A Dutch-German research team examined warning signs of chronicity of pain after surgery, with skeletal system procedures, preoperative opioid use, pain persisting two weeks after surgery, and painful cold stimuli as the most important risk factors.
In the vast majority of cases, surgical pain disappears after a few days – but for some patients, it can develop into chronic pain that severely affects them. Phantom limb pain after amputations is a well-known example, but chronic pain can also develop after many other surgeries. In a study now published in the British Journal of Anaesthesia, Dutch-German research group has investigated whether there are early warning signs of such chronicity – this would allow timely identification of affected individuals so that preventive measures could be initiated.
To this end, the group developed an early warning score on a collective of 344 patients undergoing various surgeries. In addition, however, the validity of the score was tested on a second group from a different clinic – this effort distinguishes the methodological quality of the study.
In addition to risk factors such as surgery on the skeletal system and preoperative opioid use, two factors in particular stood out: If patients still complained of pain 14 days after surgery, but especially if they reported feeling a cold stimulus as painful in the process, the risk of chronicity was significantly increased three months after surgery. “An altered pain threshold for cold is an indication that the pain-processing system is no longer functioning normally,” reports Marjelle van Driel, first author of the study, who initiated the work together with Mienke Rijsdijk at the University Hospitals of Utrecht and Rotterdam.
The study was conducted in conjunction with the PAIN OUT international pain research network, which is coordinated at Jena University Hospital in Germany. “The work illustrates what potential a simple but targeted follow-up survey of patients after surgery and anesthesia can be,” emphasized Winfried Meißner, coordinator of PAIN OUT and co-author of the study. The next step should now be to investigate which procedures can prevent chronicity in those identified as being at increased risk.
Original publication:
van Driel et al: Development and validation of a multivariable prediction model forearly prediction of chronic postsurgical pain in adults: a prospective cohort study. British Journal of Anaesthesia 2022, doi: 10.1016/j.bja.2022.04.030
