Korean J Pain.  2018 Jul;31(3):155-173. 10.3344/kjp.2018.31.3.155.

Chronic postsurgical pain: current evidence for prevention and management

• Thapa P
• Euasobhon

• KMID: 2417954
• DOI: http://doi.org/10.3344/kjp.2018.31.3.155

Abstract

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

Keyword

Chronic pain; Drug therapy; Incidence; Intractable pain; Neuropathic pain; Operative surgical procedure; Pain management; Physical therapy modalities; Postoperative pain; Prevention; Therapeutic methods

MeSH Terms

Acetaminophen
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Antidepressive Agents
Botulinum Toxins
Calcium Channel Blockers
Capsaicin
Chronic Pain
Clonidine
Cognitive Therapy
Drug Therapy
Humans
Incidence
Ketamine
Lidocaine
Life Style
Nerve Block
Neuralgia
Pain Management
Pain, Intractable
Pain, Postoperative
Perioperative Period
Physical Therapy Modalities
Psychological Trauma
Risk Factors
Surgical Procedures, Operative
Transcutaneous Electric Nerve Stimulation
Acetaminophen
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Antidepressive Agents
Botulinum Toxins
Calcium Channel Blockers
Capsaicin
Clonidine
Ketamine
Lidocaine

Figure

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  Fig. 1 Step-by-step approach to the prevention of chronic postsurgical pain.

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