title: [Predictors of chronic pain following surgery. What do we know?].
abstract: Chronic postoperative pain is known to be a significant clinical and economic problem. The estimated mean incidence is high and varies between 10 and 50%, with variations mostly related to procedure-specific conditions. High-risk types of surgeries are e.g. thoracotomy, breast or inguinal hernia surgery and amputations. Although there is increasing knowledge about the incidence of chronic postoperative pain after certain types of surgical procedures, there are only limited data related to the mechanisms and pathophysiology leading to chronic pain after surgery. Neuropathic pain components have been discussed, especially following operations with a high incidence of nerve damage (for example axillary lymphadenectomy). Besides surgical factors it seems that there are a number of other factors which likely increase the risk of chronic postoperative pain. These predictors for the development of chronic postoperative pain are multiple and include individual genetic factors, age and sex of the individual patient, preoperative chronic pain, psychosocial factors, neurophysiological factors, intraoperative nerve and muscle damage, postoperative complications and acute pain in the early postoperative period. Quantitative sensory testing including tests of inhibitory circuits like DNIC might help to predict the risk of individual patients even before surgery has started. The perioperative identification of patients who are at high risk for developing chronic pain after surgery is therefore a major goal for the future. This may help to develop preventive treatment strategies and avoid treatments with side effects for patients who are not at risk for developing chronic pain after surgery. Due to a lack of appropriate data for sufficient preventive approaches an effective postoperative acute pain management and a nerve-conserving surgical technique are the major keys in the prophylaxis of chronic postoperative pain.
authors.affiliation: Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster.
authors.forename: A
authors.initials: A
authors.lastname: Schnabel
authors.forename: E
authors.initials: E
authors.lastname: Pogatzki-Zahn
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000818:Animals; D001921:Brain / Q000503:physiopathology; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D009434:Neural Pathways / Q000502:physiology; D009437:Neuralgia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D009473:Neuronal Plasticity / Q000502:physiology; D009619:Nociceptors / Q000502:physiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D010525:Peripheral Nerves / Q000503:physiopathology; D011300:Preoperative Care; D012307:Risk Factors; D013116:Spinal Cord / Q000503:physiopathology
chemical_list: D000700:Analgesics
references.citation: Physiol Rev. 2009 Apr;89(2):707-58
references.pmid: 19342617
references.citation: Eur J Pain. 2009 Nov;13(10):1048.e1-7
references.pmid: 19231261
references.citation: Anesth Analg. 2006 Sep;103(3):703-8
references.pmid: 16931684
references.citation: Best Pract Res Clin Anaesthesiol. 2007 Mar;21(1):3-13
references.pmid: 17489216
references.citation: Anesth Analg. 2010 Apr 1;110(4):1180-5
references.pmid: 20103545
references.citation: Anesth Analg. 2002 Jan;94(1):11-5, table of contents
references.pmid: 11772793
references.citation: CNS Spectr. 2008 Mar;13(3 Suppl 5):6-11
references.pmid: 18323767
references.citation: Eur J Cardiothorac Surg. 2009 Jul;36(1):170-80
references.pmid: 19307137
references.citation: J Neurosci. 2003 Jan 1;23(1):158-66
references.pmid: 12514212
references.citation: Pain. 2003 Oct;105(3):415-423
references.pmid: 14527702
references.citation: Eur J Cardiothorac Surg. 2000 Dec;18(6):656-61
references.pmid: 11113671
references.citation: Anesthesiology. 2003 May;98(5):1214-22
references.pmid: 12717144
references.citation: Anesth Analg. 2006 Oct;103(4):995-1000
references.pmid: 17000819
references.citation: Clin J Pain. 2009 Feb;25(2):92-100
references.pmid: 19333152
references.citation: Anaesth Intensive Care. 2009 Sep;37(5):748-52
references.pmid: 19775038
references.citation: Annu Rev Neurosci. 2000;23:777-811
references.pmid: 10845081
references.citation: Eur J Pain. 2009 Nov;13(10):1054-61
references.pmid: 19138869
references.citation: Eur J Pain. 2002;6(4):295-305
references.pmid: 12161095
references.citation: Curr Opin Anaesthesiol. 2006 Oct;19(5):556-61
references.pmid: 16960491
references.citation: Neuron. 2006 Oct 5;52(1):77-92
references.pmid: 17015228
references.citation: Schmerz. 2003 Jan;17(1):11-9
references.pmid: 12579385
references.citation: J Vis Exp. 2010 Jan 27;(35):
references.pmid: 20107427
references.citation: Can J Anaesth. 1999 Dec;46(12):1127-32
references.pmid: 10608205
references.citation: Anesthesiology. 2004 Jan;100(1):115-9; discussion 5A
references.pmid: 14695732
references.citation: Pain Suppl. 1986;3:S1-226
references.pmid: 3461421
references.citation: Anesthesiology. 2010 Jan;112(1):181-8
references.pmid: 19996949
references.citation: Arch Phys Med Rehabil. 2005 Oct;86(10):1910-9
references.pmid: 16213230
references.citation: Anesthesiology. 2007 May;106(5):1003-12
references.pmid: 17457133
references.citation: Curr Opin Anaesthesiol. 2009 Feb;22(1):38-43
references.pmid: 19237975
references.citation: Pain. 2008 Aug 15;138(1):22-28
references.pmid: 18079062
references.citation: Pain Med. 2009 May-Jun;10(4):708-15
references.pmid: 19453965
references.citation: J Pain. 2006 Sep;7(9):626-34
references.pmid: 16942948
references.citation: Pain. 2004 Nov;112(1-2):204-13
references.pmid: 15494202
references.citation: Pain. 1998 May;76(1-2):167-71
references.pmid: 9696470
references.citation: Prog Neurobiol. 2000 Jun;61(2):169-203
references.pmid: 10704997
references.citation: Anesth Analg. 2009 Nov;109(5):1645-50
references.pmid: 19843803
references.citation: Pain. 2000 Aug;87(2):149-158
references.pmid: 10924808
references.citation: Pain Res Manag. 2008 Jul-Aug;13(4):335-41
references.pmid: 18719716
references.citation: Anesthesiology. 2010 Mar;112(3):511-3
references.pmid: 20124975
references.citation: Proc Natl Acad Sci U S A. 2003 Apr 15;100(8):4867-72
references.pmid: 12663858
references.citation: Anesthesiology. 2010 Mar;112(3):516-8
references.pmid: 20124976
references.citation: Surg Endosc. 2010 Nov;24(11):2735-8
references.pmid: 20376498
references.citation: Pain. 2005 Dec 15;119(1-3):16-25
references.pmid: 16298063
references.citation: Pain. 2010 Jan;148(1):103-106
references.pmid: 19959292
references.citation: Anesth Analg. 2008 Nov;107(5):1720-5
references.pmid: 18931238
references.citation: Clin Pharmacol Ther. 2007 Jul;82(1):41-7
references.pmid: 17361124
references.citation: Clin Orthop Relat Res. 2003 Nov;(416):27-36
references.pmid: 14646737
references.citation: Br J Anaesth. 2005 Jul;95(1):69-76
references.pmid: 15531621
references.citation: J Thorac Cardiovasc Surg. 1996 Nov;112(5):1346-50; discussion 1350-1
references.pmid: 8911333
references.citation: Anesthesiology. 2010 Feb;112(2):406-17
references.pmid: 20068448
references.citation: Acta Anaesthesiol Scand. 1999 May;43(5):563-7
references.pmid: 10342006
references.citation: Hernia. 2008 Apr;12(2):153-7
references.pmid: 17972007
references.citation: Ann Surg. 2007 Mar;245(3):487-94
references.pmid: 17435557
references.citation: Anesth Analg. 2002 Oct;95(4):985-91, table of contents
references.pmid: 12351281
references.citation: Hum Mol Genet. 2005 Jan 1;14(1):135-43
references.pmid: 15537663
references.citation: Curr Opin Anaesthesiol. 2009 Jun;22(3):425-30
references.pmid: 19352173
references.citation: Br J Anaesth. 2001 Jul;87(1):88-98
references.pmid: 11460816
references.citation: Eur J Pain. 2010 Apr;14(4):339
references.pmid: 20227310
references.citation: Science. 2000 Jun 9;288(5472):1765-9
references.pmid: 10846153
references.citation: Am J Phys Med Rehabil. 2009 Sep;88(9):742-51; quiz 752, 779
references.pmid: 19692791
references.citation: Anesth Analg. 2004 Jul;99(1):146-151
references.pmid: 15281521
references.citation: PLoS Genet. 2008 Jul 25;4(7):e1000086
references.pmid: 18654615
references.citation: J Pain. 2008 Oct;9(10):955-61
references.pmid: 18632308
references.citation: Anesth Analg. 2010 Jan 1;110(1):199-207
references.pmid: 19910619
references.citation: Pain. 2006 Dec 5;125(3):216-224
references.pmid: 16837133
references.citation: Eur J Pain. 2008 Nov;12(8):1069-77
references.pmid: 18374612
references.citation: J Pain. 2009 Jun;10(6):628-36
references.pmid: 19398382
references.citation: Science. 2003 Feb 21;299(5610):1240-3
references.pmid: 12595695
references.citation: Anesthesiology. 2005 Oct;103(4):813-20
references.pmid: 16192774
references.citation: Ann Surg. 2006 Aug;244(2):212-9
references.pmid: 16858183
references.citation: Clin J Pain. 2009 May;25(4):263-8
references.pmid: 19590472
references.citation: Anesth Analg. 2005 Nov;101(5):1427-1432
references.pmid: 16244006
references.citation: Acta Anaesthesiol Scand. 2009 Sep;53(8):1073-83
references.pmid: 19572933
references.citation: J Reprod Med. 2004 Jul;49(7):503-9
references.pmid: 15305821
references.citation: Pain. 1988 Apr;33(1):87-107
references.pmid: 2837713
references.citation: Anesthesiology. 2002 Nov;97(5):1234-44
references.pmid: 12411810
references.citation: Anesthesiol Clin North Am. 2005 Mar;23(1):1-20
references.pmid: 15763408
references.citation: Br J Anaesth. 2010 Jan;104(1):75-9
references.pmid: 19915188
references.citation: JAMA. 2009 Nov 11;302(18):1985-92
references.pmid: 19903919
references.citation: Clin J Pain. 2006 May;22(4):353-8
references.pmid: 16691088
references.citation: J Neurophysiol. 2002 Feb;87(2):721-31
references.pmid: 11826041
references.citation: Expert Rev Neurother. 2009 May;9(5):723-44
references.pmid: 19402781
references.citation: Anesthesiology. 2006 Nov;105(5):1008-15
references.pmid: 17065896
references.citation: Nat Med. 2006 Nov;12(11):1269-77
references.pmid: 17057711
references.citation: Anesthesiology. 2010 Mar;112(3):514-5
references.pmid: 20124977
references.citation: Neurol Clin. 2009 May;27(2):503-11
references.pmid: 19289228