Acute and chronic pain following craniotomy.
OBJECTIVE
The purpose of the review is to describe what is currently known about the mechanisms, incidence and risk factors for acute and chronic postcraniotomy pain. The review will also summarize the evidence supporting the prevention and management of acute and chronic postcraniotomy pain.


RESULTS
Current studies suggest acute and chronic pain is common in patients after craniotomy. Surgical and patient factors may influence the incidence and severity of pain and a multimodal approach to acute postcraniotomy pain is recommended. Although codeine and tramadol are frequently used in the postoperative period, research suggests morphine provides superior efficacy with a good safety profile. Local anesthesia with nerve blocks has not been shown to consistently reduce acute postoperative pain, though it has recently been demonstrated to dramatically reduce the incidence of chronic pain. Despite this, little is known about the mechanisms, prevention and treatment of chronic postcraniotomy pain.


CONCLUSIONS
Acute and chronic pain following craniotomy is frequent and underrecognized. Several surgical and patient risk factors predispose patients to pain following neurosurgery. Further research is needed to determine the mechanisms, predictors, prevention and optimal treatment of acute and chronic pain following craniotomy.
Flexman
Alana M
AM
Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0648, USA.
Ng
Julie L
JL
Gelb
Adrian W
AW
D000208:Acute Disease; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000772:Anesthesia, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015984:Causality; D002908:Chronic Disease; D003399:Craniotomy / Q000009:adverse effects*; D006261:Headache / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal