Chronic Postoperative Pain

Abstract

Chronic postoperative pain (CPOP) is a serious health issue that affects millions of patients every year. The incidence of CPOP is the highest after amputations, inguinal hernioplasty, thoracotomies, cardiac surgery and breast surgery. In addition to surgical factors, the other risk factors are: female gender, younger age, preoperative pain, psychological state and acute postoperative pain. The most common expression of CPOP is neuropathic pain after surgical trauma. The treatment of chronic postoperative neuropathic pain (CPNP) is difficult. Various methods have been recommended for its prevention, the most important being techniques that avoid nerve damage and adequate perioperative analgesia. The goal of this review was to discuss data from published studies examining the incidence, risk factors and mechanisms of CPOP, with a focus on surgery, the unique opportunity to implement pharmacological strategies for prevention of CPNP and current pharmacotherapy approaches for treatment of CPNP. Commonly used drugs to prevent and treat CPNP in the current clinical setting are: opioids, α2-adrenergic agonists, cyclooxygenase antagonists, gabapentin, pregabalin, steroids, N-methyl-D-aspartate receptor antagonists and local anesthetics.

Keywords

• chronic postoperative pain
• neuropathic pain
• sensitization
• microglia
• pharmacotherapy
• analgesia