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Review Article

Korean J Pain 2018; 31(3): 155-173

Published online July 31, 2018 https://doi.org/10.3344/kjp.2018.31.3.155

Copyright © The Korean Pain Society.

Chronic postsurgical pain: current evidence for prevention and management

Parineeta Thapa1, and Pramote Euasobhon2*

1Department of Anaesthesiology and Critical Care, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

2Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Correspondence to: Pramote Euasobhon. Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. Tel: +66-2-419-7842, Fax: +66-2-411-3713, pramoteo@hotmail.com

Received: January 17, 2018; Revised: February 23, 2018; Accepted: March 15, 2018

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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