Preventive analgesia and novel strategies for the prevention of chronic post-surgical pain.
Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute post-operative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain.
Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Toronto, ON, M5G 2C4, Canada, hance.clarke@utoronto.ca.
Hance
H
Clarke
Michael
M
Poon
Aliza
A
Weinrib
Rita
R
Katznelson
Kirsten
K
Wentlandt
Joel
J
Katz
D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000818:Animals; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D000700:Analgesics