Acute to Chronic Pain: Transition in the Postsurgical Patient

Abstract

Chronic post-surgical pain (CPSP) is a common problem possibly affecting millions in the present United States alone. The prevalence of CPSP can only be expected to grow in light of the aging population and the increased incidence of surgery among the elderly. We have discussed the pathophysiological mechanisms, predisposing risk factors, preventative strategies, and therapeutic modalities as we understand them today. For now, conservative patient selection for surgery is the key in reducing the incidence of CPSP as success with ex post facto treatment is difficult to achieve. As our basic knowledge regarding the transition from acute to chronic pain grows, our ability to prevent and treat CPSP will no doubt improve. However, a couple of logistical problems need to first be addressed before scientific advancement can lead to change. The first is education. CPSP has been recognized among those in the field of pain medicine as a prevalent syndrome for 20 years, and yet it is still mostly under recognized in the general medical community. Health care providers need to be cognizant of the fact that CPSP exists and that their patients may not discuss the problem unless prompted. Preoperative clinics should provide patient risk stratification as well as intraoperative preventative plans and make themselves widely accessible in the health care community. Additionally, chronic pain and palliative care clinics need to be prepared to care for this patient population in a timely and effective manner It has even been suggested that a new CPSP service be developed to "more accurately determine the true incidence of this phenomenon, to uncover the populations at risk, and to provide early treatment strategies". The second issue is translational science. The basic sciences have outpaced the clinical practices. Numerous biochemical targets have already been identified that might offer more successful treatments with fewer side effects. However, clinicians do not rush to incorporate the new discoveries into clinical care often because they are unaware they even exist. This gap between the basic and clinical sciences has created the opportunity for an entirely new profession of translational science to serve as a bridge. The future will need willing pain and palliative care practitioners to be more involved in this field in order to improve upon our treatment strategies. (PsycINFO Database Record (c) 2015 APA, all rights reserved). (chapter)