Brief Overview: Chronic postsurgical pain is pain that persists beyond normal healing after surgery, typically defined as pain lasting ≥3 months post-op that cannot be explained by infection, recurrence, or other causes. It is often neuropathic in nature and may involve central sensitization.
Etiology:
- Surgical trauma → nerve injury, inflammation, or scar tissue formation → peripheral and central sensitization.
- Altered pain processing (wind-up, hyperalgesia).
- Sometimes exacerbated by psychological distress or inadequate acute pain control.
Risk Factors:
- Procedures that are more extensive and produce greater tissue damage
- Excision or damage to nerves
- High risk procedures: amputation, spine surgery, thoracotomy, breast surgery, hernia repair, hysterectomy, arthroplasty
- Poorly controlled acute postoperative pain
- Pre-existing pain conditions
- Anxiety, depression
- Younger age, female
- Radiation therapy or chemotherapy in cancer patients
- Repeated surgeries on the same site
Commonly Associated Conditions:
- Neuropathic pain syndromes (allodynia, hyperalgesia)
- Phantom limb pain (after amputation)
- Fibromyalgia, chronic pain syndromes
- Anxiety, depression, sleep disorders
Common Medications:
(Multimodal pain approach recommended)
- Neuropathic pain agents: gabapentin, pregabalin, duloxetine, amitriptyline, nortriptyline
- Analgesics: acetaminophen, NSAIDs
- Topicals: lidocaine patches, capsaicin
- Muscle relaxants (if spasms present)
- Opioids: short-term role only; not recommended for long-term management of CPSP
- Adjuncts: sleep aids, anxiolytics if comorbid insomnia/anxiety
Common Labs, Imaging, and Tests:
- Primarily clinical diagnosis (pain >3 months after surgery, localized to surgical site).
- Imaging (X-ray, MRI, CT) only if new structural pathology suspected (hardware failure, infection, recurrence).
- Labs (CBC, ESR, CRP) if infection suspected.
- Neuropathic pain questionnaires (DN4, PainDETECT) may help phenotype pain.
Common Symptoms:
- Persistent pain localized to surgical site or nerve distribution
- Neuropathic descriptors: burning, shooting, stabbing, tingling, numbness
- Allodynia (pain from light touch)
- Pain interfering with sleep, mood, or daily functioning
- Reduced range of motion (from pain or scarring)
Common Treatments:
- Non-Pharmacologic:
- Physical therapy, graded exercise
- Cognitive-behavioral therapy (CBT), relaxation techniques
- Acupuncture, TENS, mindfulness
- Scar massage/desensitization techniques
- Pharmacologic:
- Neuropathic pain meds (gabapentin, pregabalin, duloxetine, TCAs)
- Topical agents (lidocaine, capsaicin)
- Multimodal analgesics (acetaminophen, NSAIDs as needed)
- Opioids only as short-term adjuncts if refractory
- Interventional:
- Nerve blocks, epidural injections
- Radiofrequency ablation
- Spinal cord stimulation in refractory cases
Physical Findings:
- Tenderness over surgical site or scar
- Sensory abnormalities (hypoesthesia, hyperesthesia, allodynia)
- Pain with light touch or pressure along nerve distribution
- Decreased range of motion (secondary to pain or scar contracture)
Potential Complications and Contraindications:
- Complications:
- Chronic disability and reduced quality of life
- Sleep disturbance, depression, anxiety
- Medication overuse and dependency
- Limited mobility, deconditioning
- Contraindications:
- Long-term opioid monotherapy (ineffective for neuropathic pain, risk of dependence)
- Repeated steroid injections without benefit
- TCAs in elderly or patients with cardiac disease, glaucoma, urinary retention
General Health and Lifestyle Guidance:
- Stay active with gentle exercise/PT to prevent stiffness and deconditioning. Ask your healthcare provider what exercises are recommended for you.
- Practice scar desensitization/massage techniques if recommended
- Use mindfulness, relaxation, and stress management strategies
- Maintain healthy sleep routines
- Maintain a balanced diet to support healing – ask your healthcare provider if there are any dietary recommendations for you
- Avoid excessive alcohol
- Smoking cessation (improves healing, reduces pain sensitization)
- Join support groups or counseling if pain affects mood/function
Suggested Questions to Ask Patients:
- How long after surgery did your pain continue?
- How would you describe your pain (burning, stabbing, tingling, numbness)?
- Is the pain localized to the surgical area, or does it radiate?
- What activities worsen or improve your pain?
- How does the pain affect your daily activities, sleep, or mood?
- What treatments have you tried so far (medications, PT, injections)?
- Did you have similar pain before surgery?
Suggested Talking Points:
- CPSP is fairly common after major surgery, especially if nerves were affected.
- It’s important to treat pain early – discuss pain management with your healthcare provider.
- There are medications that can help nerve pain.
- Physical therapy, stress reduction, and sleep hygiene are also important.
- Most patients improve with a combined approach, but some may need interventional treatments.
- Good communication with your care team helps tailor treatment to your specific needs. Always let your healthcare provider know about any new, worsening, or persistent symptoms.
Sources:
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.