Skip to main content

Advertisement

SpringerLink
Log in

Chronic pain after surgery: What can we do to prevent it?

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The development of chronic pain after surgery is not an uncommon event. Despite increased attention devoted to this topic in the recent medical literature, little is known about the underlying mechanisms, natural history, and response to therapy of each syndrome. Central nervous system plasticity that occurs in response to tissue injury may contribute to the development of persistent postsurgical pain. As evidence continues to accumulate concerning the role of central sensitization in the prolongation of postoperative pain, many researchers have focused on methods to prevent central neuroplastic changes from occurring through the use of preemptive or preventative analgesic techniques. Effective preventative analgesic techniques may be useful in reducing not only acute pain but also chronic postsurgical pain and disability. This review examines the efficacy of using a variety of analgesic techniques aimed at preventing or reducing chronic pain after surgery. Specific chronic postsurgical pain syndromes evaluated include complex regional pain syndrome, phantom limb pain, chronic donor site pain, post-thoracotomy pain syndrome, and postmastectomy pain syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 2000, 93:1123–1133.

    Article  PubMed  CAS  Google Scholar 

  2. Macrae WM, Davies HTO: Chronic postsurgical pain. In Epidemiology of Pain. Edited by Crombie IK, Croft PR, Linton SJ, et al. Seattle, WA: IASP; 1999:125–142.

    Google Scholar 

  3. Eisenberg E: Post-surgical neuralgia. Pain 2004, 111:3–7.

    Article  PubMed  Google Scholar 

  4. Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965, 150:971–979.

    Article  PubMed  CAS  Google Scholar 

  5. Coderre TJ, Katz J, Vaccarino AL, Melzack R: Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993, 52:259–285.

    Article  PubMed  CAS  Google Scholar 

  6. Woolf CJ, Salter MW: Neuronal plasticity: increasing the gain in pain. Science 2000, 288:1765–1768.

    Article  PubMed  CAS  Google Scholar 

  7. Moniche S, Kehlet H, Dahl JB: A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002, 96:725–741.

    Article  Google Scholar 

  8. Ong CK, Lirk P, Seymour RA, Jenkins BJ: The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg 2005, 100:757–773.

    Article  PubMed  Google Scholar 

  9. Kissin I: Preemptive analgesia: terminology and clinical relevance [letter]. Anesth Analg 1994, 79:809–810.

    PubMed  CAS  Google Scholar 

  10. Stanton-Hicks M, Janig W, Hassenbusch S, et al.: Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 1995, 63:127–133.

    Article  PubMed  CAS  Google Scholar 

  11. Raja SN, Grabow TS: Complex regional pain syndrome I (reflex sympathetic dystrophy). Anesthesiology 2002, 96:1254–1260.

    Article  PubMed  Google Scholar 

  12. Reuben SS: Preventing the development of complex regional pain syndrome after surgery. Anesthesiology 2004, 101:1215–1224.

    Article  PubMed  Google Scholar 

  13. Pak TJ, Martin GM, Magness JL, Kavanaugh GJ: Reflex sympathetic dystrophy: review of 140 cases. Minn Med 1970, 53:507–512.

    PubMed  CAS  Google Scholar 

  14. Allen G, Galer BS, Schwartz L: Epidemiology of complex regional pain syndrome: a retrospective chart review of 134 patients. Pain 1999, 80:539–544.

    Article  PubMed  CAS  Google Scholar 

  15. Reuben SS, Rosenthal EA, Steinberg RB: Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: a retrospective study of 100 patients. J Hand Surg (Am) 2000, 25:1147–1151.

    CAS  Google Scholar 

  16. Kiowski W, Hulthen UI, Ritz R, Buhler FR: Prejunctional alpha2-adrenoceptors and norepinephrine release in the forearm of normal humans. J Cardiovasc Pharmacol 1985, 7(Suppl):S144–S148.

    Article  PubMed  CAS  Google Scholar 

  17. Reuben SS, Steinberg RB, Klatt JL, Klatt ML: Intravenous regional anesthesia using lidocaine and clonidine. Anesthesiology 1999, 91:654–658.

    Article  PubMed  CAS  Google Scholar 

  18. Reuben SS, Steinberg RB, Madabhushi L, Rosenthal E: Intravenous regional clonidine in the management of sympathetically maintained pain. Anesthesiology 1998, 89:527–530.

    Article  PubMed  CAS  Google Scholar 

  19. Reuben SS, Pristas R, Dixon D, et al.: Incidence of complex regional pain syndrome following fasciectomy for Dupuytren’s contracture: a prospective observational study of four anesthetic techniques. Anesth Analg 2006, 102:499–503.

    Article  PubMed  Google Scholar 

  20. Zollinger PE, Tuinebreijer WE, Kreis RW, Breederveld RS: Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomized trial. Lancet 1999, 354:2025–2028.

    Article  PubMed  CAS  Google Scholar 

  21. Cazeneuve JF, Leborgne JM, Kermad K, Hassan Y: Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures [French]. Acta Orthop Belg 2002, 68:481–484.

    PubMed  CAS  Google Scholar 

  22. Reuben SS, Gutta SB, Maciolek H, et al.: Effect of initiating a preventative multimodal analgesic regimen upon long-term patient outcomes after anterior cruciate ligament reconstruction for same-day surgery: a 1200-patient case series. Acute Pain 2005, 7:65–73.

    Article  CAS  Google Scholar 

  23. Nikolajsen L, Jensen TS: Phantom limb pain. Br J Anaesth 2001, 87:107–116.

    Article  PubMed  CAS  Google Scholar 

  24. Wartan SW, Hamann W, Wedley JR, McColl I: Phantom pain and sensation among British veteran amputees. Br J Anaesth 1997, 78:652–659.

    PubMed  CAS  Google Scholar 

  25. Houghton AD, Nicholls G, Houghton AL, et al.: Phantom pain: natural history and association with rehabilitation. Ann R Coll Surg Engl 1994, 76:22–25.

    PubMed  CAS  Google Scholar 

  26. Kooijman CM, Dijkstra PU, Geertzen JHB, et al.: Phantom pain and phantom sensations in upper limb amputees: an epidemiological study. Pain 2000, 87:33–41.

    Article  PubMed  CAS  Google Scholar 

  27. Katz J: Prevention of phantom limb pain by regional anaesthesia. Lancet 1997, 349:519–520.

    Article  PubMed  CAS  Google Scholar 

  28. Parkes CM: Factors determining the persistence of phantom pain in the amputee. J Psychosom Res 1973, 17:97–108.

    Article  PubMed  CAS  Google Scholar 

  29. Karl A, Birbaumer N, Lutzenberger W, et al.: Reorganization of motor and somatosensory cortex in upper extremity amputees with phantom limb pain. J Neurosci 2001, 21:3609–3618.

    PubMed  CAS  Google Scholar 

  30. Halbert J, Crotty M, Cameron ID: Evidence for the optimal management of acute and chronic phantom pain: a systematic review. Clin J Pain 2002, 18:84–92.

    Article  PubMed  Google Scholar 

  31. Bach S, Noreng MF, Tjellden NU: Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain 1988, 33:297–301.

    Article  PubMed  CAS  Google Scholar 

  32. Jahangiri M, Bradley JWP, Jayatunga AP, et al.: Prevention of phantom pain after major lower limb amputation by epidural infusion of diamorphine, clonidine and bupivacaine. Ann R Coll Surg Engl 1994, 76:324–326.

    PubMed  CAS  Google Scholar 

  33. Nikolajsen L, Ilkjaer S, Christensen JH, et al.: Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower-limb amputation. Lancet 1997, 350:1353–1357.

    Article  PubMed  CAS  Google Scholar 

  34. Fisher V, Persen L, Lovlien M, et al.: Continuous postoperative regional analgesia by nerve sheath block for amputation surgery: a pilot study. Anesth Analg 1991, 72:300–303.

    Article  PubMed  CAS  Google Scholar 

  35. Malawer MM, Buch R, Khurana JS, et al.: Postoperative infusional continuous regional analgesia. A technique for relief of postoperative pain following major extremity surgery. Clin Orthop Relat Res 1991, 266:227–237.

    PubMed  Google Scholar 

  36. Elizaga AM, Smith DG, Sharar SR, et al.: Continuous regional analgesia by intraneural block: effect on postoperative opioid requirements and phantom limb pain following amputation. J Rehabil Res Devel 1994, 31:179–187.

    CAS  Google Scholar 

  37. Pinzur M, Garla PG, Pluth T, et al.: Continuous postoperative infusion of a regional anaesthetic after an amputation of the lower extremity. J Bone Joint Surg Am 1996, 79:1752–1753.

    Google Scholar 

  38. Lambert AW, Dashfield AK, Cosgrove C, et al.: Randomized prospective study comparing preoperative epidural and intraoperative perineural analgesia for the prevention of postoperative stump and phantom limb pain following major amputation. Reg Anesth Pain Med 2001, 26:316–321.

    Article  Google Scholar 

  39. Summers BN, Eisenstein SM: Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg Br 1989, 71:677–680.

    PubMed  CAS  Google Scholar 

  40. Kurz LT, Garfin SR, Booth RE: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 1989, 14:324–331.

    Article  Google Scholar 

  41. Fernyhough JC, Schimandle JJ, Weigel MC, et al.: Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine 1992, 12:1474–1480.

    Article  Google Scholar 

  42. Goulet JA, Senunas LE, DeSilva GL, Greenfield ML: Autogenous iliac crest bone graft: complications and functional assessment. Clin Orthop 1997, 339:76–81.

    Article  PubMed  Google Scholar 

  43. Reuben SS, Vieira P, Faruqi S, et al.: Local administration of morphine for analgesia after iliac bone graft harvest. Anesthesiology 2001, 95:390–394.

    Article  PubMed  CAS  Google Scholar 

  44. Reuben SS, Ekman EF, Raghunathan K, et al.: The effect of cyclooxygenase-2 inhibition on acute and chronic donor-site pain after spinal-fusion surgery. Reg Anesth Pain Med 2006, 31:6–13.

    Article  PubMed  CAS  Google Scholar 

  45. Gündes H, Kilickan L, Gürkan Y, et al.: Short-and long-term effects of regional application of morphine and bupivacaine on the iliac crest donor site. Acta Orthop Belg 2000, 66:341–344.

    PubMed  Google Scholar 

  46. Samad TA, Sapirstein A, Woolf CJ: Prostanoids and pain: unraveling mechanisms and revealing therapeutic targets. Trends Mol Med 2002, 8:390–396.

    Article  PubMed  CAS  Google Scholar 

  47. Gottschalk A, Smith DS: New concepts in acute pain therapy: preemptive analgesia. Am Fam Physician 2001, 63:1979–1984.

    PubMed  CAS  Google Scholar 

  48. Zhao Z, Chen SR, Eisenach JC, et al.: Spinal cyclooxygenase-2 is involved in the development of allodynia after nerve injury in rats. Neuroscience 2000, 97:743–748.

    Article  PubMed  CAS  Google Scholar 

  49. Ma W, Eisenach JC: Morphological and pharmacological evidence for the role of peripheral prostaglandins in the pathogenesis of neuropathic pain. Eur J Neurosci 2002, 15:1037–1047.

    Article  PubMed  Google Scholar 

  50. Vasquez E, Bär KJ, Ebersberger A, et al.: Spinal prostaglandins are involved in the development but not the maintenance of inflammation-induced spinal hyperexcitability. J Neurosci 2001, 21:9001–9008.

    PubMed  CAS  Google Scholar 

  51. Loan WB, Morrison JD: The incidence and severity of postoperative pain. Br J Anaesth 1967, 39:695–698.

    Article  PubMed  CAS  Google Scholar 

  52. Johnson WC: Postoperative ventilatory performance: dependence upon surgical incision. Am Surg 1975, 41:615–619.

    PubMed  CAS  Google Scholar 

  53. Merskey H: Classification of chronic pain: description of chronic pain syndromes and definitions of pain terms. Pain 1986, 3S:138–139.

    Google Scholar 

  54. Karmakar MK, Ho AMH: Postthoracotomy pain syndrome. Thorac Surg Clin 2004, 14:345–352.

    Article  PubMed  Google Scholar 

  55. Dajczman E, Gordon A, Kreisman H, Wolkove N: Long-term post-thoracotomy pain. Chest 1991, 99:270–274.

    PubMed  CAS  Google Scholar 

  56. Richardson J, Sabanathan S, Mearns AJ, et al.: Post-thoracotomy neuralgia. Pain Clin 1994, 7:87–97.

    Google Scholar 

  57. McCrory C, Diviney D, Moriarty J, et al.: Comparison between repeat bolus intrathecal morphine and epidurally delivered bupivacaine and fentanyl combination in the management of post-thoracotomy pain with or without cyclooxygenase inhibition. J Cardiothorac Vasc Anesth 2002, 16:607–611.

    Article  PubMed  Google Scholar 

  58. Hu JS, Lui PW, Wang H, et al.: Thoracic epidural analgesia with morphine does not prevent postthoracotomy pain syndrome: a survey of 159 patients. Acta Anaesthesiol Sin 2000, 38:195–200.

    PubMed  CAS  Google Scholar 

  59. Obata H, Saito S, Fujita N, et al.: Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain. Can J Anaesth 1999, 46:1127–1132.

    Article  PubMed  CAS  Google Scholar 

  60. Senturk M, Ozcan PE, Talu GK, et al.: The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg 2002, 94:11–15.

    Article  PubMed  Google Scholar 

  61. Ochroch EA, Gottschalk A, Augostides J, et al.: Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology 2002, 97:1234–1244.

    Article  PubMed  Google Scholar 

  62. Kavanagh BP, Katz J, Sandler AN: Pain control after thoracic surgery. A review of current techniques. Anesthesiology 1994, 81:737–759.

    Article  PubMed  CAS  Google Scholar 

  63. Vecht CJ, Van de Brand HJ, Wajer OJM: Post-axillary dissection pain in breast cancer due to a lesion of the intercostobrachial nerve. Pain 1989, 38:171–176.

    Article  PubMed  CAS  Google Scholar 

  64. Foley KM: Pain syndromes in patients with cancer. Med Clin N Am 1987, 71:169–184.

    PubMed  CAS  Google Scholar 

  65. Assa J: The intercostobrachial nerve in radical mastectomy. J Surg Oncol 1974, 6:123–126.

    Article  PubMed  CAS  Google Scholar 

  66. Stevens PE, Dibble SL, Miaskowski C: Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women’s experiences. Pain 1995, 61:61–68.

    Article  PubMed  CAS  Google Scholar 

  67. Tasmuth T, von Smitten K, Kalso E: Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 1996, 74:2024–2031.

    PubMed  CAS  Google Scholar 

  68. Warmuth MA, Bowen G, Prosnitz LR, et al.: Complications of axillary lymph node dissection for carcinoma of the breast: a report based on a patient survey. Cancer 1998, 83:1362–1368.

    Article  PubMed  CAS  Google Scholar 

  69. Lakdja F, Dixmeria F, Bussieres E, et al.: Preemptive analgesia on postmastectomy pain syndrome with ibuprofen-arginine. Bull Cancer 1997, 84:259–263.

    PubMed  CAS  Google Scholar 

  70. Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q: EMLA reduces acute and chronic pain after breast surgery for cancer. Reg Anesth Pain Med 2000, 25:350–355.

    Article  PubMed  CAS  Google Scholar 

  71. Fassoulaki A, Sarantopoulos C, Melemeni A, Hogan Q: Regional block and mexiletine: the effect on pain after cancer breast surgery. Reg Anesth Pain Med 2001, 26:223–228.

    Article  PubMed  CAS  Google Scholar 

  72. Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q: The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg 2002, 95:985–991.

    Article  PubMed  CAS  Google Scholar 

  73. Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C: Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg 2005, 101:1427–1432.

    Article  PubMed  CAS  Google Scholar 

  74. Miller RR: Evaluation of the analgesic efficacy of ibuprofen. Pharmacotherapy 1981, 1:21–27.

    PubMed  CAS  Google Scholar 

  75. Bartfai T: Telling the brain about pain. Nature 2001, 410:425–426.

    Article  PubMed  CAS  Google Scholar 

  76. Gilron I: Is gabapentin a “broad-spectrum” analgesic? Anesthesiology 2002, 97:537–539.

    Article  PubMed  Google Scholar 

  77. Eckhardt K, Ammon S, Hofmann U, et al.: Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg 2000, 91:185–191.

    Article  PubMed  CAS  Google Scholar 

  78. Dirks J, Fredensborg BB, Christensen D, et al.: A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology 2002, 97:560–564.

    Article  PubMed  CAS  Google Scholar 

  79. Muth EA, Haskins JT, Moyer JA, et al.: Antidepressant biochemical profile of the novel bicyclic compound Wy-45,030, and ethylcyclohexanol derivative. Biochem Pharmacol 1986, 35:4493–4497.

    Article  PubMed  CAS  Google Scholar 

  80. Tasmuth T, Härtel B, Kalso E: Venlafaxine in neuropathic pain following treatment of breast cancer. Eur J Pain 2002, 6:17–24.

    Article  PubMed  CAS  Google Scholar 

  81. Lang E, Hord AH, Denson D: Venlafaxine hydrochloride (Effexor) relieves thermal hyperalgesia in rats with an experimental mononeuropathy. Pain 1996, 68:151–155.

    Article  PubMed  CAS  Google Scholar 

  82. Reuben SS, Makari-Judson G, Lurie SD: Evaluation of efficacy of perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome. J Pain Symptom Manage 2004, 27:131–137.

    Article  CAS  Google Scholar 

  83. Cousins MJ, Power I, Smith G: 1996 Labat lecture: pain—a persistent problem. Reg Anesth Pain Med 2000, 25:6–21.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA

    Scott S. Reuben MD

Authors
  1. Scott S. Reuben MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott S. Reuben MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reuben, S.S. Chronic pain after surgery: What can we do to prevent it?. Curr Pain Headache Rep 11, 5–13 (2007). https://doi.org/10.1007/s11916-007-0015-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-007-0015-9

Keywords

Search

Navigation