Frontiers in Chronic Pain: Nonpharmacologic Presurgical Management to Reduce the Risk of Chronic Postsurgical Pain—Part 2

2021 ◽  
Vol 36 (7) ◽  
pp. 1-10
Author(s):  
Roy J. Film
Keyword(s):  
Chronic Pain ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

scholarly journals Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

2021 ◽  
Author(s):  
Yingying Zhang ◽  
Rong Zhou ◽  
Bailing Hou ◽  
Suhong Tang ◽  
Jing Hao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Thoracoscopic Surgery ◽  
Rescue Analgesia ◽  
Postsurgical Pain ◽  
Video Assisted ◽  
Chronic Postsurgical Pain ◽  
Severe Chronic Pain ◽  
Independent Risk Factors ◽  
Video Assisted Thoracoscopic Surgery

Abstract Backgroud: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP.Results: 2,348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1,033 of 2,348). Within those suffering CPSP, 14.71% (n = 152 of 1,033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. According to multivariable analysis, age ＜ 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), subcutaneous emphysema of chest wall postoperative (OR 1.255, 95% CI 1.000-1.575, P = 0.050), and history of postoperative wound infection (OR 5.949, 95% CI 1.344-1.898, P < 0.001) were independent risk factors for CPSP development.Conclusions: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

scholarly journals Transition from Acute to Chronic Pain: Evaluating Risk for Chronic Postsurgical Pain

2019 ◽  
Vol 5 (22;5) ◽  
pp. 479-488
Author(s):  
Jingping Wang
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Predictive Models ◽  
Narrative Review ◽  
Current Understanding ◽  
Anesthetic Techniques ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Pain Sensitization ◽  
Underlying Pathophysiology

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

scholarly journals A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jennifer A. Rabbitts ◽  
Chuan Zhou ◽  
Rocio de la Vega ◽  
Homer Aalfs ◽  
Caitlin B. Murray ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Randomized Controlled Trial ◽  
Spinal Fusion ◽  
Acute Pain ◽  
Controlled Trial ◽  
Opioid Use ◽  
Cognitive Behavioral Intervention ◽  
Postsurgical Pain ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Background Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. Methods Adolescents 12–18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. Discussion Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. Trial registration NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020

Preoperative frailty and its association with postsurgical pain in an older patient cohort

2019 ◽  
Vol 44 (7) ◽  
pp. 695-699 ◽  
Author(s):  
Gary Joseph Esses ◽  
Xiaoyu Liu ◽  
Hung-Mo Lin ◽  
Yury Khelemsky ◽  
Stacie Deiner
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Community Setting ◽  
Preoperative Pain ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Pain Outcomes ◽  
Registration Number ◽  
Geriatric Pain

Background and objectivesChronic postsurgical pain in patients over 65 negatively impacts recovery, quality of life and physical functioning. In the community setting, chronic pain has been shown to be related to frailty, a syndrome more commonly seen in older adults and characterized by limited physiologic reserve and ability to withstand stressors. While frailty is an important preoperative risk factor for poor surgical outcomes in older adults, the relationship between frailty and postsurgical pain in this population has not been investigated. We hypothesized that preoperative frailty would be associated with greater odds of postsurgical chronic pain.MethodsWe conducted a prospective cohort study of 116 patients older than 65 years old who underwent major elective non-cardiac surgery. Patients were assessed for frailty within 30 days prior to surgery using the FRAIL Scale assessment and pain was evaluated before surgery and at 3 months after surgery using the Geriatric Pain Measure.ResultsAfter adjusting for baseline characteristics, we found that frail patients were almost five times more likely to have intrusive postsurgical pain compared with patients who were not frail (OR 4.73, 95% CI 1.24 to 18.09). Intrusive preoperative pain and spine surgery were also associated with increased postsurgical pain (OR 10.13, 95% CI 2.81 to 36.57 and OR 4.02, 95% CI 1.22 to 13.17, respectively).ConclusionAlthough future studies are needed to establish a causal relationship between preoperative frailty and postsurgical pain, our findings suggest that older patients should have preoperative frailty assessments and frail older adults may need additional resources to improve postsurgical pain outcomes.Trial registration numberNCT02650687

scholarly journals Risk Factors for Chronic Pain after Hysterectomy

2007 ◽  
Vol 106 (5) ◽  
pp. 1003-1012 ◽  
Author(s):  
Birgitte Brandsborg ◽  
Lone Nikolajsen ◽  
Charlotte T. Hansen ◽  
Henrik Kehlet ◽  
Troels S. Jensen
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Spinal Anesthesia ◽  
Pelvic Pain ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Indication For Surgery ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Previous Cesarean

Background Women scheduled to undergo hysterectomy for benign indications frequently have preoperative pelvic pain, but it is largely unknown why pain in some cases persists or even develops after surgery. This nationwide questionnaire and database study describes pain and identifies risk factors for chronic postsurgical pain 1 yr after hysterectomy for benign indications. Methods A pain questionnaire was mailed to 1,299 women 1 yr after hysterectomy. The response rate was 90.3%, and the presence of persistent pain was correlated to indication for surgery, surgical procedure, type of anesthesia, and other perioperative data. Results Pain was reported by 31.9% 1 yr after hysterectomy (chronic pain), and 13.7% had pain more than 2 days a week. Pain was not present before surgery in 14.9% of women with chronic postsurgical pain. Risk factors for chronic pain were preoperative pelvic pain (odds ratio [OR], 3.25; 95% confidence interval [CI], 2.40-4.41), previous cesarean delivery (OR, 1.54; CI, 1.06-2.26), pain as the main indication for surgery (OR, 2.98; CI, 1.54-5.77), and pain problems elsewhere (OR, 3.19; CI, 2.29-4.44). Vaginal hysterectomy versus total abdominal hysterectomy was not significantly associated with a lower risk of chronic pain (OR, 0.70; CI, 0.46-1.06). Importantly, spinal versus general anesthesia was associated with less chronic pain (OR, 0.42; CI, 0.21-0.85). Conclusions Thirty-two percent had chronic pain after hysterectomy, and risk factors were comparable to those seen in other operations. Interestingly, spinal anesthesia was associated with a lower frequency of chronic pain, justifying prospective study of spinal anesthesia for patients with a high risk for development of chronic postsurgical pain.

scholarly journals Post-episiotomy chronic neuropatic pain: Postpartal chronic neuropathic pain

2020 ◽  
Vol 42 (5-6) ◽  
pp. 109-114
Author(s):  
Jelena Jovičić ◽  
Bojan Čegar ◽  
Nataša Petrović ◽  
Nikola Lađević ◽  
Branka Gvozdić ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Psychosocial Functioning ◽  
Current Treatment ◽  
Social Model ◽  
Health Providers ◽  
Postsurgical Pain ◽  
Pain Specialist ◽  
Epidemiological Surveys ◽  
Chronic Postsurgical Pain

Introduction: Chronic postsurgical pain has an estimated mean incidence of 30% and varies according to the type of surgery and patient characteristics. The pain can be severe and result in clinically relevant functional impairment reported by 5-10% of patients. Epidemiological surveys have shown that many patients with neuropathic pain do not receive appropriate treatment. Bio-psycho-social model of chronic pain is highly expressive in neuropathic pain management and requires the adjustment of the therapeutic approach. Case Report: A 37-year-old female complained of numbness, burning, and discomfort of the perineum. In 2016, after the vaginal baby delivery followed by episiotomy, she experienced discomfort and variety of painful sensations in the episiotomy incision region. A year later, after a hemorrhoid surgery followed by episiotomy scar reconstruction symptoms intensified with a strong influence on the patient's psychosocial condition. Consultation of obstetrician, psychiatrist and neurologist took part. Nevertheless, after two years had passed without significant clinical improvement, the patient was referred to a pain specialist. The pain specialist noticed inconsistency in the current treatment and the pain assessment was done only by one specialist. Testing revealed severe symptoms of hyperalgesia and allodynia, impaired psychosocial functioning related to chronic postsurgical pain. Pregabalin and duloxetine were introduced into the therapy and significantly improved pain relief and psychosocial functioning. Conclusion: Chronic postsurgical neuropathic pain is a complex syndrome which is not necessarily related to extensive surgical stimulus. The multidisciplinary therapy approach is crucial. Health providers who understand bio-psycho-social origin of chronic pain should be members of a multidisciplinary team.

Up-regulation of Cathepsin G in the Development of Chronic Postsurgical Pain

2015 ◽  
Vol 123 (4) ◽  
pp. 838-850 ◽  
Author(s):  
Xiaodong Liu ◽  
Yuanyuan Tian ◽  
Zhaoyu Meng ◽  
Yan Chen ◽  
Idy H. T. Ho ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Human Study ◽  
Neutrophil Infiltration ◽  
Cathepsin G ◽  
Intraplantar Injection ◽  
Postsurgical Pain ◽  
Potential Marker ◽  
Genome Wide ◽  
A Genome ◽  
Chronic Postsurgical Pain

Abstract Background: Proteases have been shown to modulate pain signaling in the spinal cord and may contribute to the development of chronic postsurgical pain. By using peripheral inflammation in rats as a chronic pain model, the authors identified the deregulation of proteases and their inhibitors as a hallmark of chronic pain development using a genome-wide screening approach. Methods: A microarray analysis was performed and identified spinal cathepsin G (CTSG) as the most up-regulated gene in rats with persistent hyperalgesia after intraplantar injection of complete Freund’s adjuvant (n = 4). Further experiments were performed to elucidate the mechanisms of CTSG-induced hyperalgesia by intrathecally applying specific CTSG inhibitor (n = 10). The authors also evaluated the association between CTSG gene polymorphisms and the risk of chronic postsurgical pain in 1,152 surgical patients. Results: CTSG blockade reduced heat hyperalgesia, accompanied by a reduction in neutrophil infiltration and interleukin 1β levels in the dorsal horns. In the gene association study, 246 patients (21.4%) reported chronic postsurgical pain at 12-month follow-up. Patients with AA genotypes at polymorphisms rs2070697 (AA-15.3%, GA-24.1%, and GG-22.3%) or rs2236742 (AA-6.4%, GA-20.4%, and GG-22.6%) in the CTSG gene had lower risk for chronic postsurgical pain compared with wild-types. The adjusted odds ratios were 0.67 (95% CI, 0.26 to 0.99) and 0.34 (95% CI, 0.21 to 0.98), respectively. Conclusions: This study demonstrated that CTSG is a pronociceptive mediator in both animal model and human study. CTSG represents a new target for pain control and a potential marker to predict patients who are prone to develop chronic pain after surgery.

Chronic postsurgical pain and complex regional pain syndrome

2021 ◽  
pp. 289-291
Author(s):  
Lesley A. Colvin ◽  
Sebastian Bourn
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Complex Regional Pain Syndrome ◽  
International Association ◽  
Emotional Experience ◽  
Adult Population ◽  
Clinical Signs ◽  
Pain Syndrome ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain

Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. Acute pain is predictable following surgical intervention; chronic pain is less so. Chronic pain, persisting for longer than 3 months, or beyond expected wound healing, is a worldwide problem affecting around 20% of the adult population. Chronic postsurgical pain is multifactorial, although it often involves some form of nerve damage, with clinical signs consistent with this. Neuropathic pain may have a greater impact on quality of life than other chronic pain syndromes. It is important, therefore, to identify neuropathic pain as early as possible, in order to initiate appropriate management and reduce longer-term impact. This chapter focuses on two types of neuropathic pain: chronic postsurgical pain and complex regional pain syndrome.

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