[Chronic postsurgical pain]

Abstract

Objectives: Update reviewing of chronic postsurgical pain.

Data sources: The following review is based on the English and French literature published in PubMed database between January 1998 and 2013. The research articles were made with following keywords alone or in combination: "chronic pain", "surgery", "postsurgical pain". These keywords were combined with "epidemiology", "incidence", "predictive factors" and "prevention". Study selection Publications were deemed relevant if they contained information about CPSP after 8 weeks post surgery. Animal publications were not included. Only randomized controlled studies were taken into consideration for the pharmacological prevention.

Data extraction: Data extracted were related to epidemiology, impact, predictive factors and prevention of CPSP.

Data synthesis: Epidemiology of CPSP is more recognized as it is experienced by 10-50% of individuals after classical operations. CPSP can be severe in about 5 to 10% of these patients. CPSP is a major public health problem still rarely diagnosed and treated. Twenty percent of patients consulting in a pain clinic have a CPSP. The frequency of neuropathic pain is important but the difference in the proportion to CPSP falls between 6-68% and depend on the type of surgery. Clinical risk factors and physiopathology of CPSP are subject of wide development. Human studies allowed better understanding of the neurophysiological as well psychological aspect of the development of CPSP. Finally, the possibility of pharmacological prevention of CPSP seems to have increased in the past years. Nevertheless, there are still many questions that need to be answers about the problem. We should clearly define the optimal characteristics of clinical and experimental studies as this will allow the better understanding of the prevention of CPSP. Anesthesiologists play a crucial role in this development. They are involved in all of the stages of the operative care of patients and play a decisive role in the evaluation of the risk, the development of a preventive strategy, and in the early detection and treatment of CPSP.