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Persistent and Chronic Perioperative Pain After Cancer Surgery

  • Anesthesiology and Critical Care (JP Cata, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Persistent and chronic pain after cancer surgery is a complex clinical problem. The etiology of pain in these cases is often multifactorial and, in addition to the surgery itself, can include or overlap with other painful syndromes such as direct effects of tumors, neuropathic pain, and pain syndromes secondary to chemotherapy and/or radiation.

Recent Findings

There is a growing body of literature which suggests that treating pain in the acute and subacute periods can prevent chronic pain, an important step in reducing the morbidity of this clinical problem.

Summary

This review describes the incidence of persistent pain after cancer surgery, its pathophysiology, and treatment considerations. Additional research on diagnostic criteria, pathophysiology, and novel medications, restorative therapies, and interventional treatments will be essential to continue to reduce the clinical burden of persistent and chronic perioperative pain after cancer surgery.

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References

Papers of particular interest, published recently, have been highlighted as: • Of major importance

  1. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016 Jun 20;6(6): e010364. https://doi.org/10.1136/bmjopen-2015-010364.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  3. Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol. 2014;32:1739–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Breivik H, Cherny N, Collett B, de Conno F, Filbet M, Foubert AJ, Cohen R, Dow L. Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol. 2009;20:1420–33.

    Article  CAS  PubMed  Google Scholar 

  5. Oldenmenger WH, Smitt PAS, van Dooren S, Stoter G, van der Rijt CC. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer. 2009;45:1370–80.

    Article  PubMed  Google Scholar 

  6. Seretny M, Currie GL, Sena ES, Ramnarine S, Grant R, MacLeod MR, Colvin L, Fallon M. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain. 2014;155:2461–70.

    Article  PubMed  Google Scholar 

  7. Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, Thompson AM, Cairns Smith W, Chambers WA, Scott NW. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain. 2014;155:232–43.

    Article  PubMed  Google Scholar 

  8. Wildgaard K, Ravn J, Nikolajsen L, Jakobsen E, Jensen TS, Kehlet H. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand. 2011;55:60–8.

    Article  CAS  PubMed  Google Scholar 

  9. Kehlet H., Jensen T.S., Woolf C.J.. Persistent postsurgical pain: risk factors and prevention, Lancet, 2006, vol. 367 9522(pg. 1618–1625)

  10. Gagnon B, Scott S, Nadeau L, Lawlor P, Johnell K. Patterns of community-based opioid prescriptions in people dying of cancer. J Pain Symptom Manage. 2015;49:36–44.

    Article  PubMed  Google Scholar 

  11. Ziegler L, Mulvey M, Blenkinsopp A, Petty D, Bennett MI. Opioid prescribing for patients with cancer in the last year of life: a longitudinal population cohort study. Pain. 2016;157:2445–51.

    Article  CAS  PubMed  Google Scholar 

  12. Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G. Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol. 2014;32:4149–54.

    Article  PubMed  Google Scholar 

  13. Portenoy RK, Ahmed E. Cancer pain syndromes. Hematol Oncol Clin North Am. 2018 Jun;32(3):371–86. https://doi.org/10.1016/j.hoc.2018.01.002.

    Article  PubMed  Google Scholar 

  14. Bennett MI, Kaasa S, Barke A, Korwisi B, Rief W, Treede RD; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain. 2019 Jan;160(1):38–44. https://doi.org/10.1097/j.pain.0000000000001363

  15. Beloeil H, Sion B, Rousseau C, Albaladejo P, Raux M, Aubrun F, Martinez V; SFAR research network. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol. 2017 Oct;34(10):652–657. https://doi.org/10.1097/EJA.0000000000000634

  16. Neil MJ, Macrae WA. Post surgical pain- the transition from acute to chronic pain. Rev Pain. 2009;3(2):6–9. https://doi.org/10.1177/204946370900300203.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sensitization of primary afferents to mechanical and heat stimuli after incision in a novel in vitro mouse glabrous skin-nerve preparation. Banik RK, Brennan TJ. Pain. 2008 Aug 31; 138(2):380–391.

  18. Lactate concentrations in incisions indicate ischemic-like conditions may contribute to postoperative pain. Kim TJ, Freml L, Park SS, Brennan TJ. J Pain. 2007 Jan; 8(1):59–66.

  19. Changes in tissue pH and temperature after incision indicate acidosis may contribute to postoperative pain. Woo YC, Park SS, Subieta AR, Brennan TJ. Anesthesiology. 2004 Aug; 101(2):468–75.

  20. Wound hypoxia in deep tissue after incision in rats. Kang S, Lee D, Theusch BE, Arpey CJ, Brennan TJ. Wound Repair Regen. 2013 Sep-Oct; 21(5):730–9.

  21. Kido K, Gautam M, Benson CJ, Gu H, Brennan TJ. Effect of deep tissue incision on pH responses of afferent fibers and dorsal root ganglia innervating muscle. Anesthesiology. 2013;119:1186–97.

    Article  PubMed  Google Scholar 

  22. King W. (2013) Acute pain, subacute pain, and chronic pain. In: Gebhart G.F., Schmidt R.F. (eds) Encyclopedia of Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28753-4_75

  23. Veal FC, Bereznicki LRE, Thompson AJ, Peterson GM, Orlikowski C. Subacute pain as a predictor of long-term pain following orthopedic surgery: an Australian prospective 12 month observational cohort study [published correction appears in Medicine (Baltimore). 2015 Oct;94(43):1]. Medicine (Baltimore). 2015;94(36):1. https://doi.org/10.1097/MD.0000000000001498. A prospective study that contributed to an important and novel theory in the development of chronic pain: the development of subacute pain is a strong predictor of chronic pain - treating acute and subacute pain adequately may limit the development of chronic pain after surgery.

  24. Wand BM, Bird C, McAuley JH, et al. Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of biopsychosocial education, manual therapy, and exercise. Spine. 2004;29:2350–6.

    Article  PubMed  Google Scholar 

  25. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926. https://doi.org/10.1016/j.jpain.2009.06.012. This article outlines an important physiological mechanism behind the development of chronic pain: sensitization of pain in the CNS may contribute to hyperalgesic states.

  26. Characterization of incisional and inflammatory pain in rats using functional tools of MRI. Amirmohseni S, Segelcke D, Reichl S, Wachsmuth L, Görlich D, Faber C, Pogatzki-Zahn E. Neuroimage. 2016 Feb 15; 127():110–122.

  27. Coding of incisional pain in the brain: a functional magnetic resonance imaging study in human volunteers. Pogatzki-Zahn EM, Wagner C, Meinhardt-Renner A, Burgmer M, Beste C, Zahn PK, Pfleiderer B. Anesthesiology. 2010 Feb; 112(2):406–17.

  28. Short-term pre- and post-operative stress prolongs incision-induced pain hypersensitivity without changing basal pain perception. Cao J, Wang PK, Tiwari V, Liang L, Lutz BM, Shieh KR, Zang WD, Kaufman AG, Bekker A, Gao XQ, Tao YX. Mol Pain. 2015 Dec 2; 11():73.

  29. G9a is essential for epigenetic silencing of K(+) channel genes in acute-to-chronic pain transition. Laumet G, Garriga J, Chen SR, Zhang Y, Li DP, Smith TM, Dong Y, Jelinek J, Cesaroni M, Issa JP, Pan HL. Nat Neurosci. 2015 Dec; 18(12):1746–55.

  30. Lawlor PG, Lawlor NA, Reis-Pina P. The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. Expert Review of Quality of Life in Cancer Care. 2018;3(2–3):47–64. https://doi.org/10.1080/23809000.2018.1467211.

    Article  Google Scholar 

  31. World Health Organization. (2004). ICD-10: international statistical classification of diseases and related health problems : tenth revision, 2nd ed. World Health Organization.

  32. WHO. International Statistical Classification of Diseases and Related Health Problems (ICD-11). Available at: https://icd.who.int/browse11/l-m/en. Accessed 20 Mar 2019.

  33. Schreiber KL, Belfer I, Miaskowski C, Schumacher M, Stacey BR, Van De Ven T. AAAPT diagnostic criteria for acute pain following breast surgery. J Pain. 2020;21(3–4):294–305. https://doi.org/10.1016/j.jpain.2019.08.008.

    Article  PubMed  Google Scholar 

  34. Interagency Pain Research Coordinating Committee. (2015). A comprehensive population healthlevel strategy for pain: National pain strategy.

  35. U.S. Department of Health and Human Services (2019, May). Pain management best practices inter-agency task force report: updates, gaps, inconsistencies, and recommendations. Retrieved from U. S. Department of Health and Human Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html. This 2019 final report from the Inter-Agency Task Force provides updates in the gaps and inconsistencies in our understanding of pain management, introduces “clinical best practice” recommendations, and provides recommendations for future research in the field.

  36. Shmagel A, Ngo L, Ensrud K, Foley R. Prescription medication use among community-based US adults with chronic low back pain: a cross-sectional population based study. J Pain. 2018;19(10):1104–12.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jadad AR, Browman GP. The WHO analgesic ladder for cancer pain management. Stepping up the quality of its evaluation. JAMA. 1995 Dec 20;274(23):1870–3.

  38. Woolf, Clifford J. Central sensitization: implications for the diagnosis and treatment of pain, Pain: March 2011 - Volume 152 - Issue 3 - p S2-S15. https://doi.org/10.1016/j.pain.2010.09.030

  39. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Straatman J, van der Wielen N, Cuesta MA, Daams F, Roig Garcia J, Bonavina L, Rosman C, van Berge Henegouwen MI, Gisbertz SS, van der Peet DL. Ann Surg. 2017 Aug; 266(2):232–236.

  40. Verret M, Lauzier F, Zarychanski R, et al. Perioperative use of gabapentinoids for the management of postoperative acute pain: a systematic review and meta-analysis [published correction appears in Anesthesiology. 2020 Aug 21;:null]. Anesthesiology. 2020;133(2):265–279. https://doi.org/10.1097/ALN.0000000000003428

  41. Nguyen BK, Svider PF, Hsueh WD, Folbe AJ. Perioperative analgesia for sinus and skull-base surgery. Otolaryngol Clin North Am. 2020;53(5):789–802. https://doi.org/10.1016/j.otc.2020.05.008.

    Article  PubMed  Google Scholar 

  42. Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Phys Med Rehabil Clin N Am. 2017 Feb; 28(1):49–64.

  43. Consequences of bed rest. Brower RG. Crit Care Med. 2009 Oct;37(10 Suppl):S422–8.

    Google Scholar 

  44. Effect of the informed consent process on anxiety and comprehension of patients undergoing esophageal and gastrointestinal surgery. Betti S, Sironi A, Saino G, Ricci C, Bonavina L. J Gastrointest Surg. 2011 Jun; 15(6):922–7.

  45. Deng G. Integrative medicine therapies for pain management in cancer patients. Cancer J. 2019 Sep/Oct;25(5):343–348. https://doi.org/10.1097/PPO.0000000000000399.

  46. Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS, Jiang J, Li Q, McMillan K, Santa Mina D, Wentlandt K, McRae K, Tamir D, Lyn S, de Perrot M, Rao V, Grant D, Roche-Nagle G, Cleary SP, Hofer SO, Gilbert R, Wijeysundera D, Ritvo P, Janmohamed T, O’Leary G, Clarke H. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res. 2015 Oct;12(8):695–702. https://doi.org/10.2147/JPR.S91924.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Lewis Katz School of Medicine at Temple University, Temple University Health System, 3401 North Broad Street, Room A059, Philadelphia, PA, 19140, USA

    Behnum Ali Habibi

  2. Department of Physical Medicine and Rehabilitation, Department of Anesthesiology, Case Western Reserve University School of Medicine, MetroHealth Medical System, Cleveland, OH, USA

    Chong Kim

  3. Department of Anesthesiology, Case Western Reserve University School of Medicine, MetroHealth Medical System, Cleveland, OH, USA

    Hesham Elsharkawy

Authors
  1. Behnum Ali Habibi
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  2. Chong Kim
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  3. Hesham Elsharkawy
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BH (writing, editing); CK (writing, editing); HE (writing, editing).

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Correspondence to Behnum Ali Habibi.

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Habibi, B.A., Kim, C. & Elsharkawy, H. Persistent and Chronic Perioperative Pain After Cancer Surgery. Curr Oncol Rep 24, 215–222 (2022). https://doi.org/10.1007/s11912-021-01152-5

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