Types of Chronic Postoperative Pain

For some people, the pain they feel when recovering from surgery can become chronic. This is called chronic postoperative pain, or chronic post-surgical pain (CPSP). Between ten and 50 percent of people who undergo certain types of surgery go on to develop chronic postoperative pain.

Some common types of chronic postoperative pain include:

• Phantom Limb Pain
• Post-mastectomy pain
• Pain following hernia repair
• Postoperative pelvic pain
• Postoperative back pain

Phantom Limb Pain

Around half to three-quarters of people who undergo surgery to have a limb, or part of a limb, amputated experience some form of phantom limb pain. For some people, it goes away after surgery. For others, unfortunately, it becomes chronic. Phantom limb pain is pain that appears to come from part of the amputated limb that is no longer attached to the body.

While years ago phantom limb pain was thought to be a psychological disorder caused by grief over the missing body part, researchers today know this is not the case. The exact cause of phantom limb pain is not entirely certain, however, many researchers believe it has to do with either the central (brain and spinal cord) or the peripheral (nerves in the body) nervous systems. For unknown reasons, pain nerves continue to send input to the brain as if the amputated limb were still there.

Post-Mastectomy Pain

Post-mastectomy pain is so common in women (it's present in anywhere from 20% to 68% of women who have undergone a mastectomy) that there is a syndrome named for it: post-mastectomy pain syndrome (PMPS). Despite its name, PMPS can occur after almost any type of breast surgery. This includes:

• Lumpectomy
• Mastectomy, partial or total
• Breast conservation surgery
• Breast augmentation or reconstruction

Post-mastectomy pain may be centralized around the breast area, or may radiate into the shoulder, armpit and/or the arm on the side of the body where the surgery was performed. Some women simply experience generalized pain following a mastectomy. PMPS can range anywhere from numbness to discomfort to severe, debilitating nerve pain.

Post Hernia Repair Pain

Chronic pain can be present in almost 10 percent of individuals who undergo hernia repair. Like most types of chronic postoperative pain, it is thought to be caused by nerve damage. Specifically, post hernia repair pain may be caused by either damage to or entrapment of the genitofemoral nerve, the ilioinguinal nerve or the iliohypogastric nerve. The exact cause, however, is not entirely clear.

Chronic post hernia repair pain tends to be localized in the groin area.

Postoperative Pelvic Pain

Postoperative pelvic pain and post hernia repair pain are very similar. Like post hernia repair pain, most postoperative pelvic pain is thought to be caused by damage to the genitofemoral, ilioinguinal or iliohypogastric nerves. This can occur during any major or minor abdominal surgeries, though these nerves are especially prone to damage following surgery in the pelvic cavity.

These pelvic nerves may be damaged, nicked or even stretched during abdominal and pelvic surgeries, especially as they are vulnerable during certain procedures.

Postoperative pelvic pain can occur in the groin area, though it may also radiate to the abdomen or the lower back.

Postoperative Back Pain

For some people, surgery to repair back injuries can result in chronic lower back pain. In fact, people with residual post-surgical back pain account for many of the patients receiving specialized chronic pain treatment.

Like many other forms of chronic postoperative pain, chronic postoperative back pain can often result from nerve damage during surgery. It can also, however, be caused by damage to or instability of the spinal column, which in turn may cause pressure on nerves or segments of the spinal cord. In cases of chronic postoperative back pain, it can be difficult to determine what portion of the problem existed prior to surgical intervention, and what is the result of the back surgery itself.

Other Causes of Chronic Postoperative Pain

The surgical procedure alone may not be the only factor that causes chronic postoperative pain. In some cases, the pain can be traced back to nerve or soft tissue damage. Some other causes of chronic postoperative pain include infections or non-healing surgical wounds.

In many cases, other risk factors play a major role in predicting who will and will not develop chronic postoperative pain. These include age and gender, as well as pre-existing health and pain conditions. Excessive fear of surgery, as well as response to postoperative anesthesia, can also be an indicator of postoperative pain development.

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_{Vilholm OJ, Cold S, Rasmussen L and Sindrup SH. The Postmastectomy Pain Syndrome: An Epidemiological Study on the Prevalence of Chronic Pain After Surgery for Breast Cancer. British Journal of Cancer. 2008 August 19; 99(4): 604–610.}

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