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Acute and Chronic Pain Management

Chronic post-surgical pain: an underestimated syndrome


Barbosa, V.1; Santos, C.1; Rebelo, T.1; Leite, A. P.1; Matos, F. J.2

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European Journal of Anaesthesiology (EJA): June 2014 - Volume 31 - Issue - p 216
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Background: Chronic post-surgical pain (CPSP) is a pain syndrome that develops postoperatively and lasts for at least 2 months in the absence of other causes for pain. It occurs in 10% to 50% of individuals after common surgeries1, such as mastectomy, amputation, thoracotomy, inguinal hernia repair, hip/knee arthroplasty and hysterectomy.Genetic predisposition, female gender, young age, preoperative anxiety, obesity, pre-existing pain and an inflammatory state are risk factors to CPSP.

Materials and methods: Retrospective study. We reviewed data from adults with non-oncologic chronic post-surgical pain, followed in Pedro Hispano Hospital Chronic Pain Unit (CPU), during 2012. The patients undergoing spine surgery were excluded.

Results and discussion: Of the 432 patients referred to the CPU during 2012, 6.25% (n=27) present with nonmalignant CPSP. The most are female (74.1%) and the mean of age is 58.15 ± 16.29 years. The specialties of origin are mainly of the surgical area, with a predominance of Orthopaedics (25.9%), General Surgery (25.9%) and Obstetrics/Gynecology (22.2%). The more often involved surgical procedures are surgical correction of abdominal wall hernia (25.9%), abdominal hysterectomy (11.1%) and hip arthroplasty/revision (11.1%). In 63% (n=17) of cases, the time elapsed until the referral was less than 1 year and 92.6% of the patients obtained a consultation within 6 months after referral.

Our results were consistent with those existent in the literature, but we believe that the prevalence of the CPSP in our CPU can underestimated and only patients with high to moderated functional limitations are referred.

Conclusions: CPSP prevention is a critical concern for the anesthetist because, once established, it can be a disabling condition and difficult to treat, like many other chronic pain conditions. It has a multifactorial aetiology, in which the deregulated postinjury hyperalgesia is included. Techniques that avoid trauma to nerves, with reduced inflammatory stimuli, should be chosen and an aggressive multimodal analgesia is mandatory. Because only a fraction of surgical patients develop CPSP, it is important to detect these patients before surgery. Kalkman score can be very useful for identification of patients who appear to have a major risk to developing CPSP.CPSP can be an important cause of morbidity. Studies like this help us to understand the importance of preventive strategies and the needing of an early diagnosis and treatment.

© 2014 European Society of Anaesthesiology