Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jul;31(3):155-173.
doi: 10.3344/kjp.2018.31.3.155. Epub 2018 Jul 2.

Chronic postsurgical pain: current evidence for prevention and management

Parineeta Thapa  1 , Pramote Euasobhon  2
Affiliations
Review

Chronic postsurgical pain: current evidence for prevention and management

Parineeta Thapa et al. Korean J Pain. 2018 Jul.

Abstract

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.

Keywords: Chronic pain; Drug therapy; Incidence; Intractable pain; Neuropathic pain; Operative surgical procedure; Pain management; Physical therapy modalities; Postoperative pain; Prevention; Therapeutic methods.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that there is no conflicts of interest and no source of funding.

Figures

Fig. 1
Fig. 1. Step-by-step approach to the prevention of chronic postsurgical pain.
See this image and copyright information in PMC

References

    1. Macrae WA, Davies HT. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, editors. Epidemiology of pain. Seattle, WA: IASP Press; 1999. pp. 125–142.
    1. Macrae WA. Chronic pain after surgery. Br J Anaesth. 2001;87:88–98. - PubMed
    1. Werner MU, Kongsgaard UE. I. Defining persistent postsurgical pain: is an update required? Br J Anaesth. 2014;113:1–4. - PubMed
    1. Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol. 2015;32:725–734. - PubMed
    1. Schug SA, Pogatzki-Zahn EM. Pain: clinical updates. Washington, D.C.: International Association for the Study of Pain; 2011. Chronic pain after surgery or injury; p. 19.