Chronic Pain After Surgery

Chronic postoperative pain is a potentially devastating outcome from successful surgical procedure. Patients experience pain long after they have healed after surgery.

Mechanism:- Surgery, by nature, involves the cutting of tissues and nerves, which induces the injury response (inflammation, hyperalgesia) and alterations of peripheral and central nervous system (CNS) pain processing (central sensitization), which can lead to chronic pain.

Criteria

• The pain must have developed after surgery.
• The pain is of at least 2 months in duration.
• Other causes for the pain have been excluded.
• The possibility that the pain is continuing from a pre-existing problem must be explored and exclusion attempted

Risk factor

• Preoperative pain
• Psychological factors (e.g. anxiety, depression, and catastrophizing)
• Demographics (e.g. female gender and younger age)
• Surgical factors (e.g. open approach and length >3 hours)
• The intensity of pain in the immediate postoperative period (i.e. first few days)

Incidence

Treatments

• NSAIDS
• Alpha-2 delta ligands
• Alpha-2 adregernic agonist: Clonidine, Dexmedetomidinev
• Ketamine
• Lidocaine
• Coticoseteroids