title: Chronic postsurgical pain in Europe: An observational study.
abstract: BACKGROUND
  Chronic postsurgical pain (CPSP) is an important clinical problem. Prospective studies of the incidence, characteristics and risk factors of CPSP are needed.
  
  
  OBJECTIVE
  The objective of this study is to evaluate the incidence and risk factors of CPSP.
  
  
  METHODS
  A multicentre, prospective, observational trial.
  
  
  METHODS
  Twenty-one hospitals in 11 European countries.
  
  
  METHODS
  Three thousand one hundred and twenty patients undergoing surgery and enrolled in the European registry PAIN OUT.
  
  
  METHODS
  Pain-related outcome was evaluated on the first postoperative day (D1) using a standardised pain outcome questionnaire. Review at 6 and 12 months via e-mail or telephonic interview used the Brief Pain Inventory (BPI) and the DN4 (Douleur Neuropathique four questions). Primary endpoint was the incidence of moderate to severe CPSP (numeric rating scale, NRS ≥3/10) at 12 months.
  
  
  RESULTS
  For 1044 and 889 patients, complete data were available at 6 and 12 months. At 12 months, the incidence of moderate to severe CPSP was 11.8% (95% CI 9.7 to 13.9) and of severe pain (NRS ≥6) 2.2% (95% CI 1.2 to 3.3). Signs of neuropathic pain were recorded in 35.4% (95% CI 23.9 to 48.3) and 57.1% (95% CI 30.7 to 83.4) of patients with moderate and severe CPSP, respectively. Functional impairment (BPI) at 6 and 12 months increased with the severity of CPSP (P < 0.01) and presence of neuropathic characteristics (P < 0.001). Multivariate analysis identified orthopaedic surgery, preoperative chronic pain and percentage of time in severe pain on D1 as risk factors. A 10% increase in percentage of time in severe pain was associated with a 30% increase of CPSP incidence at 12 months.
  
  
  CONCLUSIONS
  The collection of data on CPSP was feasible within the European registry PAIN OUT. The incidence of moderate to severe CPSP at 12 months was 11.8%. Functional impairment was associated with CPSP severity and neuropathic characteristics. Risk factors for CPSP in the present study were chronic preoperative pain, orthopaedic surgery and percentage of time in severe pain on D1.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01467102.
authors.affiliation: From the Department of Anaesthesiology Raymond Poincaré Hospital, Garches, APHP, Université Versailles St Quentin, Inserm 987, France (DF), Department of Anaesthesiology and Pain Medicine, Inselspital and Department of Clinical Research, University of Bern, Bern, Switzerland (UMS), Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster (EP-Z), Department of Anaesthesiology, University Hospital, Jena, Germany (RZ, MK), Department of Anaesthesiology, Central University and Emergency Military Hospital, Bucharest, Romania (NVT), Department of Anaesthesiology and Pain Management, Hospital of Morges and University Hospital Center of Lausanne, Lausanne, Switzerland (CP), Department of Anaesthesia and Critical Care, University Hospitals of Würzburg, Würzburg (PK), Department of Biostatistics, Friedrich-Schiller-University, Jena, Germany (TL), and Clinical Trial Network, European Society of Anaesthesiology, Brussels, Belgium (euCPSP group) *Both Dominique Fletcher and Ulrike M. Stamer contributed equally to the writing of this article.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fletcher
authors.forename: Ulrike M
authors.initials: UM
authors.lastname: Stamer
authors.forename: Esther
authors.initials: E
authors.lastname: Pogatzki-Zahn
authors.forename: Ruth
authors.initials: R
authors.lastname: Zaslansky
authors.forename: Narcis Valentin
authors.initials: NV
authors.lastname: Tanase
authors.forename: Christophe
authors.initials: C
authors.lastname: Perruchoud
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
authors.forename: Marcus
authors.initials: M
authors.lastname: Komann
authors.forename: Thomas
authors.initials: T
authors.lastname: Lehman
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology; D005060:Europe; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009437:Neuralgia / Q000453:epidemiology* / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors