Analysis of the factors of pain chronicity in the postoperative period in abdominal surgery

• Evgenya А. Tyurina
• Zagorulko O.I.
• Ludmila A. Medvedeva
• Arkady L. Bedzhanyan
• Shestakov A.L.

Abstract

Background. Chronic postoperative pain is a significant complication of surgery and is the most frequent cause of disability in the population in the long-term postoperative period, leads to social and mental disadaptation of the patient and his environment, takes away valuable resources from the economy and the healthcare system. Predictors of chronic postoperative pain are both individual patient characteristics (genotype, comorbidities, attitudes toward treatment, etc.) and medical care tactics.

The aim of our study was to assess factors influencing chronicity of postoperative pain after abdominal surgery.

Material and methods. The study included 88 patients who had undergone elective abdominal surgery for surgical pathology, excluding oncological diseases.

Methods of examination: psychometric testing including Hospital Anxiety and Depression Scale (HADS), The Pain Catastrophizing Scale (PCS), reflecting three parameters of catastrophizing: constant thinking, exaggeration, hopelessness.

Results. According to the results of the study, preoperative pain syndrome and psychological factors, such as anxiety and depression, and pain catastrophizing were predictors of chronic postoperative pain after abdominal surgery; pronounced pain syndrome on the 1^st day after surgery was also associated with a high frequency of chronic pain (12.9%).

Keywords:chronic pain; abdominal surgery; pain relief; chronicity factors

References

1. Macrae W.A. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008; 101 (1): 77–86.

2. Scholz J., et al. The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain. 2019; 160 (1): 53–9.

3. Samantaray A., et al. Chronic postoperative surgical pain after laparoscopic cholecystectomy: comparison of two anesthetic techniques [Electronic resource]. ASA Abstracts. 2017:  A4033.

4. Guck T.P. Defeating pain: the war against a silent epidemic. J Pain Symptom Manag. 1994; 9 (5): 351–2.

5. Hogan M.E., et al. Health utilities in people with chronic pain using a population-level survey and linked health care administrative data. Pain. 2017; 158 (3): 408–16.

6. Hogan M.E., et al. Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data. Pain. 2016; 157 (8): 1626–33.

7. Pagé M.G., et al. Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain. J Pain Res. 2013; 6: 167–80.

8. Fletcher D., et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol. 2015; 32 (10): 725–34.

9. Weiser T.G., et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016; 94 (3): 201–9.

10.   Abugov S.A., Bedzhanyan A.L., et al. Liver surgery. Operative techniques and minimally invasive technologies. A guide for physicians. 1st ed. In: O.G. Skipenko (ed.). Moscow: Meditsinskoe informatsionnoe agenstvo, 2016. (in Russian)

11.   Shestakov A.L., Tyurina E.A. Analysis of the frequency  of chronic postoperative pain formation after thoracotomy and video thoracoscopic operations on the esophagus. Rossiyskiy zhurnal boli [Russian Journal of Pain]. 2019; 17 (S1): 99–100. (in Russian)

12.   Charchyan E.R., Stepanenko A.B., Gens A.P., The effect of the sternal closure techniques on pain severity after cardiac surgery. Klinicheskaya i eksperimental’naya khirurgiya. Zhurnal imeni akademika B.V. Petrovskogo [Clinical and Experimental Surgery. The Journal named after academician B.V. Petrovsky]. 2016; 3 (13): 65–73. (in Russian)

13.   Medvedeva L.A., Zagorul’ko O.I., Belov Yu.V. Chronic postoperative pain: current state of the problem and stages of prevention. Anesteziologiya i reanimatologiya [Anesthesiology and Reanimatology]. 2017; 64 (4): 305–9. (in Russian)

14.   Eremenko A.A., Sorokina L.S., Analgesia of adult patients in the early period after cardiac surgery. Rossiyskiy zhurnal boli [Russian Journal of Pain]. 2018; 1 (55): 21–7. (in Russian)

15.   Kehlet H., Jensen T.S., Woolf C.J. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367 (9522): 1618–25.

16.   Katz J., Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009; 9 (5): 723–44.

17.   Vandenkerkhof E.G., et al. Impact of perioperative pain intensity, pain qualities, and opioid use on chronic pain after surgery: a prospective cohort study. Reg Anesth Pain Med. 2012; 37 (1): 19–27.

18.   Choinière M., et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. CMAJ. 2014; 186 (7): E213–23.

19.   Wang L., et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016; 188 (14): E352–61.

20.   Katz J., et al. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996; 12 (1): 50–5.

21.   Chidambaran V., et al. Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study. Eur J Pain. 2017; 21 (7): 1252–65.

22.   Aasvang E.K., et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010; 112 (4): 957–69.

23.   Tiippana E., Nilsson E., Kalso E. Post-thoracotomy pain after thoracic epidural analgesia: a prospective follow-up study. Acta Anaesthesiol Scand. 2003; 47 (4): 433–8.

24.   Perttunen K., Tasmuth T., Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand. 1999; 43 (5): 563–7.

25.   Brandsborg B., Nikolajsen L. Chronic pain after hysterectomy. Curr Opin Anaesthesiol. 2018; 31 (3): 268–73.

26.   Attal N., et al. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort. Brain. 2014; 137 (3): 904–17.

27.   Pagé M.G., et al. Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty. Pain. 2015; 156 (3): 460–8.

28.   Pinto P.R., et al. Psychological factors predict an unfavorable pain trajectory after hysterectomy: a prospective cohort study on chronic postsurgical pain. Pain. 2018; 159 (5): 956–67.

29.   Burns L.C., et al. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review.  J Pain Res. 2015; 8: 21–32.

30.   Kleiman V., Clarke H., Katz J. Sensitivity to pain traumatization: a higher-order factor underlying pain-related anxiety, pain catastrophizing and anxiety sensitivity among patients scheduled for major surgery. Pain Res Manag. 2011; 16 (3): 169–77.

31.   Nagi H. Acute pain services in the United Kingdom. Acute Pain. 2004; 5 (3–4): 89–107.

32.  32.  Powell A.E., et al. Rhetoric and reality on acute pain services in the UK: a national postal questionnaire survey. Br J Anaesth. 2004; 92 (5): 689–93.