The link between acute postoperative pain and chronic pain syndromes

Abstract

Surgery is frequently performed because a patient presents with pain. This may be acute pain, due to appendicitis, or chronic pain, because of spinal degeneration. Once the offending part of the body has been removed, or surgically corrected, the patient expects to be pain-free. Some operations are performed without a patient experiencing pain beforehand, for example a vasectomy, and these patients do not wish to suffer chronic pain as a result of such an operation. Unfortunately, whether or not an operation is performed to address pain, a certain proportion of patients who have succumbed to the scalpel, will experience chronic pain thereafter. A survey of UK pain clinics found that for patients with chronic pain, surgery was the contributory cause in 22.5% of cases, the second most common cause after degenerative disease (34.2%), and a more common cause than trauma (18.7%).¹ Why some patients, and not others, experience chronic postsurgical pain (CPSP) is the question. Any surgical incision will result in tissue damage, and activation of pain pathways. The problem is that in patients who experience CPSP, these pathways, once activated, remain activated, and do not deactivate as they should, with time and normal healing.