Postoperative chronic pain
Following some operations, postoperative pain may be chronic and chronic. Criteria for postoperative chronic pain diagnosis:
• The emergence of pain after surgical intervention
• At least 2 months duration
• Other causes of pain have been excluded (malignancy, infection)
• Excretion of pain caused by an existing problem at the beginning of surgery
The root of the chronic pain that develops after surgery may be musculoskeletal, visceral, somatic or neuropathic. Its incidence is reported to be between 10-50%. Table 1 shows the incidence of surgical interventions and pain in which postoperative chronic pain is frequent.
Table 1: Estimated incidence of postoperative chronic pain according to surgical type
Incidence of chronic pain (%) Incidence of chronic severe pain (%)
Incidence of cronic pain (%) Incidence cronic severe pain (%)
Amputation 30-50 5-10
Breast surgeon 20-30 5-10
Pulmonary surgery 30-40 10
Inguinal hernia repair 10 2-4
Coronary artery bypass surgery 30-50 5-10
Caesarean 10 4
Factors that may be related with postoperative chronic pain development; Type of surgeon, preoperative pain, acute postoperative pain severity, psychological factors and genetic factors. Prophylactic approaches in which preoperative pain is effective in the chronicity of pain may also result in the inhibition of pain development. Diffuse Noxious Inhibitory Control Test (DNIC) can be used in the prediction of postoperative chronic pain development.
Surgical technique can also affect the development of chronic pain. In laparoscopic hernia repair, it is known that nerve damage and pain are less developed than open surgery. Again, light mesh used in hernia repair can reduce the development of chronic pain by reducing the inflammatory response.
Sentinel lymph node biopsy in mastectomies may prevent nerve damage from occurring because axillary lymph node dissection may be unnecessary. Again, approaches to intercostobrachial nerve preservation are less likely to develop chronic neuropathic pain. Since the retractor is not used in thoracoscopic interventions, chronic pain is less developed as intercostal nerve injury is less common. When the intercostal suture technique is used in thoracotomy operations, the development of chronic pain is also decreased because the compression which is the sinire is less.