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

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Abstract

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.

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Toronto, ON, M5G 2C4, Canada

    Hance Clarke, Michael Poon, Aliza Weinrib, Rita Katznelson & Joel Katz

  2. Department of Anesthesia, University of Toronto, Toronto, ON, Canada

    Hance Clarke, Rita Katznelson & Joel Katz

  3. Transitional Pain Service, Toronto General Hospital, Toronto, ON, Canada

    Hance Clarke, Aliza Weinrib, Rita Katznelson, Kirsten Wentlandt & Joel Katz

  4. Department of Psychology, York University, Toronto, ON, Canada

    Joel Katz

  5. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Kirsten Wentlandt

  6. Palliative Care, Toronto General Hospital, Toronto, ON, Canada

    Kirsten Wentlandt

Authors
  1. Hance Clarke
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  2. Michael Poon
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  3. Aliza Weinrib
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  4. Rita Katznelson
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  5. Kirsten Wentlandt
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  6. Joel Katz
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Corresponding author

Correspondence to Hance Clarke.

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Clarke, H., Poon, M., Weinrib, A. et al. Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain. Drugs 75, 339–351 (2015). https://doi.org/10.1007/s40265-015-0365-2

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  • DOI: https://doi.org/10.1007/s40265-015-0365-2

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