Incidence Of Chronic Postsurgical Pain Research Articles

Clinical Analysis of the Effects of Different Anesthesia and Analgesia Methods on Chronic Postsurgical Pain in Patients With Uniportal Video-Assisted Lung Surgery

To understand whether different anesthesia and analgesia methods affected the incidence of chronic postsurgical pain (CPSP) in patients who underwent uniportal video-assisted lung surgery and to explore the influence factors of CPSP. Retrospective study. A total of 120 patients, who underwent selective uniportal video-assisted lung surgery at Zhongshan Hospital from March to June 2018, were enrolled. The visual analog scale was used to assess the degree of pain on the first and second postoperative days. At the third and sixth months after surgery, the telephone follow-up was conducted for the survey of the numerical rating scale. The incidence of acute and chronic pain in different anesthesia methods was analyzed, and the relevant factors of CPSP were statistically analyzed. Among the 111 patients who completed follow-up, no significant difference was noted in the incidences of acute and chronic postsurgical pain between patients who received different anesthesia and analgesia methods (p > 0.05). The incidence of CPSP was 29.7% at 3 months after surgery and 9.0% at 6 months after surgery. The degree of pain within 48 hours after surgery was a risk factor for CPSP (odds ratio [OR] = 2.39, p < 0.05). CPSP accounted for a specific proportion of patients after uniportal video-assisted lung surgery; however, it was significantly lower than that of patients with conventional thoracotomy. The incidence did not differ significantly among anesthesia and analgesia methods. Active and effective control of acute postsurgical pain might reduce the incidence of CPSP.

Transition from Acute to Chronic Pain: Evaluating Risk for Chronic Postsurgical Pain

Background: The pathophysiology of pain involves complex nervous system interactions after initial noxious stimuli. When stimuli persist, biochemical and structural changes occur in the nociceptive pathways of the central and peripheral nervous systems, leading to pain sensitization. Peripheral and central sensitization are key in the transition from acute to chronic pain. This development of chronic pain is particularly common following various surgical procedures, with many postsurgical patients experiencing persistent pain for significant periods. Chronic pain is a common and severe complication of surgery, and preventing its development is tantamount in improving patient outcomes. Objectives: To understand underlying pathophysiology of chronic postsurgical pain (CPSP) and the underlying risk factors predisposing the transition from acute to CPSP. To review our ability to identify patients at highest risk for the development CPSP. To identify evidence-based multimodal approaches that can aid in the prevention of CPSP. Study Design: Narrative review of peer-reviewed literature. Setting: Inpatient surgical centers. Methods: Medline and Cochrane databases were reviewed to identify publications relevant to CPSP pathophysiology, risk factors, predictive models, and prevention. Publications were selected based on author expertise to summarize our current understanding of CPSP. Results: This review presents our current understanding of CPSP in the following domains: underlying pathophysiology, predisposing risk factors, predictive models of CPSP, and preventative strategies. Each section provides a structured review of key evidence base to understand the complex topic of CPSP. Limitations: This narrative review is a nonsystematic review of relevant publications aimed at presenting succinct overview of CPSP. Conclusions: The incidence of CPSP can potentially be reduced through early identification of perioperative, genetic, physiologic, and psychologic factors. Models predicting the development of CPSP continue to improve and may help focus preventative efforts in patients at highest risk. There is a growing body of evidence supporting the use of multimodal analgesia and anesthetic techniques in the reducing rates of CPSP development. Key words: Acute pain, chronic postsurgical pain, pain sensitization, chronic pain prevention, regional anesthesia, pain adjuncts, neuraxial anesthesia, chronic pain risk factors

Chronified Pain Following Operative Procedures.

Over 18 million operative procedures are performed each year in Germany alone. Approximately 10% of surgical patients develop moderate to severe chronic post-surgical pain (CPSP), which can severely impair their quality of life. The pain must persist for at least three months to be called chronic; pain that arises after a symptom-free interval is not excluded. The perioperative use of local anesthetic agents may lessen the incidence of CPSP. We selectively reviewed the pertinent literature, including two current Cochrane Reviews. Local and regional anesthetic techniques are discussed, as is the intravenous administration of lidocaine. The main risk factors for CPSP are pre-existing (preoperative) chronic pain, opioid intake, a pain-related catastrophizing tendency, intraoperative nerve injury, and severe acute postoperative pain. CPSP is reported to be especially common after thoracic surgery, breast surgery, amputations, and orthopedic procedures. Local and regional anesthetic techniques have been shown to significantly lower the incidence of CPSP after thoracotomy (number needed to treat for an additional beneficial outcome [NNTB] = 7), breast cancer surgery (NNTB = 7), and cesarean section (NNTB = 19). Intravenous lidocaine also lowers the incidence of CPSP after various types of procedures. Local and regional anesthetic techniques and intravenous lidocaine lower the incidence of CPSP after certain types of operative procedures. The intravenous administration of lidocaine to prevent CPSP is off label and requires the patient's informed consent. The evidence for the measures presented here is of low to medium quality.

Acute postoperative pain is an independent predictor of chronic postsurgical pain following total knee arthroplasty at 6 months: a prospective cohort study

BackgroundApproximately 15% of patients report persistent knee pain despite surgical success following total knee arthroplasty (TKA). The purpose of this study was to determine the association of acute-postsurgical pain (APSP)...

Preperitoneal Bupivacaine Infiltration Reduces Postoperative Opioid Consumption, Acute Pain, and Chronic Postsurgical Pain After Bariatric Surgery: a Randomized Controlled Trial.

A multimodal pain treatment including local anesthetics is advised for perioperative analgesia in bariatric surgery. Due to obesity, bariatric surgery patients are at risk of respiratory complications. Opioid consumption is an important risk factor for hypoventilation. Furthermore, acute postoperative pain is an important risk factor for chronic postsurgical pain. In this study, we aimed to evaluate whether preperitoneal anesthesia with bupivacaine would reduce pain and opioid consumption after bariatric surgery. One hundred adults undergoing laparoscopic bariatric surgery were randomized to receive either preperitoneal bupivacaine 0.5% or normal saline before incision. Postoperative opioid consumption, postoperative pain, and postoperative recovery parameters were assessed for the first 24h after surgery. One year after surgery, chronic postsurgical pain and influence of pain on daily living were evaluated. Postoperative opioid consumption during the first hour after surgery was 2.8 ± 3.0mg in the bupivacaine group, whereas in the control group, it was 4.4 ± 3.4mg (p= 0.01). Pain scores were significantly reduced in this first hour at rest and at 6h during mobilization on the ward. One year after surgery, the incidence of chronic postsurgical pain was 13% in the bupivacaine group versus 40% in the placebo group. This study shows that preperitoneal local anesthesia with bupivacaine results in a reduction in opioid consumption and postoperative pain and seems to lower the incidence rate of chronic postsurgical pain after laparoscopic bariatric surgery.

Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of efficacy and safety.

Chronic postsurgical pain (CPSP) occurs in 12% of surgical populations and is a high priority for perioperative research. Systemic lidocaine may modulate several of the pathophysiological processes linked to CPSP. This systematic review aims to identify and synthesize the evidence linking lidocaine infusions and CPSP. The authors conducted a systematic literature search of the major medical databases from inception until October 2017. Trials that randomized adults without baseline pain to perioperative lidocaine infusion or placebo were included if they reported on CPSP. The primary outcome was the presence of procedure-related pain at 3 months or longer after surgery. The secondary outcomes of pain intensity, adverse safety events, and local anesthetic toxicity were also assessed. Six trials from 4 countries (n = 420) were identified. Chronic postsurgical pain incidence was consistent with existing epidemiological data. Perioperative lidocaine infusions significantly reduced the primary outcome (odds ratio, 0.29; 95% confidence interval, 0.18-0.48), although the difference in intensity of CPSP assessed by the short-form McGill Pain Questionnaire (4 trials) was not statistically significant (weighted mean difference, -1.55; 95% confidence interval, -3.16 to 0.06). Publication and other bias were highly apparent, as were limitations in trial design. Each study included a statement reporting no adverse events attributable to lidocaine, but systematic safety surveillance strategies were absent. Current limited clinical trial data and biological plausibility support lidocaine infusions use to reduce the development of CPSP without full assurances as to its safety. This hypothesis should be addressed in future definitive clinical trials with comprehensive safety assessment and reporting.

Chronic postsurgical pain in mixed surgical population. Does an acute pain service make a difference?

To investigate the influence of an Acute Pain Service (APS) on the incidence of chronic postsurgical pain (CPSP). To assess the acute pain intensity as a risk factor for CPSP. The impact of an APS on the incidence of CPSP has not yet been studied. Retrospective questionnaire given to randomized cohorts study, performed in two hospitals - Hospital A with an APS and Hospital B without such service. 1444 patients underwent eight different surgical procedures in both hospitals within one year, 175 patients from each hospital were randomized. 208 questionnaires were analysed. There was a significant difference in acute pain intensity in the first 24 hours after surgery. The difference of CPSP incidence between hospitals was not significant (Hospital A nine patients (8.6 %), Hospital B sixteen patients (15.5 %). The patients with CPSP experienced significantly more intensive pain in the first 24 hours and at discharge than patients without CPSP regardless of the hospital. The study did not demonstrate the incidence of CPSP was lower in the hospital with an APS despite the lower postoperative pain scores. However there was a noticeable trend toward higher incidence of CPSP in the hospital without an APS. The study demonstrated that APS decreases intensity of an acute postoperative pain and acute pain intensity is a risk factor for CPSP incidence (Tab. 5, Ref. 27).

Analysis of ralated factors of chronic post surgical pain of video assisted thoracic surgery

Objective To explore the incidence of chronic postsurgical pain (CPSP) of video assisted thoracic surgery (VATS) and its influencing factors. Methods Totally 216 patients who received elective VATS in a class Ⅲ grade A hospital between January and June 2016 were selected by convenience sampling. Their pain level was assessed with Visual Analogue Scale (VAS) in 1 to 3 days after surgery. The patients were then investigated with Simplified McGill Pain Questionnaire (SF-MPQ) in 1 to 3 months after surgery, with the features of CPSP analyzed and 11 related risk factors statistically analyzed. Results The incidence of CPSP in 3 months after surgery in the 199 patients who received follow-up visits was 49.20%, of which 18.37% suffered moderate pain, and 32.65% felt constant pain. Age (OR=2.16) and pain level in 1-3 days after surgery (OR=2.25) were independent risk factors to CPSP (P<0.05) . Conclusions CPSP occurred in a certain proportion of patients who received VATS. Actively and effectively controlling acute post surgical pain in especially young patients may help to reduce the incidenc of CPSP. Key words: Pain, postsurgerical; Thoracic surgery; Thoracoscope; Risk factors

Incidencia y factores asociados al dolor crónico postoperatorio en pacientes llevados a herniorrafia inguinal

IntroductionIn up to 50% of cases, inguinal hernia repair is associated with chronic post-surgical pain, which can be a cause of disability in a proportion of patients. ObjectiveTo estimate the incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair. Materials and methodsObservational follow-up study in a cohort of patients. Social, demographic and personal background information was obtained; the incidence and intensity of acute and chronic post-operative pain was determined; and the factors associated with the development of chronic pain were evaluated. Associations were determined in accordance with the nature of the variables. A linear regression was used to assess the role of confounding factors. ResultsOverall, 108 patients were analysed, and of them, 27.8% (n=30) had chronic post-surgical pain. The multivariate analysis showed that the use of general anaesthesia and uncontrolled pain 15days after surgery were associated with a higher risk of developing this condition. In contrast, diclofenac administration was protective. DiscussionChronic post-surgical pain is frequent in this type of surgery. According to this study, the use of peri-operative analgesia together with pain prevention and management within the first post-operative weeks help prevent the development of chronic post-surgical pain. General anaesthesia may increase the risk. Similar studies conducted at a larger scale could help identify other associated factors.

Incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair

IntroductionIn up to 50% of cases, inguinal hernia repair is associated with chronic post-surgical pain, which can be a cause of disability in a proportion of patients. ObjectiveTo estimate the incidence of chronic post-surgical pain and its associated factors in patients taken to inguinal hernia repair. Materials and methodsObservational follow-up study in a cohort of patients. Social, demographic and personal background information was obtained; the incidence and intensity of acute and chronic post-operative pain was determined; and the factors associated with the development of chronic pain were evaluated. Associations were determined in accordance with the nature of the variables. A linear regression was used to assess the role of confounding factors. ResultsOverall, 108 patients were analysed, and of them, 27.8% (n=30) had chronic post-surgical pain. The multivariate analysis showed that the use of general anaesthesia and uncontrolled pain 15 days after surgery were associated with a higher risk of developing this condition. In contrast, diclofenac administration was protective. DiscussionChronic post-surgical pain is frequent in this type of surgery. According to this study, the use of peri-operative analgesia together with pain prevention and management within the first post-operative weeks help prevent the development of chronic post-surgical pain. General anaesthesia may increase the risk. Similar studies conducted at a larger scale could help identify other associated factors.

The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management.

In an era of considerable advances in anaesthesiology and pain medicine, chronic pain after major surgery continues to be problematic. This article briefly reviews the known psychological risk and protective factors associated with the development of chronic postsurgical pain (CPSP). We begin with a definition of CPSP and then explain what we mean by a risk/protective factor. Next, we summarize known psychological risk and protective factors for CPSP. Psychological interventions that target risk factors and may impact postsurgical pain are reviewed, including the acceptance and commitment therapy (ACT)-based approach to CPSP prevention and management we use in the Transitional Pain Service (TPS) at the Toronto General Hospital. Finally, we conclude with recommendations for research in risk factor identification and psychological interventions to prevent CPSP. Several pre-surgical psychological risk factors for CPSP have been consistently identified in recent years. These include negative affective constructs, such as anxiety symptoms, depressive symptoms, pain catastrophizing and general psychological distress. In contrast, relatively few studies have examined psychological protective factors for CPSP. Psychological interventions that target known psychological risk factors while enhancing protective psychological factors may reduce new incidence of CPSP. The primary goal of our ACT intervention is to teach patients a mindful way of responding to their postsurgical pain that empowers them to interrupt the negative cycle of pain, distress, behavioural avoidance and escalating opioid use that can limit functioning and quality of life while paradoxically amplifying pain over time. Early clinical outcome data suggest that patients who receive care from TPS physicians reduce their pain and opioid use, yet patients who also receive our ACT intervention have a larger decrease in daily opioid dose while reporting less pain interference and lower depression scores.

The effect of a perioperative ketamine infusion on the incidence of chronic postsurgical pain-a pilot study.

Chronic postsurgical pain (CPSP) is a common and debilitating complication of major surgery. We undertook a pilot study at three hospitals to assess the feasibility of a proposed large multicentre placebo-controlled randomised trial of intravenous perioperative ketamine to reduce the incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was administered to 80 patients, recruited over a 15-month period, undergoing abdominal or thoracic surgery under general anaesthesia. The primary endpoint was CPSP in the area of the surgery reported at six-month telephone follow-up using a structured questionnaire. Fourteen patients (17.5%) reported CPSP (relative risk [95% confidence interval] if received ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment group and three in the control group reported ongoing analgesic use to treat CPSP and two patients in each group reported their worst pain in the previous 24 hours at ≥3/10 at six months. There were no significant differences in adverse event rates, quality of recovery scores, or cumulative morphine equivalents consumption in the first 72 hours. Numeric Rating Scale pain scores (median [interquartile range, IQR]) for average pain in the previous 24 hours among those patients reporting CPSP were 17.5 [0 to 40] /100 with no difference between treatment groups. A large (n=4,000 to 5,000) adequately powered multicentre trial is feasible using this population and methodology.

Incidence and risk factors of chronic post-surgical pain and its effect on quality of life: a large sample prospective study

Objective To investigate the incidence and risk factors of chronic post-surgical pain (CPSP) and its effects on the quality of life in a large sample prospective study. Methods A total of 1098 patients of either sex, aged 18-70 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, undergoing elective surgery, were enrolled in the study.Data regarding patient age, gender, body mass index, educational level, marital status, living situations, occupation, pre-surgical pain in the site of surgery, complications, type of surgery, surgery time and anesthesia method were recorded.The highest numeric rating scale scores within 3 days after surgery were also recorded.The patients were followed up at 3, 6 and 12 months after surgery to record the development of CPSP.The patients were divided into CPSP group and non-CPSP group according to whether or not CPSP developed.Multivariable logistic regression analysis was performed to identify the risk factors for CPSP, and the quality of life was scored. Results A total of 981 patients completed the 1 year follow-up after surgery, the incidence of CPSP was 35.7%, and the constituent ratio of the distribution of the course was as follows: 3 months≤postsurgical course 0.05). Conclusion The probability of development of CPSP is high and the course is long, and the quality of life score is decreased; female, no diabetes mellitus and pre-surgical pain in the site of surgery are the independent risk factors for CPSP. Key words: Pain, postoperative; Chronic disease; incidence; Risk factors; Quality of life

Chronic Postsurgical Pain Outcomes in Breast Reconstruction Patients Receiving Perioperative Transversus Abdominis Plane Catheters at the Donor Site: A Prospective Cohort Follow-up Study.

Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aimed to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters with bupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort. Ninety-three patients who underwent deep inferior epigastric artery perforator or muscle-sparing transverse rectus abdominis breast reconstruction were randomized to receive TAP catheters with bupivacaine or saline postoperatively. Subsequently, patients were followed for a year to assess persistent pain, pain severity, quality of life scores, and functional disability at 6 and 12months after surgery. Twenty-four percent and 23% of patients reported CPSP at 6 and 12months, respectively. There were no significant differences between groups (bupivacaine vs. placebo) on pain-related variables, including incidence of CPSP. Patients who reported greater variability in pain scores at rest over the first 48hours postoperatively were more likely to have CPSP 6months, but not 12months, later. Acute postoperative pain variability may contribute to the development of CPSP up to 6months after autologous breast reconstruction surgery. Neither postoperative use of bupivacaine vs. saline in the TAP catheters nor acute pain severity influenced the 6- or 12-month incidence of CPSP.

Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials.

The efficacy of perioperative pregabalin treatment for preventing chronic pain remains a matter of debate. We searched the MEDLINE, EMBASE, LILACS, Cochrane, and Clinical Trial Register databases, and other sources, for randomized controlled trials comparing the effects of pregabalin and placebo. The primary outcome was the incidence of chronic postsurgical pain (CPSP) at 3 months. The secondary endpoints were CPSP at 3, 6, and 12 months and the incidence of chronic postsurgical neuropathic pain at the same time points. A random-effect meta-analysis was performed on the combined data. Evidence quality was rated by the GRADE method. We included 18 studies (2485 patients) in the meta-analysis. Overall, 60% of the trials reporting the primary outcome at 3 months were unpublished; the unpublished trials corresponded to 1492/1884 (79%) of the patients included in these studies. No difference in CPSP incidence between pregabalin and placebo was found at any time point; the risk ratio was 0.87 (0.66, 1.14), I = 57% at 3 months. The evidence was considered to be of moderate quality. Subgroup analysis by publication status, daily dose, type of administration, and type of surgery did not highlight any differences between subgroups. Insufficient data concerning the incidence of chronic postsurgical neuropathic pain were available for any firm recommendation to be made. Pooled data from published and unpublished studies provide no support for the efficacy of pregabalin for preventing CPSP.

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

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. …

Chronic Postsurgical Pain.

Chronic postsurgical pain (CPSP) is defined as a persistent pain state that exists more than 2 months postoperatively and cannot be explained by other causes such as recurrence of disease, apparent inflammation, or other nonsurgical related factors. CPSP is a type of persistent pain condition that often complicates recovery from surgical procedures. It is thought to be caused by surgical nerve injury, but the fact that an identifiable nerve injury can be found in only one-third of CPSP patients suggests that the problem may be far more complex than a simple surgically created nerve injury. Certain surgical procedures report a high incidence of CPSP, helping to isolate likely candidates for this problem, but instituting preventative measures and identifying a treatable source of pain continues to be elusive. Some progress has been made in the areas of prevention and treatment.

Incidence and severity of chronic pain after caesarean section: A systematic review with meta-analysis.

The frequency of caesarean section has increased dramatically in recent decades. Despite this, robust data regarding the consequences of caesarean section in terms of developing chronic postsurgical pain (CPSP) are still lacking. This systematic review analysed the incidence and severity of CPSP in women 3 to less than 6, 6 to less than 12, and at least 12 months after caesarean section. Systematic review of prospective and retrospective observational studies and randomised controlled trials with meta-analysis. We searched MEDLINE to May 2015. We included all studies investigating the incidence and/or severity of CPSP at least 3 months after caesarean section. The primary outcome was chronic postsurgical wound pain (CPSP 'wound'). Secondary outcomes were persistent pain in the back area, pelvic region or reported as residual pain, and severity of 'birth-related' chronic pain. Meta-analysis using the random-effects model based on 15 studies (n = 4475) reporting CPSP 'wound' at 3 to less than 6 months after caesarean section revealed an incidence of 15.4% [95% confidence interval (CI): 9.9 to 20.9%]. For 6 to less than 12 and at least 12 months after caesarean section, the incidence of CPSP 'wound' was estimated at 11.5% (95% CI: 8.1 to 15.0%, n = 3345) and 11.2% (95% CI: 7.4 to 15.0%, n = 3451), respectively. Meta-regression analysis using the publication year as predictor revealed stable CPSP 'wound' incidences at each postoperative time slot from 2002 to the present. Of those patients who reported chronic pain, 9.6% (95% CI: 0.0 to 21.0%) had severe pain, 23.5% (95% CI: 10.0 to 37.0%) had moderate pain and 49.2% (95% CI: 18.9 to 79.4%) had mild pain at 6 months. Major limitations are high statistical heterogeneity of the meta-analyses and inconsistencies in reporting severity of chronic 'birth-related' pain. This meta-analysis finds a clinically relevant incidence of CPSP 'wound' after caesarean section ranging from 15% at 3 months to 11% at 12 months or longer that has been largely stable in recent years.

Patient coping and expectations about recovery predict the development of chronic post-surgical pain after traumatic tibial fracture repair

BackgroundThe association of patient expectations about recovery with the development of chronic post-surgical pain (CPSP) is uncertain. MethodsThree hundred and fifty-nine patients enrolled in the SPRINT trial completed the Somatic Preoccupation and Coping (SPOC) questionnaire six weeks after a traumatic tibial fracture repair. The SPOC questionnaire measures patients’ somatic complaints, coping, and optimism for recovery. Using adjusted models, we explored the association of SPOC scores with ≥ mild CPSP and ≥ moderate pain interference with activity at one yr after surgery. ResultsOf 267 tibial fracture patients with data available for analysis, 147 (55.1%) reported CPSP at one yr. The incidence of CPSP was 37.6% among those with low (≤40) SPOC scores, 54.1% among those with intermediate (41–80) scores, and 81.7% among those with high (>80) scores. Addition of SPOC scores to an adjusted regression model to predict CPSP improved the c-statistic from 0.61 (95% CI 0.55–0.68) to 0.70 (95% CI 0.64–0.76, P=0.005 for the difference) and found the greatest risk was associated with high SPOC scores (OR 6.56, 95% CI 2.90–14.81). Similarly, an adjusted regression model to predict pain interference with function at one yr (c-statistic 0.77, 95% CI 0.71–0.83) found the greatest risk for those with high SPOC scores (OR 10.10, 95% CI 4.26–23.96). ConclusionsPatient's coping and expectations of recovery, as measured by the SPOC questionnaire, is an independent predictor of CPSP and pain interference one yr after traumatic tibial fracture. Future studies should explore whether these beliefs can be modified, and if doing so improves prognosis. Clinical trial registrationNCT 00038129

Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service.

To identify the 3-month incidence of chronic postsurgical pain and long-term opioid use in patients at the Toronto General Hospital. 200 consecutive patients presenting for elective major surgery completed standardized questionnaires by telephone at 3 months after surgery. 51 patients reported a preoperative chronic pain condition, with 12 taking opioids preoperatively. 3 months after surgery 35% of patients reported having surgical site pain and 13.5% continued to use opioids for postsurgical pain relief. Postoperative opioid use was associated with interference with walking and work, and lower mood. Chronic postsurgical pain and ongoing opioid use are concerns that warrant the implementation of a Transitional Pain Service to modify the pain trajectories and enable effective opioid weaning following major surgery.