Prevention of chronic pain after surgery: new insights for future research and patient care

Excerpt

Management of acute pain following surgery is a vital effort that involves safely alleviating pain, nausea/vomiting, anxiety/depression, and other disabling symptoms as well as minimizing pain-related organ system dysfunction and promoting recovery.1 Various interventions, including opioids, cyclooxygenase inhibitors, local anesthetics and other classes of agents, have been proven effective in relieving pain early after surgery.2 Previous dogma that “acute” pain is always short-lived and related only to peripheral inflammatory changes at the injured site has been progressively challenged over the past 30 years.3‐5 Mounting evidence that tissue injury often results in changes to nervous system function has provided a new understanding of mechanisms that explain how surgery can often lead to chronic pain.6,7 Reported associations between the severity of preoperative and early postoperative pain and increased likelihood of transition to chronic pain8 have generated a number of research questions, for example: 1) Does more successful acute pain treatment prevent chronic pain? 2) Which other factors – that are associated with more severe early pain – are also associated with transition to chronic pain? 3) Can we preoperatively predict those patients at risk for high intensity, early, and persistent postoperative pain? Anesthesiologists, together with other health professionals, have been uniquely positioned to address these hypotheses with the ultimate goals of improving pain management and, furthermore, preventing chronic pain. …