From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis.
OBJECTIVE
The pathogenesis and risk of chronic pain after cholecystectomy are unknown. In this prospective study of 150 consecutive patients undergoing laparoscopic cholecystectomy, the preoperative clinical data, cold pressor test, state of neuroticism and early postoperative pain intensity were assessed.


METHODS
Follow-up questionnaires were sent to all patients 1 year after surgery. Patients with moderate/severe chronic pain were interviewed and invited to participate in a structured examination programme.


RESULTS
The questionnaire response rate was 100%. Twenty patients reported moderate or severe chronic pain. The 1-year in-office interview revealed that two patients without chronic pain had misinterpreted the questionnaire. Sixteen patients were enrolled for the examination programme. Demonstrable pathology explained the aetiology of chronic pain in 8 patients (5%); another 8 patients with moderate (n=6) or severe (n=2) chronic pain were without pathological findings. In total, 132 patients had no chronic pain. Chronic pain patients suffered significantly more intense acute postoperative pain compared with those without chronic pain (p < or =0.05). The incidence of chronic pain patients was higher in the group of patients with intense acute postoperative pain than in patients with low acute postoperative pain (p = 0.030-0.063). Development of chronic pain was not statistically related to a preoperative cold pressor nociceptive stimulus, preoperative state of neuroticism or to any other variables examined.


CONCLUSIONS
The risk of significant chronic pain after laparoscopic cholecystectomy for symptomatic cholecystolithiasis is low but was significantly associated with the intensity of acute postoperative pain. Patients should be carefully examined to exclude somatic causes of chronic pain after laparoscopic cholecystectomy.
Bisgaard
Thue
T
Department of Surgical Gastroenterology, H:S Hvidovre Hospital, Hvidovre, Denmark. thuebisgaard@tdcadsl.dk
Rosenberg
Jacob
J
Kehlet
Henrik
H
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D002908:Chronic Disease; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D017562:Postcholecystectomy Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013997:Time Factors
D000700:Analgesics