Post-Surgical Pain

What is post-surgical pain?

As the name implies, post-surgical pain is pain that occurs as a result of a surgical procedure. Post-surgical pain is normal when immediately following a surgery. Such pain is usually treated with the use of medications. As patients heal from the surgery, pain typically diminishes. In a surprising number of patients, however, pain continues long after the normal healing process is completed. As such, the pain becomes chronic. Post-surgical pain is typically considered chronic when it continues for longer than six months.

The rate at which post-surgical pain becomes chronic depends on the type of surgery that is performed. In their review of the research, Katz and Seltzer1 found the following rates of chronic post-surgical pain for the given types of surgery:

  • Radical mastectomy: 10-15%
  • Groin pain following hernia repair: 19-39%
  • Leg amputation: 59-79%
  • Total hip replacement: 28%

Searle and Simpson2 found in their review of the research the following additional rates of chronic post-surgical pain:

  • Iliac crest bone harvest site: 30%
  • Hysterectomy: 25%
  • Total knee replacement: 19-43%

As is evident, chronic pain following surgery is common.

Many factors can lead to the development of post-surgical pain. A common misperception that patients and some healthcare providers make is that chronic post-surgical pain is always the result of mistakes made in the surgery. Of course, mistakes do occur sometimes. However, the misperception assumes that surgery is always benign unless something goes awry. This assumption is likely unwarranted. The current state of the art for many surgeries is not perfect. Surgeries can result in chronic post-surgical pain. Phantom limb pain following leg amputation is likely an example. Other factors are also predictive of chronic post-surgical pain. Central sensitization, pre-surgical pain, anxiety reactions to pain, and overly-solicitous responses by the patient’s social support can all play a role in the development of chronic post-surgical pain.1

Is there a cure for post-surgical pain?

Typically, there are no cures for post-surgical pain symptoms. Healthcare providers and their patients focus on management of the symptoms. Chronic pain management has two broad goals:

  • Reduce symptoms to the extent possible
  • Reduce the emotional distress and functional impairments that are associated with the symptoms

The first goal involves reducing pain and related symptoms. The second goal is two-fold: to reduce the fear, anger, anxiety, depression or sleep problems that tend to go along with living with chronic pain, and reducing the sense of disability that tends to occur with pain. Overall, these goals amount to assisting the patient to live well, work, and be involved in life, despite having some chronic post-surgical pain symptoms.

The healthcare system has different ways it pursues chronic pain management. Broadly speaking, there are three different types of pain clinics in our healthcare system:

  • Pain clinics that focus on surgical and/or interventional procedures (surgeries, injections, nerve-burning procedures, and the like)
  • Pain clinics that focus on long-term medication management (such as long-term use of narcotic pain medications)
  • Pain clinics that focus on chronic pain rehabilitation (such as interdisciplinary chronic pain rehabilitation programs)

All three types of clinics treat post-surgical pain symptoms.

Therapies & procedures for post-surgical pain

Common symptom management therapies include lidocaine patches, antidepressant medications, anticonvulsant medications, opioid medications, cognitive behavioral therapy, epidural steroid injections, nerve burning procedures called radiofrequency neuroablations, implantable spinal cord stimulators, surgeries, and chronic pain rehabilitation programs.

Most, but not all, of these therapies have been shown in research to be effective in reducing pain. It is important to note, however, that ‘effective’ in this context does not mean ‘curative.’ Rather, it means that many of these therapies are helpful in reducing pain, but some degree of pain will typically remain. Also, it is important to note that these therapies, even the ones with demonstrated effectiveness, are not all equally effective. The research shows that some are more effective than others.

References

1. Katz, J. & Seltzer, Z. (2009). Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert Reviews of Neurotherapeutics, 9, 723-744.

2. Searle, R. D. & Simpson, K. H. (2010). Chronic Post-Surgical Pain. Continuing Education in Anaesthesia, Critical Care & Pain, 10, 12-14.

 

Date of publication: April 27, 2012

Date of last modification: October 23, 2015

Murray J. McAllister, PsyD, is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Its mission is to lead the field in making pain management more empirically supported. Additionally, the ICP provides Academic quality information on chronic pain that is approachable to patients and their families. Dr. McAllister is also the clinical director of pain services for Courage Kenny Rehabilitation Institute (CKRI), part of Allina Health, in Minneapolis, MN. Among other services, CKRI provides chronic pain rehabilitation services on a residential and outpatient basis.

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