Persistent post-operative and traumatic pain is considered to be one of the most serious complications of various surgical procedures and the injuries experienced by patients. Although many risk factors for its occurrence are known (including the type of surgery and the surgical technique used), the causes of persistent postoperative and post-traumatic pain are still not fully understood. More and more attention is being paid to this problem - this is due to the fact that not only is it recognized in more and more people, but also because it significantly worsens the daily functioning of patients.

Persistent post-operative and post-traumatic pain(abbreviated CPSP, derived from the English name chronic post-surgical pain) is a unit that has been more and more talked about for some time now. It is so for a reason - it turns out that 10%, and according to some authors, even 50% of all patients operated on for various reasons.

The frequency of this problem, as well as the extremely negative way it affects the lives of patients with it, are responsible for the fact that it is now postulated that the diagnosis of persistent post-operative and post-traumatic pain should be included in the official medical classifications of diseases and he alth disorders (it is possible that such a diagnosis will be present in the currently prepared 11th version of the ICD classification).

Persistent post-operative and traumatic pain: causes

Despite the fact that persistent post-operative and post-traumatic pain is relatively common, it has not really been possible to state its causes so far.

One of the most popular theories concerning the pathogenesis of CPSP is the one that the problem develops when some nerve structures are damaged during surgery.

Such damages can be, among others stretching or crushing the nerve root, but also breaking the continuity of nerve fibers.

Persistent post-operative and traumatic pain: risk factors

The risk factors for this occurrence are much better known than the exact causes of persistent post-operative and post-traumatic pain.problem. It turns out that the development of this disorder may be influenced, among others, by inherited genes, and more precisely the innate sensitivity to pain stimuli determined from them.

Personality traits may also play a role in the pathogenesis of the disorder - patients who show a significant degree of anxiety prior to surgery, and those who experience serious fear of the potential emergence of postoperative pain, generally more likely to struggle with CPSP afterwards.

The relationship with persistent postoperative and post-traumatic pain also has the type of surgery that is performed on the patient. The observations carried out so far show that the following treatments are particularly predisposed to CPSP:

  • performed within the chest (e.g. mastectomy)
  • limb amputation
  • hernia repair
  • gynecological procedures (e.g. hysterectomy)

What is also important is the surgical technique used in the patient - persistent postoperative pain is more often found after laparotomy than after laparoscopic surgery.

Interestingly, CPSP is also related to the patient's feelings that appear after the procedure - those people who struggle with severe pain immediately after surgery are at an increased risk of developing persistent pain postoperative.

Persistent post-operative and traumatic pain: symptoms

Pain is the basic symptom of persistent post-operative and post-traumatic pain. However, there is no single, precise characteristic of the pain that results from CPSP - different patients who develop this problem may complain of slightly different ailments.

Pain associated with persistent postoperative pain is usually severe and difficult to relieve with the use of available painkillers or other pain relieving methods other than pharmacotherapy.

This pain is so strong that it makes it difficult for the patient to function in everyday life - because of his ailments, it is more difficult for the patient to perform their duties, whether at home or at work.

Pain, however, is not the only problem of those who develop persistent postoperative pain. Continuous experience of pain may contribute to the constant feeling of fatigue in patients, apart from it, they are also at increased risk of developing mood disorders or anxiety disorders.

Persistent post-operative and traumatic pain: diagnosis

The criteria for recognizing persistent post-operative and post-traumatic pain are not like thisreally unambiguous - there are at least several different descriptions of this disorder in the literature. For example, the criterion of the time of pain occurrence, after which CPSP can be diagnosed, is diverse.

It is most often mentioned that persistent postoperative pain can be recognized when the patient has been struggling with his ailments for at least 3 months.

However, other authors suggest that the diagnosis of the disorder can be made after its symptoms persist for 2 months, and other specialists are of the opinion that the diagnosis of chronic postoperative pain can only be made after the symptoms persist for a period of 6 months. months.

Other aspects to consider in identifying persistent post-operative and post-traumatic pain include:

  • pain was not present in the patient before surgery or trauma (it is possible to diagnose CPSP when the patient suffered from pain before the above-mentioned, although the pain after the injury or surgery must be of a different nature or of greater intensity)
  • pain occurs in the patient in the operated area or in the area where the trauma occurred (it is also possible to project pain, but it must always be related to the operation or trauma)
  • Inability to relate pain to any cause other than the state after surgery or post-traumatic condition (such as cancer or an infection)

Persistent post-operative and traumatic pain: treatment

Persistent postoperative pain is a serious problem because its treatment is very difficult - the use of commonly available painkillers by patients usually does not lead to pain relief.

Usually, the treatment of CPSP is very complex and involves many different interactions, such as, for example, pharmacotherapy (where a combination of different drugs that can bear the pain is usually used), neuromodulation, or even psychotherapy.

Helping a patient with chronic postoperative and post-traumatic pain is not easy - this is why it is so important to try to prevent the occurrence of this disorder.

Persistent post-operative and traumatic pain: prevention

In order to reduce the risk of persistent postoperative and post-traumatic pain, first of all it is necessary to make efforts to prevent nerve damage during the surgical procedure. When the procedure is without complications and it lasts as short as possible, the risk of CPSP decreases.

It has already been mentioned that one of the risk factors for CPSP is pain that occurs in the patient after surgery. For this very reason - vto prevent persistent post-operative pain - proper pain management is essential, both in the pre-, peri-and post-operative periods.

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