Preoperative pain as a risk factor for chronic post-surgical pain - six month follow-up after radical prostatectomy.
BACKGROUND
Chronic post-surgical pain (CPSP) by definition develops for the first time after surgery and is not related to any preoperative pain. Preoperative pain is assumed to be a major risk factor for CPSP. Prospective studies to endorse this assumption are missing.


METHODS
In order to assess the incidence and the risk factors for CPSP multidimensional pain and health characteristics and psychological aspects were studied in patients prior to radical prostatectomy. Follow-up questionnaires were completed three and six months after surgery.


RESULTS
CPSP incidences in 84 patients after three and six months were 14.3% and 1.2%. Preoperatively, CPSP patients were assigned to higher pain chronicity stages measured with the Mainz Pain Staging System (MPSS) (p=0.003) and higher pain severity grades (Chronic Pain Grading Questionnaire) (p=0.016) than non-CPSP patients. CPSP patients reported more pain sites (p=0.001), frequent pain in urological body areas (p=0.047), previous occurrence of CPSP (p=0.008), more psychosomatic symptoms (Symptom Check List) (p=0.031), and worse mental functioning (Short Form-12) (p=0.019). Three months after surgery all CPSP patients suffered from moderate to high-risk chronic pain (MPSS stages II and III) compared to 66.7% at baseline and 82.3% had high disability pain (CPGQ grades III and IV) compared to 41.7% before surgery. CPSP patients scored significantly less favorably in physical and mental health, habitual well-being, and psychosomatic dysfunction three months after surgery.


CONCLUSIONS
All patients with CPSP reported on preoperative chronic pain. Patients with preoperative pain, related or not related to the surgical site were significantly at risk to develop CPSP. High preoperative pain chronicity stages and pain severity grades were associated with CPSP. CPSP patients reported poorer mental health related quality of life and more severe psychosomatic dysfunction before and 3 months after surgery.
Gerbershagen
Hans J
HJ
Department of Anesthesiology, University of Cologne, Cologne, Germany. hans.gerbershagen@uk-koeln.de
Ozgür
Enver
E
Dagtekin
Oguzhan
O
Straub
Karin
K
Hahn
Moritz
M
Heidenreich
Axel
A
Sabatowski
Rainer
R
Petzke
Frank
F
D000368:Aged; D000768:Anesthesia, General; D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology; D010523:Peripheral Nervous System Diseases / Q000473:pathology / Q000523:psychology; D057234:Preoperative Period; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires