Chronic Postoperative Pain

Abstract

Understanding the definition of pain has imposed numerous challenges toward pain practitioners. The pain experience phenomena are complicated to understand, and this construct goes beyond biomedical approaches. Persistent pain as a disease implicates changes that include modified sensory feedback within the somatosensory system. It has been documented that different anatomical restructuring in nociceptive integration and adaptations in nociceptive primary afferents and perception conduits are present in persistent pain situations. Chronic postoperative pain (CPOP) is known as a particular disorder, not only associated with a specific nerve damage or manifestation of a unique inflammatory response but also with a mixture of both. The occurrence of CPOP varies substantially among the literature and depends on the kind of procedure. There are reports informing that 10 to 50% of the patients undergoing common procedures had CPOP, and 2 to 10% of patients complained of severe pain. Systematic review has been performed trying to identify the Holy Grail, none showed sufficient evidence to guide CPOP treatment, and multimodal approaches must be tried in large randomized controlled trials (RCTs) to provide robust evidence as evidence-based management for CPOP still lacking.