Postsurgical pain management can be a factor that influences the progression to chronic pain. Understanding the preop and postop factors that influence the success of postsurgical pain management may help prevent this progression.

Timothy Brennan, MD, anesthesiologist and professor at University of Iowa Medical Center, spoke this conclusion during the Global Year Against Pain Lecture, “What Can We Learn from Post-operative Pain?”, delivered at the recent American Pain Society Annual Scientific Conference.

“Post-operative pain, its consequences and response to treatment, vary greatly among patients,” Brennan states, in a media release from the American Pain Society. “Most postoperative pain resolves, however, chronic pain after surgery and continued medication use are increasingly recognized as important perioperative problems.”

“Although we assume that good treatment of acute post-surgical pain will prevent chronic pain, higher severity of acute pain during the first three days after surgery is associated with greater likelihood for progression to chronic pain,” he adds.

“We know that procedure-specific chronic conditions occur after common operations, such as the severe pain associated with breast and cardiac surgeries and orthopedic joint replacements. However, it has been very difficult to understand the pathogenesis, prevention and treatment of postoperative chronic pain,” Brennan shares, the release continues.

“Also, it is well known that psychosocial factors strongly impact transition from acute to chronic pain. Limited coping ability, depression, and anxiety can predict poorer acute pain control and advancement to persistent postsurgical pain.”

Sometimes high doses of opioids are required to aid in treatment success. With that in mind, Brennan notes that those involved in perioperative care need better understanding about long-term use of opioids after acute post-op pain.

“We need to learn more about long-term use of opioids after acute postoperative pain and identify patient subgroups at high risk in order to reduce progression to chronic opioid use,” he adds.

Further studies are needed to help predict which surgical patients are most likely to develop chronic pain and continue using opioids and other drugs, Brennan concludes.  “In future studies, batteries of psychosocial variables could be assessed before and after surgery in larger numbers of patients. Measures of neuropathic pain, mood and function can be added to assess the impact of these factors on pain outcomes.”

[Source(s): American Pain Society, Newswise]