Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain
Section snippets
Physiologic consequences
Inadequately treated pain, particularly acute pain, is associated with physiologic changes caused by endocrine, metabolic, and inflammatory responses (Table 1). This stress response activates the autonomic system, which may have adverse effects on various organ systems [2]. The somatic pathway stimulation caused by surgical injury increases the secretion of hypothalamic-releasing hormones, which in turn stimulates the secretion of the anterior and posterior pituitary gland [2]. The autonomic
Psychologic and behavioral consequences
The psychologic factor related most to high levels of pain is anxiety [18]. Severe pain causes individual behavioral changes including increased sensitivity to external stimuli such as light and sound, withdrawal from interpersonal contact, and increased self-absorption and self-concern. Patients experience a loss of control over their environment if acute pain is unrelieved for prolonged periods, culminating in depression and helplessness. Prolonged and unrelieved pain can lead to the
Recovery and health care use
Uncontrolled pain has also been shown to prolong a patient's stay in the postanesthesia care unit and the hospital and to delay discharge and increase the incidence of unanticipated hospital admissions after ambulatory surgery [22], [23], [24], [25], [26]. Inadequate management of pain after ambulatory surgery has significant consequences (Box 1). Pavlin et al [25] reported that the three most common medical causes of delayed discharge after ambulatory surgery were pain, drowsiness, and nausea
Persistent postoperative pain
Recently, persistent pain after surgery, also referred to as chronic postsurgical pain syndrome, has been recognized as a major factor in delaying recovery and return to normal daily living [5], [6]. Long-lasting pain has been reported after numerous surgical procedures including thoracotomy, mastectomy, hernia repair, and limb amputation [5], [6]. Of note, all surgical procedures have the potential to develop persistent postoperative pain. The devastating consequences of persistent
Summary
It is now well accepted that inadequately treated pain and associated stress response have significant physiologic and psychologic consequences, which may lead to organ dysfunction and increase postoperative mortality and morbidity. In addition, unrelieved postoperative pain reduces the ability to participate in rehabilitation programs, leading to poor postoperative outcomes. Furthermore, poorly controlled pain can potentially increase the incidence of chronic persistent postoperative pain.
References (94)
Chronic pain after surgery
Br J Anaesth
(2001)Pain management and pulmonary dysfunction
Crit Care Clin
(1999)The relationship between pain and negative affect in older adults: anxiety as a predictor of pain
J Anxiety Disord
(2004)- et al.
The effects of failing to control pain: an experimental investigation
Pain
(2004) - et al.
Postoperative pain control in ambulatory surgery
Surg Clin North Am
(1999) - et al.
A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit
J Clin Anesth
(2004) - et al.
Patient care after discharge from the ambulatory surgical center
J Perianesth Nurs
(2001) - et al.
A comparison of pain and its treatment in advanced dementia and cognitively intact patients with hip fracture
J Pain Symptom Manage
(2000) - et al.
Suffering: the contributions of persistent pain
Lancet
(1999) - et al.
The influence of preamputation pain on postamputation stump and phantom pain
Pain
(1997)
Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics, and relationship to pre-mastectomy breast pain
Pain
Persistent pain after elective trauma surgery
Acute Pain
Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower limb amputation
Lancet
The prevalence of phantom limb sensation and pain in pediatric amputees
J Pain Symptom Manage
Effect of present pain and mood on the memory of past postoperative pain in women treated surgically for breast cancer
Pain
Non serratus-sparing antero-axillary thoracotomy with disconnection of anterior rib cartilage: improvement in postoperative pulmonary function and pain in comparison to posterolateral thoracotomy
Chest
Neuroradiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy
J Thorac Cardiovasc Surg
Thoracic epidural analgesia with bupivacaine and fentanyl for postoperative thoracotomy pain
J Cardiothorac Vasc Anesth
Pain after breast surgery: a survey of 282 women
Pain
Spinal mechanisms of acute and persistent pain
Reg Anesth
“Balanced analgesia” in the perioperative period: is there a place for ketamine?
Pain
The nitric oxide-cyclic GMP pathway is required for nociceptive signaling at specific loci within the somatosensory pathway
Neuroscience
Role of nitric oxide in the physiopathology of pain
J Pain Symptom Manage
The mesh plug technique for recurrent groin herniorrhaphy: a nine-year experience of 407 repairs
Surgery
Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade
Pain
Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes
Pain
Reflex sympathetic dystrophy: early treatment and psychological aspects
Arch Phys Med Rehabil
The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study
Pain
Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomized trial
Lancet
Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged
Anesth Analg
Effects of perioperative analgesic technique on rate of recovery after colon surgery
Anesthesiology
The effect of pain on health-related quality of life in the immediate postoperative period
Anesth Analg
Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients
Anesthesiology
Chronic pain as an outcome of surgery: a review of predictive factors
Anesthesiology
Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis
Anesthesiology
The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials
Anesth Analg
Epidural analgesia in gastrointestinal surgery
Br J Surg
Postoperative ileus: a review
Dis Colon Rectum
Does postoperative pain induce emesis?
Clin J Pain
Anaesthesia and emesis I: aetiology
Can Anaesth Soc J
The effect of education, assessment, and standardized prescription on postoperative pain management: the value of clinical audit in the establishment of acute pain services
Anaesthesia
Neural mechanisms in emesis
Can J Physiol Pharmacol
Hemostatic effects of stress hormone infusion
Anesthesiology
Idiopathic brachial neuritis
Iowa Orthop J
Patients' experiences of psychosis in an inpatient setting
J Psychiatr Ment Health Nurs
Behavioral changes in children following day-case surgery: a 4-week follow-up of 551 children
Anaesthesia
Unanticipated admission after ambulatory surgery – a prospective study
Can J Anaesth
Cited by (379)
A multi-stream spatio-temporal network based behavioural multiparametric pain assessment system
2024, Biomedical Signal Processing and ControlThe effects of magnesium sulfate added to epidurally administered local anesthetic on postoperative pain: a systematic review
2023, Brazilian Journal of Anesthesiology (English Edition)Pregabalin versus Gabapentin Efficacy in the Management of Neuropathic Pain Associated with Failed Back Surgery Syndrome
2024, Journal of Korean Neurosurgical SocietyNon-Neuraxial Chest and Abdominal Wall Regional Anesthesia for Intensive Care Physicians—A Narrative Review
2024, Journal of Clinical Medicine