported moderate, severe, or extreme pain. 8 When poorly controlled, APSP can prolong hospital stay, increase opioid use, and contribute to health care costs. 9,10 Additionally, APSP is correlated with poor prognosis including postoperative delirium, cardiovascular events, thromboembolism, pulmonary complications, and chronic pain syndrome. [11][12][13][14][15] Although the interest in APSP is growing in the recent decades, effective pain management is a clinical challenge. 8,16 Identifying patients with high APSP-related risk factors on the basis of individual differences in patients' social, psychological, and genetic factors is essential for the early prevention and individualized treatment of APSP.APSP-related risk factors vary according to the surgery type. Ip et al 17 were the first to systematically review APSP predictors. They found that preoperative pain, anxiety, age, and surgery type were the four most significant predictors of APSP. Sobol-Kwapinska et al 18 reviewed APSP-related psychological factors and noted the probable association between APSP and anxiety, pain catastrophizing, expectation of pain, and depression. On conducting a systematic review of literature on pain sensitivity for predicting APSP, Werner et al 19 observed that the predictive strength of pain sensitivity is