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Anesthesiology:
Review Articles

Chronic Pain as an Outcome of Surgery: A Review of Predictive Factors

Perkins, Frederick M. M.D.*; Kehlet, Henrik M.D., Ph.D.†

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ONE potential adverse outcome from surgery is chronic pain. Analysis of predictive and pathologic factors is important to develop rational strategies to prevent this problem. Additionally, the natural history of patients with and without persistent pain after surgery provides an opportunity to improve the understanding of the physiology and psychology of chronic pain.
Ideally, studies of chronic postoperative pain should include (1) sufficient preoperative data (assessment of pain, physiologic and psychologic risk factors for chronic pain); (2) detailed descriptions of the operative approaches used (location and length of incisions, handling of nerves and muscles); (3) the intensity and character of acute postoperative pain and its management; and (4) follow-up at intervals to 1 yr or more. In addition, there would be information about postoperative interventions that may influence pain, such as radiation therapy or chemotherapy. At long-term follow-up visits, patient function, physical signs, and symptoms would be evaluated using a standardized algorithm, including quantitative and descriptive pain assessments. We found no studies that contain all of these data.
For this review, we specifically sought population data that reflect the incidence of chronic postoperative pain or predictors (medical, physiologic, and psychologic) of chronic pain. We selected five groups of surgeries (limb amputations, breast surgery, gallbladder surgery, lung surgery, and inguinal hernia surgery). These surgeries were selected because the incidence of pain is known to be high, thus improving the probability of detecting predictive factors. They also represent a range of major surgical procedures.
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Methods

We performed a computerized search of the medical literature using the OVID search engine (OVID Technologies, Wolters Kluwer, Amsterdam, The Netherlands). The search was performed on the entire database in January 1999 and covered 1966 through most of 1998. Additional articles published during the review process have also been included. Terms were used in their “exploded” format. The term “pain” was combined with the other appropriate term (e.g., “cholecystectomy”); also the text words associated with the pain syndromes were searched, resulting in more than 1,700 citations. Letters to the editor were not reviewed. Additionally, articles known to the authors but not found in the search were used. If the article contained data about persistent pain (12 weeks or more after surgery), it was considered for inclusion in this review. To calculate the incidence of pain, we used the number of individuals responding at the time the chronic pain data was gathered, and only used data from articles in which the methods section indicated that there was systematic collection of long-term pain information from patients. Studies of fewer than 50 patients were excluded in the incidence data analysis for breast surgery, gallbladder surgery, and lung surgery. Studies of fewer than 100 patients were excluded from the data analysis for inguinal hernia surgery. Amputation studies of 25 subjects or more were included because of the higher incidence of chronic pain.
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Results

Limb Amputation
Pain Incidence.
Table 1
Table 1
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The reported incidence of phantom limb pain varies from 30 to 81% (table 1). Finch et al. 1 reported pain in 30% of 57 long-term survivors of amputation for vascular insufficiency. Fisher and Hanspal 2 described 93 consecutive amputees referred to a prosthetic rehabilitation clinic; therefore, selection bias may be a factor. The remainder of the studies (table 1) report an incidence of phantom limb pain of more than 50%. Sherman et al.3 noted at least a 78% incidence of phantom limb pain, and perhaps as high as 85%; however, their questionnaire response rate was not high (55%). Stump pain was noted in 66% of patients with phantom pain and in half of those without phantom pain; therefore, the overall stump pain incidence exceeds 60%. Wartan et al. 4 reported a 62% incidence of phantom limb pain and 63% for stump pain. Similar to Sherman et al., 66% of patients with phantom limb pain also have stump pain.
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Preoperative Factors:
Smith and Thompson 5 reported that pain was more common after amputation for cancer than for trauma, but this study was a chart review (phantom pain noted in medical record), and there were only eight amputations for trauma. No large studies systematically evaluate the incidence of phantom limb pain after trauma, vascular disease, and cancer-related surgeries. The presence of intense preoperative pain in the extremity increases the probability of phantom limb pain (from 33 to 72% at 3 months). 6,7 Some early reports 8,9 indicated that the incidence of phantom limb pain decreased with prolonged (72 h) preoperative epidural pain control, followed by postoperative epidural pain control. Both studies were small (23 and 24 patients, respectively at 6 months follow-up), and neither was properly randomized. In a subsequent randomized controlled study, 10 this observation was not confirmed, but preoperative pain control was limited to 18 h, and the extent and intensity of perioperative blockade was not sufficient to control pain without supplemental systemic opioids.
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Intraoperative Factors.
The effect of anesthesia (epidural, spinal, or general) alone has not been studied. Surgical handling of the major nerves is rarely mentioned, so we cannot assess the effect of nerve ligation or clipping versus section alone.
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Postoperative Factors.
Administration of chemotherapy increases the incidence of phantom limb pain. 5 Stump pain at 1 week is significantly associated with phantom pain at 1 week, 6 and long-term stump pain predicts long-term phantom limb pain. 3 There is also a correlation between nonpainful phantom sensations and phantom pain. 4 Control of acute postoperative pain with nerve sheath infusion of local anesthetic decreased the incidence of phantom limb pain in one series of 11 patients, 11 but a subsequent randomized controlled trial (n = 14 at long term follow-up) 12 failed to confirm this finding. Both of these studies are small, and the negative study 12 does not have the statistical power to conclude that there is no significant effect. There has also been a negative retrospective report of this technique (n = 21). 13 As mentioned previously, data regarding epidural analgesia 8–10 as a method to decrease the incidence of phantom limb pain conflict.
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Apparent Etiology.
Most authorities believe that phantom limb sensation and phantom limb pain are central phenomena and explain them using the neuromatrix theory expounded by Melzack. 14,15 That is, there is a matrix in the central nervous system for the perception of a body part, and this matrix exists even when the body part does not. Sherman et al. 3 emphasized that multiple etiologies may lead to phantom limb pain, based on the inconsistency of therapeutic responses.
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Progression.
The incidence of phantom limb pain decreases during the first year after amputation, as does the frequency of painful episodes 7,16; however, about half the individuals with long-term phantom pain report no decrease in the intensity of this pain. 3
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Section Summary.
Phantom limb pain is common after extremity amputation, and documented predictors of this pain include preamputation pain and persistent stump pain (acute and chronic). No conclusive studies have evaluated the effect of acute or subacute stump pain control on long-term stump pain or on long-term phantom limb pain. Also no psychologic studies have evaluated patients before amputation for predictors of chronic pain.
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Thoracotomy
Pain Incidence.
Table 2
Table 2
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Long-term pain after thoracotomy, the postthoracotomy pain syndrome (PTPS), may have an incidence of more than 50%. 17,18 Six studies met our inclusion–exclusion criteria (table 2), assessing 878 patients, of whom 417 (47%) had PTPS.
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Preoperative Factors.
Katz et al. 2 could not predict PTPS from preoperative psychologic testing (state or trait anxiety, depression inventory) or preoperative pain sensitivity as determined by pressure algometry. This study (n = 23) was the extension of a previous acute pain study; it therefore lacks statistical power and may be subject to selection bias. Perttunen et al. 19 noted the presence of preoperative pain in 17% of their patients but did not analyze it as an independent risk factor.
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Intraoperative Factors.
Several recent case series report that video-assisted thoracoscopic lung surgery (VATS) is associated with a low incidence of PTPS. Walker et al. 20 reported only 1 case of 83 (1.2%), and Mouroux et al. 21 noted a 3% incidence of PTPS, but neither group reports systematically looking for PTPS. In a large retrospective survey, Landreneau et al. 22 (table 2) noted a lower incidence of pain in patients who had VATS compared with those who underwent lateral thoracotomy (30 vs. 44%); however, pain medication requirements did not differ. The difference in pain incidence was statistically significant only during the first year after surgery. In a small (n = 30), nonrandomized prospective study, Furreret al.23 found a 36% incidence of PTPS in patients undergoing VATS wedge resection, and a 33% incidence of PTPS in a matched group of patients undergoing lobectomy by a classic posterolateral thoracotomy. However, the results are confounded because the thoracotomy group received thoracic epidural analgesia with local anesthetic and opioid, whereas the thoracoscopic group received intravenous patient-controlled opioids. Nomori et al.24 retrospectively and Benedetti et al.25 prospectively (case series) reported a decreased severity of chronic pain after anterolateral thoracotomy when compared with classic posterolateral thoracotomy (mean visual analog scale [VAS] score, 6 of 100 vs. 21 of 100). Both studies were small (24 and 42 patients), and chronic postoperative pain was not a primary outcome parameter. In descriptions of the surgical technique for posterolateral thoracotomy, details about whether a rib was resected or about how the intercostal nerves were handled were missing from most reports.
A recent report by Obata et al. 26 (table 2) found a significant effect of intraoperative plus postoperative epidural analgesia when compared with just postoperative epidural analgesia (decreasing the incidence of pain at 6 months from 67% to 33%). This is a prospective, randomized, single-blind study.
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Postoperative Factors.
The intensity of acute postoperative pain is a statistically significant predictor 18,27 of PTPS (36 vs. 56% PTPS for minor vs. moderate to severe acute pain). As mentioned previously herein, the combination of intraoperative plus postoperative epidural analgesia with local anesthetic was associated with a decreased incidence of pain at 6 months. An attempt at preemptive analgesia 28 had not improved analgesia on long-term follow-up. 18 Another small study found that the type of postoperative analgesia affected the incidence of pain at 12 weeks (less pain with epidural analgesia or intercostal nerve cryoablation), but data of only 33 subjects divided among four treatment regimens were reported. 29 Benedetti et al.25,30 showed that intercostal nerve dysfunction (loss of the superficial abdominal reflex) is associated with more acute, subacute, and chronic (3 months) pain. Of 23 patients with intact reflexes on postoperative day 1, none had pain at 2 to 3 months, whereas 50% of individuals with persistent loss of the reflex still had pain at this time.
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Apparent Etiology.
The etiology of PTPS may depend on nerve damage because it is more severe after chest wall resection, 31–33 and the loss of superficial abdominal reflexes is associated with an increased probability of PTPS. 25,30 Another contributing factor is recurrence of tumor. 31
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Progression.
For thoracoscopic surgeries and posterolateral thoracotomy, Landreneau et al. 22 noted a 30% decrease in the incidence in pain reported by patients more than 12 months after surgery compared with those 3–12 months after surgery. The prospective study by Perttunen et al. 19 noted the incidence of pain at 3, 6, and 12 months to be decreasing (80, 75, and 61%, respectively). Of patients with long-term pain after thoracotomy, up to half describe their pain as moderate or severe, 18 and 66% are prescribed analgesics for the pain. 27
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Section Summary.
Postthoracotomy pain syndrome is common. The predictors of this syndrome (when tumor recurrence is excluded) include the extent of acute postoperative pain and intercostal nerve dysfunction (which may link more acute pain and persistent pain). One prospective, randomized controlled study 28 found that the combination of intraoperative plus postoperative thoracic epidural analgesia decreases the incidence of PTPS at 6 months.
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Breast Surgery
Incidence.
Table 3
Table 3
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Table 3 summarizes various studies of pain after breast surgery. Women who undergo breast surgery experience chest wall, breast, or scar pain (range, 11–57%), phantom breast pain (13–24%), and arm and shoulder pain (12–51%). The incidence of pain in one or more of these sites is close to 50% 1 yr after breast surgery for cancer. The postmastectomy pain syndrome (PMPS) has recently been reviewed, 34 with some disagreement about which pains to include in this syndrome. Husted et al. 35 documented that, of 163 women who had undergone mastectomy with axillary node dissection, 45% reported cicatrix pain, 45% reported arm, neck, or shoulder pain, and only 21% were symptom free (symptoms included pain, paresthesia, lymphedema, and impaired shoulder function) 1–5 yr after surgery. Moderate to severe pain was reported by 16 patients (10%).
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Preoperative Factors.
Krøner et al. 36 reported a significant relation between preoperative breast pain and postoperative phantom breast pain in a prospective study of 120 patients. In contrast, Tasmuth et al.,37,38 in a prospective study of 93 patients, did not find the presence of preoperative pain to be a predictive factor, but only 9 patients had pain before surgery. Preoperative depression and anxiety were more common in patients in whom chronic pain developed when compared with those in whom chronic pain did not develop, although statistical significance was not achieved. 37
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Intraoperative Factors.
The type of surgery may affect the incidence of pain. Tasmuth et al.39 found that chronic pain was more common after breast conserving surgery than after radical surgery in their large retrospective study, but did not confirm this in smaller prospective studies. 37,38 Wallace et al.,40 in their questionnaire survey of women who had undergone breast surgery, found that mastectomy combined with implantation of a breast prosthesis yielded a higher incidence of pain (53%) than did mastectomy alone (31%). Abdullah et al. 41 reported sensory deficits in the distribution of the intercostobrachial nerve at 3 months after axillary node dissection in 61% of women in whom the nerve was preserved and in 80% of women in whom it was divided. Maunsell et al. 42 found that axillary dissection increased the likelihood of arm problems and greater levels of psychologic distress. Kerampoulos et al. 43 also found the extent of axillary dissection correlated with the incidence of arm pain and symptoms.
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Postoperative Factors.
Tasmuth et al. 44 performed a multivariate analysis of factors that predisposed the patient to chronic pain after breast cancer surgery. The extent of acute postoperative pain and the number of doses of postoperative analgesics were the best predictors of persistent pain in both the breast area and the ipsilateral arm. Additionally, adjuvant postoperative radiation therapy was a risk factor for chronic pain in both the breast area and the arm. 44 Kerampoulos et al. 43 found that immediate axillary radiation therapy increased the incidence of arm pain and symptoms. Neither Staps et al. 45 nor Krøner et al. 36 found a relation between phantom breast sensations and radiation therapy, but their studies were smaller and only sought a particular subgroup of symptoms.
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Apparent Etiology.
Much of the pain after breast surgery has been attributed to nerve damage, whether from surgery or radiation. 39,46,47 Courtiss and Goldwyn 48 demonstrated that nipple and areola sensation decreased (intercostal nerve dysfunction) in the long-term in 15% of 249 women undergoing augmentation mammoplasty and 65% of 138 women undergoing reduction mammoplasty, but pain data were not reported. Sensation was altered in the distribution of the intercostobrachial nerve in 48–84% of women undergoing axillary dissection. In turn, in 25–50% of women with these sensory alterations intercostobrachial neuralgia developed. 41,49 Psychologic distress was associated with a higher incidence of arm pain and arm symptoms 42; and both were more common after breast surgery with axillary node dissection. The relations among distress, pain, and preoperative psychologic characteristics have not been elucidated among women undergoing breast surgery.
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Progression.
The natural history of pain during the first year after surgery has not been well-characterized. In one study, the incidence of pain in the breast area decreased from 35 to 23% from 3 weeks to 1 yr after surgery, whereas the incidence of hyperesthesia decreased from 38 to 13%. 50 In another study, the incidence of arm pain decreased insignificantly from 3 to 15 months after surgery (55 to 51%, respectively). 42 The incidence of phantom breast pain is constant from 3 weeks to 6 yr. 51,52
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Section Summary.
Chronic pain is common after breast surgery, and the major predictive factors are the extent of acute postoperative pain, the presence of pain before surgery, the type of surgery, intercostobrachial nerve damage, adjuvant radiation therapy, and possibly preoperative anxiety or depression.
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Gallbladder Surgery
Incidence.
Table 4
Table 4
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Chronic abdominal pain after cholecystectomy is common (range, 3–56%;table 4), but less frequent than the preoperative incidence of pain (83–100%). The postcholecystectomy syndrome (PCS) has a number of components in addition to abdominal pain, and may not have a single underlying etiology. 53 “Pathogenic” factors include postoperative somatic incisional pain; pain causes by postoperative sphincter of Oddi dysfunction; pain caused by a preoperatively undiagnosed disease other than gallbladder stone; pain caused by a bile duct stone; and other preoperative factors that predispose the patient to an unfavorable outcome. 54
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Preoperative Factors.
Psychologic vulnerability is a predictor of long-term pain and symptoms after cholecystectomy, 54–56 whereas other risk factors include female gender 57 and long-standing symptoms before surgery. 58 A history of classic gallbladder attack symptoms is associated with reduced risk of chronic pain and symptoms. 59–61
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Intraoperative Factors.
The surgical approach appears to make no significant difference in overall complaints. Nicholl et al.,62 in a randomized controlled trial (n = 163), noted that patients randomized to lithotripsy had more complications related to biliary “colic,” whereas patients randomized to open cholecystectomy had more complaints of scar pain and diarrhea; they did not report pain incidence data. There appears to be no difference in chronic abdominal pain when laparoscopic cholecystectomy is compared with open cholecystectomy. 63 Gui et al. 61 reported a 30% incidence of nonspecific abdominal pain more than 1 yr after cholecystectomy, but this incidence did not include 16 patients (17.4%) with wound pain. Stiff et al. 64 noted significantly more right upper quadrant pain after open cholecystectomy than after laparoscopic surgery and hypothesized that there was more intercostal nerve damage from the open procedures.
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Postoperative Factors.
Borly et al.,56 in a prospective study of 100 patients who underwent cholecystectomy, noted that pain at 6 weeks was a strong predictor of persistent pain and other symptoms at 1 yr (written communication, L. Borly and H. Kehley, 1999). We found no studies that evaluated acute postoperative pain as a predictor of chronic pain.
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Apparent Etiology.
There are multiple etiologies of the PCS, including sphincter of Oddi dysfunction, bile duct stones, ulcer, colonic dysfunction, and scar pain. The relative importance of each factor has not been evaluated.
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Progression.
Despite the frequency of persistent symptoms after cholecystectomy, patient satisfaction after the procedure is high, with authors documenting satisfaction rates that exceed 90%. 65–67 This may relate to patient expectations 68 because most patients with abdominal pain and gallstones believe that they will worsen without surgery and that their lives will improve after surgery.
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Section Summary.
Chronic symptoms are common after cholecystectomy, as is chronic abdominal pain. Predictive factors include psychologic vulnerability, long-standing preoperative symptoms (including pain), and pain at 6 weeks after surgery. Prospective studies of the postcholecystectomy syndrome have not separated scar pain and neuropathic pain from other causes of chronic visceral pain and symptoms.
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Inguinal Hernia Surgery
Incidence.
Table 5
Table 5
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A number of studies have evaluated chronic pain after groin surgery, with the reported incidence of chronic pain varying from 0 to 37% (table 5). The overall incidence from these studies is 11.5% (616 of 5,357). Chronic pain was a primary outcome parameter in only four studies, 69–72 and these studies report a variable incidence.
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Preoperative Factors.
In a prospective study of 500 surgeries, surgery for a recurrent hernia had a higher incidence of moderate to severe pain at 12 months than did surgery for a primary repair. 70 Patients receiving care under workers’ compensation for work-related injury have a higher pain incidence at 6 months than those who are being cared for by commercial insurance (5 of 22 vs. 1 of 22) 73; additionally, they have had pain for a longer period of time before surgery.
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Intraoperative Factors.
The data are inconclusive about whether the surgical approach alters the incidence of chronic pain. Liem et al.,74 in a prospective randomized controlled study that evaluated recurrence rates, found a lower incidence of chronic pain (2%) after a laparoscopic repair when compared with an open nonmesh repair (14%). The Medical Research Council study 72 also found a significantly lower incidence of pain at 12 months after a laparoscopic repair (28%) compared with an open repair (37%). Dirksen et al.75 found no difference in the incidence of chronic pain in their prospective randomized controlled study that compared an open repair (14%) to a laparoscopic repair (20%). Likewise, Gillion and Fagniez 71 found no difference in the incidence of pain in their case series, with both open and laparoscopic repairs having approximately a 14% incidence of chronic pain. Two of the studies 71,75 noted that complications, including pain, were more common early in their experience with laparoscopic hernia repair.
In a prospective multicenter study, Hay et al.76 did not find statistically significant differences in chronic pain after open repairs (Bassini, Cooper ligament, or Shouldice). Likewise, in a prospective analysis of 500 surgeries, Callesen et al.,70 found no significant differences in chronic pain between mesh and nonmesh open repairs in primary hernia surgery. Whether the experience of the surgeon or the degree of specialization is a factor in chronic pain or recurrence has been debated. 77 The incidence of chronic pain in case series data from hernia centers is low, 78,79 whereas reports with higher incidences of chronic pain typically come from teaching institutions. 72,74,75,80 There are no controlled, prospective studies of this factor.
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Postoperative Factors.
The extent of pain at 1 and 4 weeks after surgery is a predictive factor 70 for pain at 1 yr. Neither length of convalescence nor type of employment affects the incidence of chronic pain. 70
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Apparent Etiology.
The demonstrated relation between postoperative sensory dysfunction and chronic pain 71 supports the interpretation that nerve damage is a pathologic factor. Most authors assume the pain is usually of neuropathic origin, 81–83 although Wantz 84 also mentions the possibility of the repair being too tight.
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Progression.
Callesen et al. 70 noted the incidence of moderate to severe pain decreased from 11% at 4 weeks to 6% at 1 yr. Moderate to severe pain at 1 and 4 weeks was the strongest predictor of pain at 1 yr.
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Section Summary.
Chronic pain after groin hernia surgery is not rare, but it appears to be less common than chronic pain after the surgeries previously cited. Because hernia surgery is common, a large number of individuals are affected by chronic pain. Nerve dysfunction has been shown to be a factor, as has the intensity of early postoperative pain. The role of acute pain therapy on the incidence of chronic pain is unknown.
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Discussion

Although patient satisfaction with surgical results is reported to be high, 65–67 the studies reported herein show that chronic pain is common after these surgeries, and this has been confirmed in a recent review. 85 Chronic pain is costly to society in terms of suffering and disability. For humanitarian and economic reasons, the problem of chronic pain after surgery should be addressed. It is also clear there is significant variability in the incidence of chronic pain among these surgical procedures (11.5–47% for inguinal hernia and thoracic surgery). We believe that our review has been thorough, but despite the use of broad search criteria, our electronic search did not detect all articles known to the authors that relate to the development or incidence of chronic pain after the selected surgeries. Reasons for this include publication in journals not included in the Index Medicus at the time of publication (e.g., Kanner et al. 31 and Gillion and Fagniez 71) or “pain” not being identified as a key word or used in the title or abstract (e.g., Hay et al.76). As a result, we are not certain that we identified all articles that contain data relevant to this review.
Table 6
Table 6
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We identified a number of risk factors for prolonged pain after surgery and divide these factors into three categories: (1) preoperative factors, (2) intraoperative factors, and (3) postoperative factors (table 6). Preoperative pain is a predictor of chronic pain for postamputation pain, 16 phantom breast pain, 36 and noncolicky abdominal pain and symptoms after cholecystectomy. 56,58,86 For each of these surgeries, the characteristic of the preoperative pain that predicted chronic pain tended to be continuous pain of 1 month or more in duration. Psychologic vulnerability is a risk factor for persistent pain after cholecystectomy 54–56 but has not been evaluated in the other surgeries reviewed herein. It has also been found to predict outcome after lumbar spine surgery. 87
Nerve damage is an intraoperative factor that contributes to chronic postoperative pain. Patients undergoing anterior thoracotomy are less likely to have intercostal nerve dysfunction and less likely to have PTPS. 24,25 After breast surgery, intercostobrachial neuralgia is associated with damage of that nerve, and attempts to preserve the nerve are associated with a lower incidence of pain. 41 However, nerve damage per se does not necessarily cause pain because the incidence of decreased sensation was 2–4 times higher than the incidence of pain in the distribution of the intercostobrachial nerve after axillary node dissection. 41,49 Likewise, Benedetti et al.25,30 found chronic pain in only 50% of individuals with intercostal nerve dysfunction after thoracotomy. Nevertheless, nerve dysfunction appears to be associated with chronic pain. 30
The most striking predictive postoperative factor is the severity of acute postoperative pain after breast surgery, 44 thoracic surgery, 18,27 and hernia repair. 70 Postoperative adjuvant radiation therapy increases the risk of chronic pain after breast surgery, 44 and neurotoxic chemotherapy increases the risk of phantom limb pain. 5
Whether acute pain causes chronic pain has been debated. 88–92 Dworkin 88 proposed a model that incorporates psychosocial and pathophysiologic factors and the severity of acute pain as factors in the development of chronic pain. Using his model, we believe that ongoing nociceptive input from peripheral nerve injury increases acute pain and maintains early (3–12 months) chronic pain. Basbaum 93 recently reviewed changes in the nervous system associated with acute pain, with the conclusion that “persistent pain should be considered a disease state of the nervous system, not merely a symptom of some other disease conditions.” If persistent pain after surgery results from sensitization, prevention may be possible if sensitization can be blocked. Obata et al. 26 achieved this in thoracotomy patients with intraoperative plus postoperative epidural analgesia, but other clinical studies of preemptive analgesia are far from consistent. 94–96
Psychosocial factors are also predictors of chronic pain. Of the surgical procedures we reviewed, the only reproducible psychologic predictor has been “psychologic vulnerability.” The questionnaire for psychologic vulnerability measures a personality disorder that correlates with neuroticism. 55 Neither depression nor anxiety are preoperative predictors of chronic pain after surgery. 18,37 Gatchel et al. 97 noted similar findings when trying to predict chronic back pain in acute back pain patients. They concluded that psychopathology (e.g., depression) is not associated with an increased risk of development of chronic low back pain, but personality disorders may reflect psychosocial vulnerabilities or deficits in coping skills that are antecedents to chronic pain. The hypothesis of Gatchel et al.97 is consistent with the psychologic vulnerability observations in PCS.
In conclusion, chronic pain is common after amputation, inguinal hernia surgery, breast surgery, gallbladder surgery, and lung surgery, and this is also confirmed in another recent review. 85 For each of these surgeries, data may be interpreted as showing chronic neuropathic pain as one etiology. Intensity of acute postoperative pain is a predictor of chronic pain. Future studies should characterize the factors of importance in the transition from acute to chronic pain. Such knowledge may result in designing more effective and more rational early interventions. We hypothesize that, in some patients, the type of nerve injury may explain both the increase in acute pain and the chronic pain, but the extent of pain will be modified by other factors, particularly psychologic and physiologic factors that heighten pain sensitivity.
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Anesthesia and Analgesia
Cyclooxygenase inhibition for postoperative analgesia
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Anesthesia and Analgesia, 95(1): 169-176.
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Current Drug Targets
Epidural analgesia in the post-anaesthesia care unit
Donatelli, F; Tran, D; Mistraletti, G; Carli, F
Current Drug Targets, 6(7): 795-806.

European Journal of Pharmacology
The novel analgesic, F 13640, produces intra- and postoperative analgesia in a rat model of surgical pain
Kiss, I; Degryse, AD; Bardin, L; de Segura, IAG; Colpaert, FC
European Journal of Pharmacology, 523(): 29-39.
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Regional Anesthesia and Pain Medicine
Treating and preventing chronic pain: A view from the spinal cord-Bonica lecture, ASRA Annual Meeting, 2005
Eisenach, JC
Regional Anesthesia and Pain Medicine, 31(2): 146-151.
10.1016/j.rapm.2005.11.011
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Canadian Medical Association Journal
Neuropathic pain: a practical guide for the clinician
Gilron, I; Watson, CPN; Cahill, CM; Moulin, DE
Canadian Medical Association Journal, 175(3): 265-275.
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Journal of Pain and Symptom Management
Predictors and consequences of multiple persistent postmastectomy pains
Kudel, I; Edwards, RR; Kozachik, S; Block, BM; Agarwal, S; Heinberg, LJ; Haythornthwaite, J; Raja, SN
Journal of Pain and Symptom Management, 34(6): 619-627.
10.1016/j.jpainsymman.2007.01.013
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Pain
Descending facilitation from the brainstem determines behavioural and neuronal hypersensitivity following nerve injury and efficacy of pregabalin
Bee, LA; Dickenson, AH
Pain, 140(1): 209-223.
10.1016/j.pain.2008.08.008
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Jama-Journal of the American Medical Association
Efficacy of postoperative epidural analgesia - A meta-analysis
Block, BM; Liu, SS; Rowlingson, AJ; Cowan, AR; Cowan, JA; Wu, CL
Jama-Journal of the American Medical Association, 290(): 2455-2463.

Orthopade
The use of regional anesthesia in orthopedics
Zimmermann, M; Jansen, V; Rittmeister, M
Orthopade, 33(7): 784-795.
10.1007/s00132-004-0673-9
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Anaesthesia
Impact on postoperative pain of long-lasting pre-emptive epidural analgesia before total hip replacement: a prospective, randomised, double-blind study
Klasen, J; Haas, M; Graf, S; Harbach, H; Quinzio, L; Jurgensen, I; Hempelmann, G
Anaesthesia, 60(2): 118-123.

Cancer Investigation
The epidemiology of cancer pain
Goudas, LC; Bloch, R; Gialeli-Goudas, M; Lau, J; Carr, DB
Cancer Investigation, 23(2): 182-190.
10.1081/CNV-200050482
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Acta Anaesthesiologica Scandinavica
Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: A systematic review of randomized studies
Straube, S; Derry, S; McQuay, HJ; Moore, RA
Acta Anaesthesiologica Scandinavica, 49(5): 601-613.
10.1111/j.1399-6576.2005.00666.x
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Jama-Journal of the American Medical Association
When shingles wanes but pain does not - Researchers target chronic postherpetic neuralgia
Hampton, T
Jama-Journal of the American Medical Association, 293(): 2459-2460.

British Journal of Anaesthesia
Editorial I: Acute pain management: scientific evidence revisited
Macintyre, PE; Walker, S; Power, I; Schug, SA
British Journal of Anaesthesia, 96(1): 1-U1.

Cochrane Database of Systematic Reviews
Perioperative ketamine for acute postoperative pain
Bell, RF; Dahl, JB; Moore, RA; Kalso, E
Cochrane Database of Systematic Reviews, (1): -.
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Acta Anaesthesiologica Scandinavica
Prediction of post-operative pain by an electrical pain stimulus
Nielsen, PR; Norgaard, L; Rasmussen, LS; Kehlet, H
Acta Anaesthesiologica Scandinavica, 51(5): 582-586.
10.1111/j.1399-6576.2007.01271.x
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Best Practice & Research in Clinical Rheumatology
Neuropathic pain in soft tissue complaints
Abrahams, MJ
Best Practice & Research in Clinical Rheumatology, 21(2): 223-244.
10.1016/j.berh.2006.12.005
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Oral Diseases
Genetic contributions to pain: a review of findings in humans
Fillingim, RB; Wallace, MR; Herbstman, DM; Ribeiro-Dasilva, M; Staud, R
Oral Diseases, 14(8): 673-682.
10.1111/j.1601-0825.2008.01458.x
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Acta Anaesthesiologica Scandinavica
Procedure-related pain among adult patients with hematologic malignancies
Liden, Y; Landgren, O; Arner, S; Sjolund, KF; Johansson, E
Acta Anaesthesiologica Scandinavica, 53(3): 354-363.
10.1111/j.1399-6576.2008.01874.x
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Pain Management Nursing
Pain prevalence study in a large Canadian teaching hospital
Sawyer, J; Haslam, L; Robinson, S; Daines, P; Stilos, K
Pain Management Nursing, 9(3): 104-112.
10.1016/j.pmn.2008.02.001
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Pain
Prediction of chronic post-operative pain: Pre-operative DNIC testing identifies patients at risk
Yarnitsky, D; Crispel, Y; Eisenberg, E; Granovsky, Y; Ben-Nun, A; Sprecher, E; Best, LA; Granot, M
Pain, 138(1): 22-28.
10.1016/j.pain.2007.10.033
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Pain
Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression
Eisenach, JC; Pan, PH; Smilley, R; Lavand'homme, P; Landau, R; Houle, TT
Pain, 140(1): 87-94.
10.1016/j.pain.2008.07.011
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Journal of Clinical Nursing
Understanding inadequate pain management in the clinical setting: the value of the sequential explanatory mixed method study
Carr, ECJ
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10.1111/j.1365-2702.2008.02428.x
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Douleur Et Analgesie
Role of analgesic blocks in preventing chronic postoperative pain
Baylot, D; Navez, ML
Douleur Et Analgesie, 22(1): 26-29.
10.1007/s11724-009-0122-y
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Pediatric Anesthesia
Continuous infusion of ropivacaine: an optimal postoperative analgesia regimen for iliac crest bone graft in children
Ouaki, J; Dadure, C; Bringuier, S; Raux, O; Rochette, A; Captier, G; Capdevila, X
Pediatric Anesthesia, 19(9): 887-891.
10.1111/j.1460-9592.2009.03095.x
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International Journal of Obstetric Anesthesia
Post cesarean delivery pain management: multimodal approach
Pan, PH
International Journal of Obstetric Anesthesia, 15(3): 185-188.
10.1016/j.ijoa.2006.04.004
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Regional Anesthesia and Pain Medicine
Acute post-surgical pain management: A critical appraisal of current practice
Rathmell, JP; Wu, CL; Sinatra, RS; Ballantyne, JC; Ginsberg, B; Gordon, DB; Liu, SS; Perkins, FM; Reuben, SS; Rosenquist, RW; Viscusi, ER
Regional Anesthesia and Pain Medicine, 31(4): 1-41.
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Lancet Neurology
Brain imaging of clinical pain states: a critical review and strategies for future studies
Kupers, R; Kehlet, H
Lancet Neurology, 5(): 1033-1044.

Journal of Rehabilitation Research and Development
Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice
Clark, ME; Bair, MJ; Buckenmaier, CC; Gironda, RJ; Walker, RL
Journal of Rehabilitation Research and Development, 44(2): 179-193.
10.1682/JRRD.2006.05.0057
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British Journal of Anaesthesia
Gabapentin: a multimodal perioperative drug?
Kong, VKF; Irwin, MG
British Journal of Anaesthesia, 99(6): 775-786.
10.1093/bja/aem316
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Clinics in Geriatric Medicine
Pharmacotherapy of pain in older adults
Strassels, SA; McNicol, E; Suleman, R
Clinics in Geriatric Medicine, 24(2): 275-+.
10.1016/j.cger.2007.12.011
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Acta Anaesthesiologica Scandinavica
Chronic pain following Caesarean section
Nikolajsen, L; Sorensen, HC; Jensen, TS; Kehlet, H
Acta Anaesthesiologica Scandinavica, 48(1): 111-116.

Anesthesia and Analgesia
The short-lasting analgesia and long-term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery
De Kock, M; Lavand'homme, P; Waterloos, H
Anesthesia and Analgesia, 101(2): 566-572.
10.1213/01.ANE.0000157121.71808.04
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Journal of Clinical Anesthesia
Does the evidence support the use of spinal and epidural anesthesia for surgery?
Battantyne, JC; Kupelnick, B; McPeek, B; Lau, J
Journal of Clinical Anesthesia, 17(5): 382-391.
10.1016/j.jclinane.2004.10.005
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Anesthesia and Analgesia
Health-Related Quality of Life After Hip Arthroplasty With and Without an Extended-Duration Continuous Posterior Lumbar Plexus Nerve Block: A Prospective, 1-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study
Ilfeld, BM; Ball, ST; Gearen, PF; Mariano, ER; Le, LT; Vandenborne, K; Duncan, PW; Sessler, DI; Enneking, FK; Shuster, JJ; Maldonado, RC; Meyer, RS
Anesthesia and Analgesia, 109(2): 586-591.
10.1213/ane.0b013e3181a9db5d
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European Journal of Pain
Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - A systematic review
Hinrichs-Rocker, A; Schulz, K; Jarvinen, I; Lefering, R; Simanski, C; Neugebauer, EAM
European Journal of Pain, 13(7): 719-730.
10.1016/j.ejpain.2008.07.015
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Current Medical Research and Opinion
Management of neuropathic pain after surgical and non-surgical trauma with lidocaine 5% patches: study of 40 consecutive cases
Hans, G; Joukes, E; Verhulst, J; Vercauteren, M
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Neuroscience Letters
Effect of analgesic standards on persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR)
Flatters, SJL
Neuroscience Letters, 477(1): 43-47.
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Pain
Polyamine deficient diet to relieve pain hypersensitivity
Rivat, C; Richebe, P; Laboureyras, E; Laulin, JP; Havouis, R; Noble, F; Moulinoux, JP; Simonnet, G
Pain, 137(1): 125-137.
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Journal of Evaluation in Clinical Practice
Outpatient versus inpatient laparoscopic cholecystectomy: a prospective randomized study of symptom occurrence, symptom distress and general state of health during the first post-operative week
Barthelsson, C; Anderberg, B; Ramel, S; Bjorvell, C; Giesecke, K; Nordstrom, G
Journal of Evaluation in Clinical Practice, 14(4): 577-584.
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Oncologie
Pains related to cancer
George, B; Delfieu, D
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10.1007/s10269-008-0959-3
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Neurocritical Care
The Perioperative Management of Pain from Intracranial Surgery
Gottschalk, A; Yaster, M
Neurocritical Care, 10(3): 387-402.
10.1007/s12028-008-9150-3
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Douleur Et Analgesie
Orofacial pain of ear, nose and throat origin
Navez, ML; Prades, JM
Douleur Et Analgesie, 22(2): 76-81.
10.1007/s11724-009-0128-5
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Current Medical Research and Opinion
A randomized, double-blind, placebo-controlled phase 3 study of the relative efficacy and tolerability of tapentadol IR and oxycodone IR for acute pain
Daniels, S; Casson, E; Stegmann, JU; Oh, C; Okamoto, A; Rauschkolb, C; Upmalis, D
Current Medical Research and Opinion, 25(6): 1551-1561.
10.1185/03007990902952825
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Journal of Cardiothoracic and Vascular Anesthesia
The Role of the Anesthesiologist in Thoracic Surgery: We Can Make A Difference!
Sullivan, EA
Journal of Cardiothoracic and Vascular Anesthesia, 23(6): 761-765.
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Canadian Journal of Surgery
A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair
Testini, M; Lissidini, G; Poli, E; Gurrado, A; Lardo, D; Piccinni, G
Canadian Journal of Surgery, 53(3): 155-160.

Anesthesia and Analgesia
Chronic phantom limb pain: The effects of calcitonin, ketamine, and their combination on pain and sensory thresholds
Eichenberger, U; Neff, F; Sveticic, G; Bjorgo, S; Petersen-Felix, S; Arendt-Nielsen, L; Curatolo, M
Anesthesia and Analgesia, 106(4): 1265-1273.
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Canadian Journal of Surgery
Chronic pain after Lichtenstein and preperitoneal (posterior) hernia repair
Erhan, Y; Erhan, E; Aydede, H; Mercan, M; Tok, D
Canadian Journal of Surgery, 51(5): 383-387.

Clinical Orthopaedics and Related Research
Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion
Gomez-Cardero, P; Rodriguez-Merchan, EC
Clinical Orthopaedics and Related Research, 468(5): 1242-1247.
10.1007/s11999-009-1202-2
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Pain
Cutaneous endothelin-A receptors elevate post-incisional pain
Mujenda, FH; Duarte, AM; Reilly, EK; Strichartz, GR
Pain, 133(): 161-173.
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Journal of Pain
Maternal separation leads to persistent reductions in pain sensitivity in female rats
Weaver, SA; Diorio, J; Meaney, MJ
Journal of Pain, 8(): 962-969.
10.1016/j.jpain.2007.07.001
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Gastroenterology
Development of abdominal pain and IBS following gynecological surgery: A prospective, controlled study
Sperber, AD; Morris, CB; Greemberg, L; Bangdiwala, SI; Goldstein, D; Sheiner, E; Rusabrov, Y; Hu, Y; Katz, M; Freud, T; Neville, A; Drossman, DA
Gastroenterology, 134(1): 75-84.
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British Journal of Anaesthesia
Chronic post-surgical pain: 10 years on
Macrae, WA
British Journal of Anaesthesia, 101(1): 77-86.
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Assistenza Infermieristica E Ricerca
Clinical-caring epidemiology of pain in hospital the ECAD-O project
Sichetti, D; Fosco, B; Romero, M; Tognoni, G
Assistenza Infermieristica E Ricerca, 26(2): 84-87.

Journal of Bone and Joint Surgery-British Volume
The management of patients with painful total knee replacement The management of patients with painful total knee replacement
Toms, AD; Mandalia, V; Haigh, R; Hopwood, B
Journal of Bone and Joint Surgery-British Volume, 91B(2): 143-150.
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Acta Anaesthesiologica Scandinavica
Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty
Clarke, H; Pereira, S; Kennedy, D; Andrion, J; Mitsakakis, N; Gollish, J; Katz, J; Kay, J
Acta Anaesthesiologica Scandinavica, 53(8): 1073-1083.
10.1111/j.1399-6576.2009.02039.x
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Regional Anesthesia and Pain Medicine
A lovely idea: Forming an ASRA acute postoperative pain (AcutePOP) database
Liu, SS; Warren, DT; Wu, CL; Ballantyne, JC; Ginsberg, B; Rathmell, JP; Rosenquist, RW; Viscusi, ER
Regional Anesthesia and Pain Medicine, 31(4): 291-293.
10.1016/j.rapm.2006.05.006
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Pain
Chronic pain and sensory changes after augmentation mammoplasty: Long term effects of preincisional administration of methylprednisolone
Romundstad, L; Breivik, H; Roald, H; Skolleborg, K; Romundstad, PR; Stubhaug, A
Pain, 124(): 92-99.
10.1016/j.pain.2006.03.020
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Journal of Pain and Symptom Management
Pain, demographics, and clinical characteristics in persons who received hospice care in the United States
Strassels, SA; Blough, DK; Hazlet, TK; Veenstra, DL; Sullivan, SD
Journal of Pain and Symptom Management, 32(6): 519-531.
10.1016/j.jpainsymman.2006.06.005
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Journal of Bone and Joint Surgery-American Volume
Preventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques
Reuben, SS; Buvanendran, A
Journal of Bone and Joint Surgery-American Volume, 89A(6): 1343-1358.

Journal of Clinical Anesthesia
The efficacy of postoperative perineural infusion of bupivacaine and clonidine after lower extremity amputation in preventing phantom limb and stump pain
Madabhushi, L; Reuben, SS; Steinberg, RB; Adesioye, J
Journal of Clinical Anesthesia, 19(3): 226-229.
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European Spine Journal
Persistent pain in patients following scoliosis surgery
Wong, GTC; Yuen, VMY; Chow, BFM; Irwin, MG
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Danish Medical Bulletin
Inguinal hernia repair: anaesthesia, pain and convalescence
Callesen, T
Danish Medical Bulletin, 50(3): 203-218.

Pain
Perioperative administration of the alpha 2-adrenoceptor agonist clonidine at the site of nerve injury reduces the development of mechanical hypersensitivity and modulates local cytokine expression
Lavand'homme, PM; Eisenach, JC
Pain, 105(): 247-254.
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Regional Anesthesia and Pain Medicine
"He said, she said, NSAIDs"
Wedel, DJ; Berry, D
Regional Anesthesia and Pain Medicine, 28(5): 372-375.
10.1016/S1098-7339(03)00400-0
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Journal of Orofacial Pain
Long-lasting mechanical sensitization following third molar surgery
Juhl, GI; Svensson, P; Norholt, SE; Jensen, TS
Journal of Orofacial Pain, 20(1): 59-73.

Anesthesia and Analgesia
Update on acute pain management
Rowlingson, JC
Anesthesia and Analgesia, (): 95-106.

Journal of Cardiovascular Pharmacology
The role of COX-2 inhibitors in the treatment of postoperative pain
Schug, SA
Journal of Cardiovascular Pharmacology, 47(): S82-S86.

Orthopade
A multimodal and multidisciplinary postoperative pain management concept
Ettrich, U; Seifert, J; Scharnagel, R; Gunther, KP
Orthopade, 36(6): 544-+.
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Anaesthesist
Microvascular bone transplantation in a child - Pain therapy with combined nerve blocks
Winter, R; Strassburger, U; Li, L; Dornheim, U; Gottschalk, A
Anaesthesist, 56(9): 886-889.
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British Journal of Cancer
The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer
Vilholm, OJ; Cold, S; Rasmussen, L; Sindrup, SH
British Journal of Cancer, 99(4): 604-610.
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Orthopade
Patients with pre-existing chronic pain and/or psychological problems
Schiltenwolf, M; Klinger, R
Orthopade, 37(): 990-+.
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American Journal of Geriatric Pharmacotherapy
Efficacy and Safety Profile of a Single Dose of Hydromorphone Compared with Morphine in Older Adults with Acute, Severe Pain: A Prospective, Randomized, Double-Blind Clinical Trial
Chang, AK; Bijur, PE; Baccelieri, A; Gallagher, EJ
American Journal of Geriatric Pharmacotherapy, 7(1): 1-10.
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Anesthesia and Analgesia
The Early and Delayed Analgesic Effects of Ketamine After Total Hip Arthroplasty: A Prospective, Randomized, Controlled, Double-Blind Study
Remerand, F; Le Tendre, C; Baud, A; Couvret, C; Pourrat, X; Favard, L; Laffon, M; Fusciardi, J
Anesthesia and Analgesia, 109(6): 1963-1971.
10.1213/ANE.0b013e3181bdc8a0
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European Journal of Neuroscience
A subpopulation of rats show social and sleep-waking changes typical of chronic neuropathic pain following peripheral nerve injury
Monassi, CR; Bandler, R; Keay, KA
European Journal of Neuroscience, 17(9): 1907-1920.
10.1046/j.1460-9568.2003.02627.x
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Pain
Multiple phases of relief from experimental mechanical allodynia by systemic lidocaine: responses to early and late infusions
Araujo, MC; Sinnott, CJ; Strichartz, GR
Pain, 103(): 21-29.
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Proceedings of the 8th Biennial Congress of the Asian & Oceanic Society of Regional Anesthesia and Pain Medicine
Pre-emptive analgesia
Scott, DA
Proceedings of the 8th Biennial Congress of the Asian & Oceanic Society of Regional Anesthesia and Pain Medicine, (): 43-45.

Douleur Et Analgesie
Obstetric analgesia and postpartum pain
Landau, R
Douleur Et Analgesie, 20(3): 167-172.
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Schmerz
Risk minimization in pain therapy - Important target but how can it be reached?
Hanekop, GG; Ensink, FBM
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Anesthesia and Analgesia
Low-Dose Systemic Bupivacaine Prevents the Development of Allodynia After Thoracotomy in Rats
Shin, JW; Pancaro, C; Wang, CF; Gerner, P
Anesthesia and Analgesia, 107(5): 1587-1591.
10.1213/ane.0b013e31818200aa
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Anesthesia and Analgesia
Health-Related Quality of Life After Tricompartment Knee Arthroplasty With and Without an Extended-Duration Continuous Femoral Nerve Block: A Prospective, 1-Year Follow-Up of a Randomized, Triple-Masked, Placebo-Controlled Study
Ilfeld, BM; Meyer, RS; Le, LT; Mariano, ER; Williams, BA; Vandenborne, K; Duncan, PW; Sessler, DI; Enneking, FK; Shuster, JJ; Maldonado, RC; Gearen, PF
Anesthesia and Analgesia, 108(4): 1320-1325.
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Douleur Et Analgesie
Post-mastectomy chronic pain
Labreze, L; Lakdja, F; Dixmerias, F; Monnin, D
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Urologe
Postoperative pain therapy after radical prostatectomy with and without epidural analgesia
Ozgur, E; Dagtekin, O; Straub, K; Engelmann, U; Gerbershagen, HJ
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Internist
Limitations of anesthesiology: high risk and older patients
Gottschalk, A; Esch, JSA
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Scandinavian Journal of Gastroenterology
From acute to chronic pain after laparoscopic cholecystectomy: A prospective follow-up analysis
Bisgaard, T; Rosenberg, J; Kehlet, H
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Current Opinion in Investigational Drugs
5-HT1A receptor activation: New molecular and neuroadaptive mechanisms of pain relief
Colpaert, FC
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Anesthesia and Analgesia
Effect of postoperative analgesia on major postoperative complications: A systematic update of the evidence
Liu, SS; Wu, CL
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Annales Francaises D Anesthesie Et De Reanimation
Ketamine for paediatric anaesthesia: useful, fool or... ?
De Kock, M
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British Journal of Anaesthesia
Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery
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Regional Anesthesia and Pain Medicine
Anticoagulation and neuraxial regional anesthesia: Perspectives
Bergqvist, D; Wu, CL; Neal, JM
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Anesthesia and Analgesia
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Kharasch, ED
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Anesthesia and Analgesia
Persistent pain as a disease entity: Implications for clinical management
Siddall, PJ; Cousins, MJ
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Journal of Neuroscience
Chronic back pain is associated with decreased prefrontal and thalamic gray matter density
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Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Factors contributing to poor post-operative abdominal pain management in adult patients: a review
Al Samaraee, A; Rhind, G; Saleh, U; Bhattacharya, V
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Langenbecks Archives of Surgery
Effect of postoperative pain treatment on outcome - current status and future strategies
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Langenbecks Archives of Surgery, 389(4): 244-249.
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Journal of Thoracic and Cardiovascular Surgery
Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: A cross-sectional study
Taillefer, MC; Carrier, M; Belisle, S; Levesque, S; Lanctot, H; Boisvert, AM; Choiniere, M
Journal of Thoracic and Cardiovascular Surgery, 131(6): 1274-1280.
10.1016/j.jtcvs.2006.02.001
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Journal of Advanced Nursing
Challenges of pain management for the 21st century
Seers, K; Watt-Watson, J; Bucknall, T
Journal of Advanced Nursing, 55(1): 4-6.

Anesthesia and Analgesia
Intrathecal administration of a cylcooxygenase-1, but not a cyclooxygenase-2 inhibitor, reverses the effects of laparotomy on exploratory activity in rats
Martin, TJ; Buechler, NL; Eisenach, JC
Anesthesia and Analgesia, 103(3): 690-695.
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Pain
Characterization of a model of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR)
Flatters, SJL
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10.1016/j.pain.2007.05.013
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Journal of Oral Rehabilitation
Incidence of symptoms and signs of TMD following third molar surgery: a controlled, prospective study
Juhl, GI; Jensen, TS; Norholt, SE; Svensson, P
Journal of Oral Rehabilitation, 36(3): 199-209.
10.1111/j.1365-2842.2008.01925.x
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Journal of Korean Neurosurgical Society
Disability Evaluation of the Pain: The Present and Prospect in Korea
Lee, KS; Shim, JJ; Yoon, SM; Doh, JW; Yun, IG; Bae, HG
Journal of Korean Neurosurgical Society, 45(5): 293-296.
10.3340/jkns.2009.45.5.293
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European Journal of Cardio-Thoracic Surgery
Chronic post-thoracotomy pain: a critical review of pathogenic mechanisms and strategies for prevention
Wildgaard, K; Ravn, J; Kehlet, H
European Journal of Cardio-Thoracic Surgery, 36(1): 170-180.
10.1016/j.ejcts.2009.02.005
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British Journal of Surgery
Endoscopic retroperitoneal neurectomy for chronic pain after groin surgery
Giger, U; Wente, MN; Buchler, MW; Krahenbuhl, S; Lerut, J; Krahenbuhl, L
British Journal of Surgery, 96(9): 1076-1081.
10.1002/bjs.6623
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Clinical Therapeutics
A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Ibuprofen 400 and 800 mg Every 6 Hours in the Management of Postoperative Pain
Southworth, S; Peters, J; Rock, A; Pavliv, L
Clinical Therapeutics, 31(9): 1922-1935.
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Journal of Oral Rehabilitation
Quantitative sensory tests before and 11/2 years after orthognathic surgery: a cross-sectional study
Baad-Hansen, L; Arima, T; Arendt-Nielsen, L; Neumann-Jensen, B; Svensson, P
Journal of Oral Rehabilitation, 37(5): 313-321.
10.1111/j.1365-2842.2010.02059.x
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British Journal of Anaesthesia
Pain relief after thoracotomy: is epidural analgesia the optimal technique?
Ng, A; Swanevelder, J
British Journal of Anaesthesia, 98(2): 159-162.
10.1093/bja/ael360
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Neuropsychopharmacology
Non-nociceptive environmental stress induces hyperalgesia, not analgesia, in pain and opioid-experienced rats
Rivat, C; Laboureyras, E; Laulin, JP; Le Roy, C; Richebe, P; Simonnet, G
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Pain Management Nursing
Evaluation of a continuous epidural analgesia program for postoperative pain in children
Ellis, JA; Martelli, B; LaMontagne, C; Splinter, W
Pain Management Nursing, 8(4): 146-155.
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Anesthesia and Analgesia
Early use of memantine for neuropathic pain
Buvanendran, A; Kroin, JS
Anesthesia and Analgesia, 107(4): 1093-1094.
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Anasthesiologie & Intensivmedizin
The relevance of psychological variables in postoperative pain
Huber, C; Lautenbacher, S
Anasthesiologie & Intensivmedizin, 49(): 436-+.

Oncologie
Long-term post-thoracotomy pain: an update
Cornet, C; Krakowski, I
Oncologie, 10(9): 551-553.
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Head and Neck-Journal for the Sciences and Specialties of the Head and Neck
Botulinum toxin type A for the treatment of chronic neck pain after neck dissection
Wittekindt, C; Liu, WC; Klussmann, JP; Guntinas-Lichius, O
Head and Neck-Journal for the Sciences and Specialties of the Head and Neck, 26(1): 39-45.
10.1002/hed.10340
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Pain
Intrathecal morphine and ketorolac analgesia after surgery: comparison of spontaneous and elicited responses in rats
Martin, TJ; Zhang, Y; Buechler, N; Conklin, DR; Eisenach, JC
Pain, 113(3): 376-385.
10.1016/j.pain.2004.11.017
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American Journal of Health-System Pharmacy
Postoperative pain management: A practical review, part 1
Strassels, SA; McNicol, E; Suleman, R
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Acta Anaesthesiologica Scandinavica
Response Entropy (TM) is not more sensitive than State Entropy (TM) in distinguishing the use of esmolol instead of remifentanil in patients undergoing gynaecological laparoscopy
Valjus, M; Ahonen, J; Jokela, R; Korttila, K
Acta Anaesthesiologica Scandinavica, 50(1): 32-39.
10.1111/j.1399-6576.2005.00876.x
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Pain Medicine
Grand rounds case presentation: Adjacent-level degeneration following multilevel decompression and fusion with neuropathic axial and right leg pain
Carr, DB; Wolinsky, JP; Stanos, S; Menefee, LA; Bennett, DS; Villavicencio, AT
Pain Medicine, 7(): S146-S158.

Anesthesia and Analgesia
The analgesic efficacy of celecoxib, pregabalin, and their combination for spinal fusion surgery
Reuben, SS; Buvanendran, A; Kroin, JS; Raghunathan, K
Anesthesia and Analgesia, 103(5): 1271-1277.
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Cirugia Espanola
New trends in the treatment of post-operative pain in general and gastrointestinal surgery
Verges, MTS; Puigbo, EC; Cortada, MG; Rizo, MR; Garcia, MVM
Cirugia Espanola, 86(2): 63-71.
10.1016/j.ciresp.2009.03.028
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Archives of Surgery
Pain Following Breast Cancer Surgery A Quality-of-Life Issue
Shockney, LD
Archives of Surgery, 145(3): 224-225.

Cirugia Espanola
Perioperative pharmacological treatment recommendations
Rudilla, MC; Rodriguez, JPD; Santana, AR; Molist, MG; Gomez, MDO; Conde, JAM; Alonso, JM
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10.1016/j.ciresp.2009.04.012
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Journal of the American College of Surgeons
Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: A quantitative and qualitative systematic review of randomized controlled trials
Liu, SS; Richman, JM; Thirlby, RC; Wu, CL
Journal of the American College of Surgeons, 203(6): 914-932.
10.1016/j.jamcollsurg.2006.08.007
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Journal of Laparoendoscopic & Advanced Surgical Techniques
Esophagogastroduodenoscopy prior to laparoscopic cholecystectomy
Al-Azawi, D; Rayis, A; Hehir, DJ
Journal of Laparoendoscopic & Advanced Surgical Techniques, 16(6): 593-597.

Anesthesia and Analgesia
The effect of initiating a preventive multimodal analgesic regimen on long-term patient outcomes for outpatient anterior cruciate ligament reconstruction surgery
Reuben, SS; Ekman, EF
Anesthesia and Analgesia, 105(1): 228-232.
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Deutsche Medizinische Wochenschrift
What is chronic pain?
Nilges, P; Nagel, B
Deutsche Medizinische Wochenschrift, 132(): 2133-2138.
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American Surgeon
Invited commentary - Pain after mastectomy and breast reconstruction
Vadivelu, N; Schreck, M; Lopez, J; Kodumudi, G; Narayan, D
American Surgeon, 74(4): 285-296.

Pharmacotherapy
Iontophoretic drug delivery system: Focus on fentanyl
Herndon, CM
Pharmacotherapy, 27(5): 745-754.

Pain
A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges
Fletcher, D; Fermanian, C; Mardaye, A; Aegerter, P
Pain, 137(2): 441-451.
10.1016/j.pain.2008.02.026
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International Journal of Gynecology & Obstetrics
Parietal peritoneal closure and persistent postcesarean pain
Shahin, AY; Osman, AM
International Journal of Gynecology & Obstetrics, 104(2): 135-139.
10.1016/j.ijgo.2008.09.012
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Douleur Et Analgesie
Risk factors of chronic postsurgical pain
Fletcher, D; Baudic, S
Douleur Et Analgesie, 22(1): 13-18.
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Rheumatic Disease Clinics of North America
Abnormal Pain Modulation in Patients with Spatially Distributed Chronic Pain: Fibromyalgia
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Rheumatic Disease Clinics of North America, 35(2): 263-+.
10.1016/j.rdc.2009.05.006
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European Journal of Pain
Emotional numbing and pain intensity predict the development of pain disability up to one year after lateral thoracotomy
Katz, J; Asmundson, GJG; Mcrae, K; Halket, E
European Journal of Pain, 13(8): 870-878.
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Journal of Psychosomatic Research
Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery
Cohen, L; Fouladi, RT; Katz, J
Journal of Psychosomatic Research, 58(2): 201-209.
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British Journal of Anaesthesia
Recent advances in postoperative pain therapy
Power, I
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British Journal of Surgery
Surgical management of chronic pain after inguinal hernia repair
Aasvang, E; Kehlet, H
British Journal of Surgery, 92(7): 795-801.
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Acta Anaesthesiologica Scandinavica
Chronic post-thoracotomy pain: a retrospective study
Pluijms, WA; Steegers, MAH; Verhagen, AFTM; Scheffer, GJ; Wilder-Smith, OHG
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Biomedicine & Pharmacotherapy
Modem concepts of acute and chronic pain management
Spacek, A
Biomedicine & Pharmacotherapy, 60(7): 329-335.
10.1016/j.biopha.2006.06.011
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Medical Clinics of North America
Interventional approaches to pain management
Markman, JD; Philip, A
Medical Clinics of North America, 91(2): 271-+.
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British Journal of Anaesthesia
Gabapentin: a new drug for postoperative pain?
Rowbotham, DJ
British Journal of Anaesthesia, 96(2): 152-155.
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Anesthesia and Analgesia
The associations between severity of early postoperative pain, chronic postsurgical pain and plasma concentration of stable nitric oxide products after breast surgery
Iohom, G; Abdalla, H; O'Brien, J; Szarvas, S; Larney, V; Buckley, E; Butler, M; Shorten, GD
Anesthesia and Analgesia, 103(4): 995-1000.

Anesthesia and Analgesia
The effect of pain on health-related quality of life in the immediate postoperative period
Wu, CL; Naqibuddin, M; Rowlingson, AJ; Lietman, SA; Jermyn, RM; Fleisher, LA
Anesthesia and Analgesia, 97(4): 1078-1085.
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Journal of Pain and Symptom Management
Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome
Reuben, SS; Makari-Judson, G; Lurie, SD
Journal of Pain and Symptom Management, 27(2): 133-139.
10.1016/j.jpainsymman.2003.06.004
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Journal of Manipulative and Physiological Therapeutics
Chiropractic high-velocity low-amplitude spinal manipulation in the treatment of a case of postsurgical chronic Cauda Equina syndrome
Lisi, AJ; Bhardwaj, MK
Journal of Manipulative and Physiological Therapeutics, 27(9): 574-578.
10.1016/j.jmpt.2004.10.002
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European Journal of Pain
Can opioids prevent post-operative chronic pain?
Stubhaug, A
European Journal of Pain, 9(2): 153-156.
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Anaesthesia
Pain management
Rowbotham, DJ
Anaesthesia, 58(): 1196-1199.

Journal of Cardiothoracic and Vascular Anesthesia
Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation
Chakravarthy, M; Nadiminti, S; Krishnamurthy, J; Thimmannagowda, P; Royse, CF; Minzter, BH
Journal of Cardiothoracic and Vascular Anesthesia, 18(4): 512-520.
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Emergency Medicine Clinics of North America
Changing attitudes about pain and pain control in emergency medicine
Fosnocht, DE; Swanson, ER; Barton, ED
Emergency Medicine Clinics of North America, 23(2): 297-+.
10.1016/j.emc.2004.12.003
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Emergency Medicine Clinics of North America
The psychology of pain
Hansen, GR; Streltzer, J
Emergency Medicine Clinics of North America, 23(2): 339-+.
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British Journal of Anaesthesia
Chronic postoperative pain: the case of inguinal herniorrhaphy
Aasvang, E; Kehlet, H
British Journal of Anaesthesia, 95(1): 69-76.
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Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie
Continuous interscalenic nerve block in a 3 year old child after amputation of upper extremity
Gottschalk, A; Rempf, C; Freitag, M; Lohmann, C; Standl, T
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie, 41(1): 47-50.
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Anesthesia and Analgesia
Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety
Tiippana, EM; Hamunen, K; Kontinen, VK; Kalso, E
Anesthesia and Analgesia, 104(6): 1545-1556.
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Presse Medicale
Chronic pain after surgery
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Pain Medicine
Cancer Pain: Part 2: Physical, Interventional and Complimentary Therapies; Management in the Community; Acute, Treatment-Related and Complex Cancer Pain: A Perspective from the British Pain Society Endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners
Raphael, J; Hester, J; Ahmedzai, S; Barrie, J; Farqhuar-Smith, P; Williams, J; Urch, C; Bennett, MI; Robb, K; Simpson, B; Pittler, M; Wider, B; Ewer-Smith, C; DeCourcy, J; Young, A; Liossi, C; McCullough, R; Rajapakse, D; Johnson, M; Duarte, R; Sparkes, E
Pain Medicine, 11(6): 872-896.

Journal of Endodontics
Frequency of Persistent Tooth Pain after Root Canal Therapy: A Systematic Review and Meta-Analysis
Nixdorf, DR; Moana, EJ; Law, AS; McGuire, LA; Hodges, JS; John, MT
Journal of Endodontics, 36(2): 224-230.
10.1016/j.joen.2009.11.007
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European Journal of Pain-London
Persistent secondary hyperalgesia after gastrocnemius incision in the rat
Pogatzki, EM; Niemeier, JS; Brennan, TJ
European Journal of Pain-London, 6(4): 295-305.
10.1053/eujp.2002.0339
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Rheumatology
The burden of acute postoperative pain and the potential role of the COX-2-specific inhibitors
Stephens, J; Laskin, B; Pashos, C; Pena, B; Wong, J
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Javma-Journal of the American Veterinary Medical Association
Clinical evaluation of perioperative administration of gabapentin as an adjunct for postoperative analgesia in dogs undergoing amputation of a forelimb
Wagner, AE; Mich, PM; Uhrig, SR; Hellyer, PW
Javma-Journal of the American Veterinary Medical Association, 236(7): 751-756.

Annales De Chirurgie
Rapid rehabilitation after abdominal surgery. The anaesthesist point of view
Beaussier, M; Delva, E
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European Journal of Pain
Breakthrough pain in malignant and non-malignant diseases: a review of prevalence, characteristics and mechanisms
Svendsen, KB; Andersen, S; Arnason, S; Arner, S; Breivik, H; Heiskanen, T; Kalso, E; Kongsgaard, UE; Sjogren, P; Strang, P; Bach, FW; Jensen, TS
European Journal of Pain, 9(2): 195-206.
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European Journal of Pain
Reduced cold pressor pain tolerance in non-recovered whiplash patients: a 1-year prospective study
Kasch, H; Qerama, E; Bach, FW; Jensen, TS
European Journal of Pain, 9(5): 561-569.
10.1016/j.ejpain.2004.11.011
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Journal of Pain
Using the American Pain Society's patient outcome questionnaire to evaluate the quality of postoperative pain management in a sample of Norwegian patients
Dihle, A; Helseth, S; Kongsgaard, UE; Paul, SM; Miaskowski, C
Journal of Pain, 7(4): 272-280.
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Journal of Cardiothoracic and Vascular Anesthesia
Comparison of lumbar epidural tramadol and lumbar epidural morphine for pain relief after thoracotomy: A repeated-dose study
Singh, B; Tempe, DK; Datt, V; Shekhar, S
Journal of Cardiothoracic and Vascular Anesthesia, 20(5): 757-758.
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Pain
Neurophysiological characterization of posthemiotomy pain
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Pain, 137(1): 173-181.
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Singapore Medical Journal
The acute pain service after ten years: experiences of a Singapore public hospital
Phua, DSK; Leong, WM; Yoong, CS
Singapore Medical Journal, 49(): 1007-1011.

Journal of Pain
Experimental and Clinical Applications of Quantitative Sensory Testing Applied to Skin, Muscles and Viscera
Arendt-Nielsen, L; Yarnitsky, D
Journal of Pain, 10(6): 556-572.
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Urologe
Preoperative pain in urological patients scheduled for surgical intervention. Incidence, severity and chronicity
Ozgur, E; Straub, K; Dagtekin, O; Engelmann, U; Heidenreich, A; Gerbershagen, HJ
Urologe, 48(8): 894-900.
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Anesthesia and Analgesia
Ketoprofen Produces Modality-Specific Inhibition of Pain Behaviors in Rats After Plantar Incision
Spofford, CM; Ashmawi, H; Subieta, A; Buevich, F; Moses, A; Baker, M; Brennan, TJ
Anesthesia and Analgesia, 109(6): 1992-1999.
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Anesthesia and Analgesia
The Effects of Resiniferatoxin in an Experimental Rat Thoracotomy Model
Shin, JW; Pancaro, C; Wang, CF; Gerner, P
Anesthesia and Analgesia, 110(1): 228-232.
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Regional Anesthesia and Pain Medicine
Hernia surgery, anesthetic technique, and urinary retention - Apples, oranges, and kumquats?
Mulroy, MF
Regional Anesthesia and Pain Medicine, 27(6): 587-589.
10.1053/rapm.2002.37326
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Journal of Clinical Anesthesia
Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: The use of intravenous regional anesthesia with clonidine (Retracted article. See vol. 21, pg. 235, 2009)
Reuben, SS; Rosenthal, EA; Steinberg, RB; Faruqi, S; Kilaru, PA
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Lancet
Persistent postsurgical pain: risk factors and prevention
Kehlet, H; Jensen, TS; Woolf, CJ
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Surgical Endoscopy and Other Interventional Techniques
PROSPECT: a practical method for formulating evidence-based expert recommendations for the management of postoperative pain
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Surgical Endoscopy and Other Interventional Techniques, 21(7): 1047-1053.
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American Journal of Surgery
Chronic pain after mesh repair of inguinal hernia: a systematic review
Nienhuijs, S; Staal, E; Strobbe, L; Rosman, C; Groenewoud, H; Bleichrodt, R
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European Journal of Pharmacology
Ameliorative effects of amiloride and pralidoxime in chronic constriction injury and vincristine induced painful neuropathy in rats
Muthuraman, A; Jaggi, AS; Singh, N; Singh, D
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European Journal of Pain
Central sensitization phenomena after third molar surgery: A quantitative sensory testing study
Juhl, GI; Jensen, TS; Norholt, SE; Svensson, P
European Journal of Pain, 12(1): 116-127.
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Acta Anaesthesiologica Scandinavica
Pain and disability 1 year after knee arthroscopic procedures
Rosseland, LA; Solheim, N; Stubhaug, A
Acta Anaesthesiologica Scandinavica, 52(3): 332-337.
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Journal of Health Psychology
The Association of Perceived Partner-related Social Support with Self-reported Outcomes in Women Post-mastectomy
Kudel, I; Edwards, R; Raja, S; Haythornthwaite, J; Heinberg, LJ
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Pain
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Cochrane Database of Systematic Reviews
Vitamin D for the treatment of chronic painful conditions in adults
Straube, S; Derry, S; Moore, RA; McQuay, HJ
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Pain Physician
Spinal Cord Stimulation for the Treatment of Chronic Knee Pain Following Total Knee Replacement
Lowry, AM; Simopoulos, TT
Pain Physician, 13(3): 251-256.

Canadian Journal of Anaesthesia-Journal Canadien D Anesthesie
High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion
Reuben, SS; Ablett, D; Kaye, R
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Neurology
Individual differences in endogenous pain modulation as a risk factor for chronic pain
Edwards, RR
Neurology, 65(3): 437-443.

Journal of Clinical Nursing
Patients undergoing total hip arthroplasty: a perioperative pain experience
Stomberg, MW; Oman, UB
Journal of Clinical Nursing, 15(4): 451-458.

Journal of Pain and Symptom Management
Persistent pain: A disease entity
Cousins, MJ
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Chirurgische Gastroenterologie
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Anesthesia and Analgesia
The evolution of primary hyperalgesia in orthopedic surgery: Quantitative sensory testing and clinical evaluation before and after total knee arthroplasty
Martinez, V; Fletcher, D; Bouhassira, D; Sessler, DI; Chauvin, M
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Anesthesia and Analgesia
Preincisional paravertebral block reduces the prevalence of chronic pain after breast surgery
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Journal of Pain
Risk factors for chronic pain following breast cancer surgery: A prospective study
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Anesthesia and Analgesia
Postoperative analgesia: Economics, resource use, and patient satisfaction in an urban teaching hospital
Strassels, SA; Chen, C; Carr, DB
Anesthesia and Analgesia, 94(1): 130-137.

Lancet
Anaesthesia, surgery, and challenges in postoperative recovery
Kehlet, H; Dahl, JB
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Anesthesia and Analgesia
Perioperative rofecoxib improves early recovery after outpatient herniorrhaphy
Ma, H; Tang, J; White, PF; Zaentz, A; Wender, RH; Sloninsky, A; Naruse, R; Kariger, R; Quon, R; Wood, D; Carroll, BJ
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Anesthesia and Analgesia
Ketamine as adjuvant analgesic to opioids: A quantitative and qualitative systematic review
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Journal of Pain and Symptom Management
Strategies in pain management: New and potential indications for COX-2 specific inhibitors
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Back to Top | Article Outline
Keywords:
Acute pain; neuropathic pain; prevention; review; risk factors.

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