, Volume 75, Issue 4, pp 339–351 | Cite as

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

  • Hance Clarke
  • Michael Poon
  • Aliza Weinrib
  • Rita Katznelson
  • Kirsten Wentlandt
  • Joel Katz
Leading Article


Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient’s quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute post-operative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain.



HC is supported by a Merit Award (Department of Anaesthesia, University of Toronto) and the STAGE Training Program in Genetic Epidemiology (Canadian Institutes of Health Research, CIHR) and a grant by the Physicians Services Incorporated Foundation. JK is supported by a Canada Research Chair in Health Psychology. The authors of this manuscript have no conflicts of interest to declare.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Hance Clarke
    • 1
    • 2
    • 3
  • Michael Poon
    • 1
  • Aliza Weinrib
    • 1
    • 3
  • Rita Katznelson
    • 1
    • 2
    • 3
  • Kirsten Wentlandt
    • 3
    • 5
    • 6
  • Joel Katz
    • 1
    • 2
    • 3
    • 4
  1. 1.Pain Research Unit, Department of Anesthesia and Pain ManagementToronto General HospitalTorontoCanada
  2. 2.Department of AnesthesiaUniversity of TorontoTorontoCanada
  3. 3.Transitional Pain Service, Toronto General HospitalTorontoCanada
  4. 4.Department of PsychologyYork UniversityTorontoCanada
  5. 5.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  6. 6.Palliative Care, Toronto General HospitalTorontoCanada

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