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Chronic Postoperative Pain

Causes of, Treatments for, and Coping with Chronic Postoperative Pain

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Updated June 13, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Postoperative pain is fairly common after surgery. In fact, you would likely expect to have some degree of pain immediately after going under the knife. When you are cut open and operated on, your body responds with tissue swelling and a certain amount of discomfort. This is called acute postoperative pain.

Chronic postoperative pain, however, persists after the expected healing time from surgery. It is more common than you might think. In fact, it is estimated that between ten and 50 percent of people who have surgery experience chronic postoperative pain.

What Causes Chronic Postoperative Pain?

The cause of chronic postoperative pain, also known as chronic post surgical pain or CPSP, is not completely understood. However, most researchers agree on a few potential causes:

  • Peripheral nerve damage during surgery
  • Inflammation at the site of the wound
  • Damage to bodily tissues during surgery
While there is not much research pinpointing the risk factors for chronic postoperative pain, there are a few things that may predispose certain individuals to this condition. These include:
  • Prior history of chronic pain disorders
  • A history of anxiety and/or depression
  • Excessive fear of the surgery
  • Pre-operative pain
  • Extensive (lasting more than three hours) or complicated surgeries

Common Types of Chronic Postoperative Pain

You can experience chronic postoperative pain from almost any type of surgery, including outpatient procedures. Examples of postoperative pain include:

Treating Chronic Postoperative Pain

Chronic postoperative pain can be treated with any of the following:

  • NSAIDs. Anti-inflammatories such as ibuprofen and aspirin may be used to control mild to moderate postoperative pain. They may be used to treat severe pain as well, in combination with other painkillers.
  • Acetaminophen. Acetaminophen is another option in treating mild, moderate or severe postoperative pain. It may be used alone or in conjunction with other painkillers.
  • Opioids. Weaker opioids may be used to treat moderate postoperative pain, while stronger ones may be utilized for more severe cases.
  • Anticonvulsants. Anticonvulsants may be used to manage certain types of postoperative pain, especially those associated with nerve damage.
  • Nerve blocks. In some cases of severe postoperative pain, nerve blocks may be used to reduce pain sensations.

Chronic postoperative pain treatment is often multimodal – this means that treatments are often combined to provide maximal pain relief. If you have chronic postoperative pain, it's likely you are (or will be) taking more than one type of painkiller.

Coping With Chronic Postoperative Pain

Coping with chronic postoperative pain is not easy. Many people may feel that something in their surgery “went wrong.” However, with certain types of surgery, nerve and tissue damage are difficult to avoid. If you have chronic postoperative pain, you may feel surprised that surgery did not take your pain away. This can lead to feelings of hopelessness, anger or even depression.

Coping with any type of chronic pain is difficult. However, there are a few things you can do to help.

  • Keep a pain journal. Use your pain journal to record pain patterns as well as how your pain makes you feel. You can use this to help your doctor find the right treatment. You can also use it to vent your feelings about your pain.
  • Learn to relax. The stress response can increase both pain sensations and pain intensity. Taking the time to relax can help you decrease this pain response and allow you to focus on other things.
  • Distract yourself. No, your pain is not all in your head. However, you are still in control. Focusing on your pain alone can make the sensations seem more intense. Instead, try to focus your mind elsewhere. Read a book or watch some television.
  • Find support. Talk to someone who is willing to listen, or who knows what you are going through. Share ideas and coping strategies, or simply vent your feelings.

Sources:

European Society of Regional Anesthesia and Pain Therapy. Postoperative Pain Management – Good Clinical Practice: General Recommendations and Principles for Successful Pain Management. Accessed 10/2/09. http://www.esraeurope.org/PostoperativePainManagement.pdf

Ip, Hui Yun Vivian, Abrishami, Amir, Peng, Philip W et al. Predictors of Postoperative Pain and Analgesic Consumption: A Qualitative Systematic Review. Anesthesiology. September 2009. 111(3) pp 657-677

Lake, Alfred Philips. Chronic Post-Surgical Pain: Prevention Remains Better Than Cure. The Internet Journal of Anesthesiology 2008 : Volume 15 Number 2

Kehlet H, Jensen TS, Woolf CJ. Persistent Postsurgical Pain: Risk Factors and Prevention. Lancet. 2006 May 13;367(9522):1618-25

Macrae, WH. Chronic Post-Surgical Pain: 10 Years On. British Journal of Anaesthesia, doi:10.1093/bja/aen099

Visser, Eric J. Chronic Post-Surgical Pain: Epidemiology and Clinical Implications for Acute Pain Management. Acute Pain. Volume 8, Issue 2, June 2006, Pages 73-81

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