This won’t hurt a bit: Reflections on a career in chronic pain.

Abstract

Chronic Postsurgical Pain (CPSP)CPSP is a major, costly public health problem that has managed to remain under the radar for far too long (Hogan, Taddio, Katz, Shah, & Krahn, 2016; Katz & Seltzer, 2009; Parsons et al., 2013). Fortunately, most people who undergo major surgery do not develop CPSP. They recover uneventfully and return to their everyday activities usually within weeks-often with an improved quality of life. But this ideal recovery trajectory does not occur in a substantial proportion of people. For them, the pain persists and continues to cause suffering and distress. When CPSP is severe and intractable, it has a way of lodging itself into the core of the person and leads to many secondary downstream effects (Katz, Page, Fashler, Rosenbloom, & Asmundson, 2014; Katz, Rosenbloom, & Fashler, 2015). CPSP destroys lives. It destroys the lives of the people in pain as well their families'. It leads to job loss, marital and family problems, social isolation, worry, anxiety, depression, and even suicide (Choiniere et al., 2010; Ratcliffe, Enns, Belik, & Sareen, 2008).OverviewIn the remainder of this article, I present a working definition of CPSP, describe some of the epidemiology and outline its course in children and adults. I then describe some of my early work in identifying the risk factors for chronic postsurgical pain using phantom limb pain memories as an example and then show how these tied into what was then the newly developing field of preemptive analgesia. I end by presenting some of the current research we are engaged in as well as our future directions. In doing so, I highlight the research of several my current and former graduate students and postdocs. This is particularly fitting because students are our field's most important asset. They represent the future of Canadian psychology-the next generation of scholars, academics, and clinicians who will make the next new discoveries and advances and who will ensure the tradition of excellence continues.CPSP Definition and IncidenceVarious definitions of CPSP have been proposed (Macrae, 2008; Macrae & Davies, 1999; Werner & Kongsgaard, 2014) although it is unlikely that any one will prove useful for all surgeries. Nevertheless, it is generally accepted that (a) the pain must have developed after surgery; (b) the pain has been present for at least 2 months; (c) other causes for the pain have been ruled out (including pain from a preexisting condition); and (d) the pain interferes to a significant extent with health-related quality of life.Even though the vast majority of patients who undergo major surgery do not develop CPSP, the incidence is still unacceptably high and this is especially true for certain surgical procedures (Katz & Seltzer, 2009). The 1-year incidence of CPSP is highly variable and surgery-specific. Nevertheless, it is estimated that, overall, one year after surgery, between 1.5% and 10% of patients develop moderate-to-severe CPSP. However, CPSP estimates for thoracic surgery and postamputation phantom limb and stump pain may be as high 60% to 70%. And we know very little about the incidence beyond the 1-year mark: Pain occurs in up to 60% of patients 2 years after limb amputation and it persists in ~20% of patients 6 years after hernia repair, with severe or very severe pain occurring in ~2% (Katz & Seltzer, 2009). Even less is known about CPSP in children and adolescents. Current estimates indicate that the incidence of moderate-to-severe pain 1 and 5 years after surgery for scoliosis is ~20% (Page, Stinson, Campbell, Isaac, & Katz, 2013) and ~15% (Sieberg et al., 2013), respectively. These statistics are alarming especially given the estimate that, worldwide, 234 million people undergo major surgery each year (Weiser et al., 2008). That ~25% of patients who are referred to chronic pain treatment centers have CPSP (Crombie, Davies, & Macrae, 1998), is a sad reflection of the magnitude of the problem. …