New planning tool helps identify patients' risks of chronic pain after surgery

There are many variables that contribute to a patient's risk of chronic pain after surgery; physicians are still exploring ways to identify those variables prior to surgery. A study published in the Online First edition of Anesthesiology, the official medical journal of the American Society of Anesthesiologists® (ASA®), gives physicians a new planning tool to help identify patients' risks of chronic pain after surgery.

"Our study rigorously examined patients' risks of chronic postsurgical pain," said Antonio Montes Perez, M.D., Ph.D., lead study author, department of anesthesiology, Hospital del Mar in Barcelona, Spain. "We sought a tool that would reliably predict a patient's risk preoperatively, at the time surgery is being planned. We developed a risk scoring system that can be used before surgery, when care planning and preventive measures are critically important."

The researchers followed 2,929 patients undergoing three common types of surgery (hernia repair, hysterectomy and thoracotomy) for two years, assessing their pain at four, 12 and 24 months after surgery. The study, referred to as GENDOLCAT, demonstrated that there is substantial risk of chronic pain after surgery, with 18 percent of the patients developing chronic pain after four months, and 5.2 percent still experiencing chronic pain after 24 months.

The scoring system was developed based on six predictors among the patients in the study:

•Type of surgery
•Age
•Physical health status
•Mental health status
•Preoperative pain in the surgical area
•Preoperative pain in another area.

According to Dr. Montes, risk scoring facilitates informed patient-physician discussion of strategies so together they can:

•Carefully consider the surgery
•Plan to use the most appropriate pain relief techniques during the recovery period
•Implement preventive measures before and during surgery
•Set a pain monitoring schedule and follow-ups

The researchers also tested for 90 genetic predictors, but found they did not play a role in the development of chronic pain after surgery in this study.

"This scoring system improves the way we examine patients prior to surgery, which is based on an extensive physical examination rather than just clinical factors," said Dr. Montes. "As far as genetic influence, additional research should be conducted to determine whether or not other genetic factors not considered in this study contribute to chronic pain after surgery.