Conduite à tenir devant une douleur neuropathique après chirurgie du genou

Abstract

Chronic postsurgical pain (CPSP) is experienced by 10 to 30% of individuals after classical operations. After knee surgery, epidemiology of CPSP varies between 16 to 20% of patients. Among these persistent pains without infection, mechanic injury or algodystrophy, the frequency of neuropathic pain is important. Neuropathic pain is due to nerve injury or impaired pain modulation with central sensitization. Variables that were commonly associated with a greater risk of chronic postoperative pain included greater preoperative pain, other pain sites, acute postoperative pain severity, psychological factors indicating negative affect, cognitive factors as catastrophism and comorbidities. The diagnosis is clinic and early detection is the better way to reduce chronic pain. The management of CPSP is based on preventive strategies and treatment of neuropathic pain. After knee surgery, first-line treatment of neuropathic pain coud be transcutaneous electrical nerve stimulation and lidocain patch, associated to tramadol. If insufficient, the recommended treatments are antidepressants, pregabalin and gabapentin, then capsaicin high-concentration patches in thrird line and strong opioids in last line. A rehabilitation programme and physical activity are strongly recommended. Several intervention strategies exist to address psychological distress or cognitive and emotional variables.