Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain

https://doi.org/10.1016/j.atc.2004.11.013Get rights and content

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.

First page preview

First page preview
Click to open first page preview

References (94)

  • K. Kroner et al.

    Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics, and relationship to pre-mastectomy breast pain

    Pain

    (1989)
  • M. Gehling et al.

    Persistent pain after elective trauma surgery

    Acute Pain

    (1999)
  • L. Nikolajsen et al.

    Randomised trial of epidural bupivacaine and morphine in prevention of stump and phantom pain in lower limb amputation

    Lancet

    (1997)
  • E.J. Krane et al.

    The prevalence of phantom limb sensation and pain in pediatric amputees

    J Pain Symptom Manage

    (1995)
  • T. Tasmuth et al.

    Effect of present pain and mood on the memory of past postoperative pain in women treated surgically for breast cancer

    Pain

    (1996)
  • H. Nomori et al.

    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

    (1997)
  • F. Benedetti et al.

    Neuroradiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy

    J Thorac Cardiovasc Surg

    (1998)
  • F.W. Burgess et al.

    Thoracic epidural analgesia with bupivacaine and fentanyl for postoperative thoracotomy pain

    J Cardiothorac Vasc Anesth

    (1994)
  • M.S. Wallace et al.

    Pain after breast surgery: a survey of 282 women

    Pain

    (1996)
  • A.I. Basbaum

    Spinal mechanisms of acute and persistent pain

    Reg Anesth

    (1999)
  • M. De Kock et al.

    “Balanced analgesia” in the perioperative period: is there a place for ketamine?

    Pain

    (2001)
  • M. Salter et al.

    The nitric oxide-cyclic GMP pathway is required for nociceptive signaling at specific loci within the somatosensory pathway

    Neuroscience

    (1996)
  • M. Anbar et al.

    Role of nitric oxide in the physiopathology of pain

    J Pain Symptom Manage

    (1997)
  • I.M. Rutkow et al.

    The mesh plug technique for recurrent groin herniorrhaphy: a nine-year experience of 407 repairs

    Surgery

    (1998)
  • S. Bach et al.

    Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade

    Pain

    (1988)
  • R.I. Schmid et al.

    Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

    Pain

    (1999)
  • J.H.B. Geertzen et al.

    Reflex sympathetic dystrophy: early treatment and psychological aspects

    Arch Phys Med Rehabil

    (1994)
  • R.S. Perez et al.

    The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study

    Pain

    (2003)
  • P.E. Zollinger et al.

    Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomized trial

    Lancet

    (1999)
  • J.L. Apfelbaum et al.

    Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged

    Anesth Analg

    (2003)
  • S.S. Liu et al.

    Effects of perioperative analgesic technique on rate of recovery after colon surgery

    Anesthesiology

    (1995)
  • C.L. Wu et al.

    The effect of pain on health-related quality of life in the immediate postoperative period

    Anesth Analg

    (2003)
  • D. Tong et al.

    Predictive factors in global and anesthesia satisfaction in ambulatory surgical patients

    Anesthesiology

    (1997)
  • F.M. Perkins et al.

    Chronic pain as an outcome of surgery: a review of predictive factors

    Anesthesiology

    (2000)
  • S.S. Liu et al.

    Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis

    Anesthesiology

    (2004)
  • J.C. Ballantyne et al.

    The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials

    Anesth Analg

    (1998)
  • R.J. Fotiadis et al.

    Epidural analgesia in gastrointestinal surgery

    Br J Surg

    (2004)
  • M.K. Baig et al.

    Postoperative ileus: a review

    Dis Colon Rectum

    (2004)
  • Y.Y. Chia et al.

    Does postoperative pain induce emesis?

    Clin J Pain

    (2002)
  • M.G.A. Palazzo et al.

    Anaesthesia and emesis I: aetiology

    Can Anaesth Soc J

    (1984)
  • M. Harmer et al.

    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

    (1998)
  • D.O. Carpenter

    Neural mechanisms in emesis

    Can J Physiol Pharmacol

    (1990)
  • B.A. Rosenfeld et al.

    Hemostatic effects of stress hormone infusion

    Anesthesiology

    (1994)
  • P. Gonzalez-Alegre et al.

    Idiopathic brachial neuritis

    Iowa Orthop J

    (2002)
  • K. Koivisto et al.

    Patients' experiences of psychosis in an inpatient setting

    J Psychiatr Ment Health Nurs

    (2003)
  • L.H. Kotiniemi et al.

    Behavioral changes in children following day-case surgery: a 4-week follow-up of 551 children

    Anaesthesia

    (1997)
  • J. Fortier et al.

    Unanticipated admission after ambulatory surgery – a prospective study

    Can J Anaesth

    (1998)
  • Cited by (379)

    View all citing articles on Scopus
    View full text