High rate of chronic pain found after general surgery

By Afsaneh Gray, medwireNews Reporter

More than 2 years after undergoing an operation, almost 15% of general surgery patients suffer from chronic postsurgical pain (CPSP), say researchers.

They also found that despite standardized pain therapy algorithms being in place at the facility from which study participants were recruited, one in three suffered severe acute postoperative pain that required further intervention.

Lead author Christian Simanski (Cologne-Merheim Medical Center, Germany) and colleagues report that “there was a high CPSP rate after 2 years both generally and particularly in orthopedic/trauma (57%) patients”. Furthermore, “[b]oth ‘major’ and ‘minor’ surgical procedures led to CPSP.”

Over 3000 patients admitted to a facility for vascular (17%), abdominal/visceral (33%) or orthopaedic/trauma surgery (50%) over a 1-year period were invited to participate in the study. Exclusion criteria included cognitive impairment and communication/language barriers.

While in hospital, patients' pain intensity was assessed at least twice daily using a visual analogue scale from 0 (no pain) to 10 (worst pain imaginable). If they rated pain intensity at 3 or above, they were offered additional pharmacological intervention.

At an average of 19 months after surgery, 911 patients completed questionnaires designed to assess postoperative pain. Those who reported pain more than or equal to 3 on a numerical rating scale (NRS) from 0 to 10 were further analyzed to determine whether their pain was related to their surgery.

A total of 522 (57.3%) patients reported pain intensity on the NRS of ≥3, while 389 (42.7%) patients reported a pain intensity of less than 3. Analysis of a second questionnaire, completed on average 29 months postoperatively, showed that 337 patients still had pain ≥3 on the NRS, representing the same 57.3% rate of incidence as at 19 months.

After a follow-up examination to determine whether patients met the criteria for CPSP – namely, pain that developed after surgery, that is likely to be connected to the surgery, and that was not an exacerbation of a pre-existing problem – 83 (14.8%) patients were diagnosed as having CPSP. Of these, 28% had undergone abdominal/visceral, 15% vascular and 57% trauma/orthopaedic surgery.

All the patients who classified themselves as labourers or unemployed reported pain on the NRS ≥3 after 1 year, although the authors caution that in the 6 months before administration of the second questionnaire, almost 72% of the respondents had not yet returned to work or were retired.

Writing in Pain Medicine, the authors also warn that “[w]e achieved a questionnaire response rate of only 30.2%; thus, selection bias cannot be excluded.”

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