Chronic Pain after Surgery

© Copyright 2011 Elsevier Inc., Ltd., BV. All rights reserved. EPIDEMIOLOGY OF CHRONIC PAIN AFTER SURGERY The incidence of CPSP varies significantly by site of surgical procedure (Table 35-1); however, most reports support an incidence of at least 10% of patients having pain 1 year after surgery. Several high-quality reviews since the 1990s have highlighted the problem of chronic pain after surgery. Crombie et al.1 highlighted the problem with their survey of greater than 5000 patients presenting to North British pain clinics, and found that surgery contributed to pain in 22.5% of those patients. In particular, pain in the abdomen, anal, perineal, and genital pain was associated with surgical procedures. Perkins and Kehlet2 reviewed the evidence for CPSP and found an incidence of phantom limb pain of 30% to 81%, greater than 50% for chronic post-thoracotomy pain, postmastectomy pain syndrome in 11% to 57%, phantom breast pain in 13% to 24%, and post–breast surgery arm and shoulder pain in 12% to 51%. Chronic pain after cholecystectomy is common (3% to 56%) and the overall incidence of chronic pain after inguinal hernia surgery is 11.5%. Despite improvements in methods of providing acute pain control since the 1990s, there have been no dramatic improvements in the incidence of CPSP. Studies examining pain after inguinal hernia repair,3 breast surgery,4 thoracic surgery,5 and hip surgery6 indicate that a very conservative estimate of approximately 10% of patients continue to suffer chronic pain following many types of surgery.