Persistent postsurgical pain: evidence from breast cancer surgery, groin hernia repair, and lung cancer surgery
- PMID: 24523139
- DOI: 10.1007/7854_2014_285
Persistent postsurgical pain: evidence from breast cancer surgery, groin hernia repair, and lung cancer surgery
Abstract
The prevalences of severe persistent postsurgical pain (PPP) following breast cancer surgery (BCS), groin hernia repair (GHR), and lung cancer surgery (LCS) are 13, 2, and 4-12 %, respectively. Estimates indicate that 80,000 patients each year in the U.S.A. are affected by severe pain and debilitating impairment in the aftermath of BCS, GHR, and LCS. Data across the three surgical procedures indicate a 35-65 % decrease in prevalence of PPP at 4-6 years follow-up. However, this is outweighed by late-onset PPP, which appears following a pain-free interval. The consequences of PPP include severe impairments of physical, psychological, and socioeconomic aspects of life. The pathophysiology underlying PPP consists of a continuing inflammatory response, a neuropathic component, and/or a late reinstatement of postsurgical inflammatory pain. While the sensory profiles of PPP-patients and pain-free controls are comparable with hypofunction on the surgical side, this seems to be accentuated in PPP-patients. In BCS-patients and GHR-patients, the sensory profiles indicate inflammatory and neuropathic components with contribution of central sensitization. A number of surgical factors including increased duration of surgery, repeat surgery, more invasive surgical techniques, and intraoperative nerve lesion have been associated with PPP. One of the most consistent predictive factors for PPP is high intensity acute postsurgical pain, but also psychological factors including anxiety, catastrophizing trait, depression, and psychological vulnerability have been identified as significant predictors of PPP. The quest to identify improved surgical and anesthesiological techniques to prevent severe pain and functional impairment in patients after surgery continues.
Similar articles
-
Predictive risk factors for persistent postherniotomy pain.Anesthesiology. 2010 Apr;112(4):957-69. doi: 10.1097/ALN.0b013e3181d31ff8. Anesthesiology. 2010. PMID: 20234307
-
Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer.J Pain. 2013 Aug;14(8):854-64. doi: 10.1016/j.jpain.2013.02.013. Epub 2013 May 17. J Pain. 2013. PMID: 23685186
-
Seven-year follow-up of persistent postsurgical pain in cardiac surgery patients: A prospective observational study of prevalence and risk factors.Eur J Pain. 2021 Sep;25(8):1829-1838. doi: 10.1002/ejp.1794. Epub 2021 Jun 13. Eur J Pain. 2021. PMID: 33982819
-
The mechanisms and management of persistent postsurgical pain.Front Pain Res (Lausanne). 2023 Jul 6;4:1154597. doi: 10.3389/fpain.2023.1154597. eCollection 2023. Front Pain Res (Lausanne). 2023. PMID: 37484030 Free PMC article. Review.
-
Persistent postsurgical pain: risk factors and prevention.Lancet. 2006 May 13;367(9522):1618-25. doi: 10.1016/S0140-6736(06)68700-X. Lancet. 2006. PMID: 16698416 Review.
Cited by
-
Patient-Reported Symptom Interference as a Measure of Postsurgery Functional Recovery in Lung Cancer.J Pain Symptom Manage. 2016 Dec;52(6):822-831. doi: 10.1016/j.jpainsymman.2016.07.005. Epub 2016 Aug 10. J Pain Symptom Manage. 2016. PMID: 27521528 Free PMC article.
-
Depression and Anxiety Are Associated With Increased Health Care Costs and Opioid Use for Patients With Femoroacetabular Impingement Undergoing Hip Arthroscopy: Analysis of a Claims Database.Arthroscopy. 2020 Mar;36(3):745-750. doi: 10.1016/j.arthro.2019.09.048. Epub 2020 Jan 8. Arthroscopy. 2020. PMID: 31924382 Free PMC article.
-
Effect of a high-dose target-controlled naloxone infusion on pain and hyperalgesia in patients following groin hernia repair: study protocol for a randomized controlled trial.Trials. 2015 Nov 10;16:511. doi: 10.1186/s13063-015-1021-6. Trials. 2015. PMID: 26554360 Free PMC article. Clinical Trial.
-
Membrane protein Nav1.7 contributes to the persistent post-surgical pain regulated by p-p65 in dorsal root ganglion (DRG) of SMIR rats model.BMC Anesthesiol. 2017 Nov 7;17(1):150. doi: 10.1186/s12871-017-0438-8. BMC Anesthesiol. 2017. PMID: 29115943 Free PMC article.
-
Lost but making progress--Where will new analgesic drugs come from?Sci Transl Med. 2014 Aug 13;6(249):249sr3. doi: 10.1126/scitranslmed.3008320. Sci Transl Med. 2014. PMID: 25122640 Free PMC article. Review.
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical