Background: The pathophysiology of pain involves complex nervous system interactions
after initial noxious stimuli. When stimuli persist, biochemical and structural changes occur
in the nociceptive pathways of the central and peripheral nervous systems, leading to pain
sensitization. Peripheral and central sensitization are key in the transition from acute to chronic
pain. This development of chronic pain is particularly common following various surgical
procedures, with many postsurgical patients experiencing persistent pain for significant periods.
Chronic pain is a common and severe complication of surgery, and preventing its development
is tantamount in improving patient outcomes.
Objectives: To understand underlying pathophysiology of chronic postsurgical pain (CPSP)
and the underlying risk factors predisposing the transition from acute to CPSP. To review our
ability to identify patients at highest risk for the development CPSP. To identify evidence-based
multimodal approaches that can aid in the prevention of CPSP.
Study Design: Narrative review of peer-reviewed literature.
Setting: Inpatient surgical centers.
Methods: Medline and Cochrane databases were reviewed to identify publications relevant
to CPSP pathophysiology, risk factors, predictive models, and prevention. Publications were
selected based on author expertise to summarize our current understanding of CPSP.
Results: This review presents our current understanding of CPSP in the following domains:
underlying pathophysiology, predisposing risk factors, predictive models of CPSP, and
preventative strategies. Each section provides a structured review of key evidence base to
understand the complex topic of CPSP.
Limitations: This narrative review is a nonsystematic review of relevant publications aimed at
presenting succinct overview of CPSP.
Conclusions: The incidence of CPSP can potentially be reduced through early identification of
perioperative, genetic, physiologic, and psychologic factors. Models predicting the development
of CPSP continue to improve and may help focus preventative efforts in patients at highest risk.
There is a growing body of evidence supporting the use of multimodal analgesia and anesthetic
techniques in the reducing rates of CPSP development.
Key words: Acute pain, chronic postsurgical pain, pain sensitization, chronic pain prevention,
regional anesthesia, pain adjuncts, neuraxial anesthesia, chronic pain risk factors
Transition from Acute to Chronic Pain:
Evaluating Risk for Chronic Postsurgical Pain
