Chronic Post-surgical Pain

What is chronic post-surgical pain?

Chronic post-surgical pain is pain of at least 2 months duration that has developed after a surgical procedure. It is a common condition with the incidence ranging from 10-70% depending on the surgical procedure.

What are the symptoms of chronic post-surgical pain?

Such pain frequently has a neuropathic component to it namely: spontaneous sharp, stabbing pain, increased sensitivity over the skin area to touch, numbness, burning and throbbing pain. There may also be sensory loss over the surgical incision.

Who gets it?

We cannot predict who will develop pain after operation, however some risk factors have been identified. This includes the type of surgery (with higher risk for thoracotomy, mastectomy, amputation, hernia repair, coronary artery bypass surgery), degree of postoperative pain, anxiety and depression.

How do you manage it?

Good pain relief after surgery is important. This usually involves multimodal analgesia that can be given via the:

• Oral route:
  

• Paracetamol
• Anti-inflammatory medications (e.g. naproxen, diclofenac)
• COX-2 inhibitors (e.g. etoricoxib, celecoxib)
• Tramadol

• Intravenous route using Patient Controlled Analgesia with:
  

• Morphine
• Fentanyl

Patients often under-utilise these medications for fear of addiction and poor drug effect when pain is very severe. However these beliefs are unfounded and when used appropriately can aid in faster postoperative recovery and early mobilisation.

• Regional techniques:
  

• Epidurals
• Nerve catheters

Both offer excellent analgesia with minimal side effects.

Discuss with your anaesthetist about analgesic options after your surgery.

Other ways to help you is to recognise the symptoms and refer yourself to a pain specialist early. Your pain specialist may start you on medication for nerve pain, perform nerve blocks and if resistant to medical management, consider a spinal cord stimulator.