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Chronic pain after surgery

Sunday May 4, 2014

Chronic pain after surgery – who is at risk and can it be prevented?

Persistent pain after common surgery affects up to 50 per cent of patients but it should soon be possible to identify those most at risk and prevent this debilitating complication, a meeting of pain medicine specialists heard today.

Procedures that carried the highest incidence of patient reports of persistent post-operative pain were procedures with an inherent high risk of nerve lesion like amputations, thoracic surgery and breast cancer surgery, Professor Audun Stubhaug told the Australian and New Zealand’s College of Anaesthetists’ Faculty of Pain Medicine Refresher Course Day meeting, “Pain at the Cutting Edge: Surgery and Pain“. Although the majority experience mild, and moderate pain, a considerable proportion get disabling pain affecting their daily life.

Leading international pain medicine specialist Professor Stubhaug, from the department of pain management and research at Oslo University Hospital in Norway, said several risk factors for the development of post-surgical chronic pain had already been identified. These included psychosocial and genetic factors as well as whether the patient experienced pain at the time of the operation – whether related to the surgery or another condition.

Chronic post-surgical pain, defined as pain that lasts at least three months after surgery and where other causes for the pain have been excluded, was a complex syndrome that had environmental, genetic and psychological influences.

Professor Stubhaug said recent studies of twins have indicated there is a 50 per cent genetic factor in the development of migraine, headache and chronic widespread pain and 35 per cent in chronic back pain.

These recent findings had boosted hope that genes increasing risk for both acute pain and the subsequent development of chronic pain can be identified and possibly guide development of new treatments.

“If we pre-operatively test for those genetic markers and other factors that we know are associated with an increased risk of chronic pain conditions we can identify those patients who will need high-intensive treatment after surgery,” he said.

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