Is Chronic Post-Surgical Pain Preventable?

Chronic post-surgical pain (CPSP) is a common problem following surgery. It has significant impact on the patients’ quality of life, chronic pain treatment services and resources in general. The prevalence of CPSP ranges between 5 and 50% of all surgical patients, but severe CPSP is present in less than 10% of the patients. The recognised potential risk factors for CPSP are young age, female gender, overweight, psychological factors, genetic tendency, pre-operative pain, surgery-related factors and severe post-operative pain. Hence, early identification of patients at risk will help to reduce the proportion of patients who are likely to develop CPSP. Different modalities of treatments or interventions are used to prevent the CPSP. These modalities include pre-emptive use of gabapentin, pregabalin or SNRIs, perioperative administration of ketamine, NSAIDs and steroids. In addition, the following interventions have been studied: surgical technique selection, regional and local anaesthesia, intrathecal administration of morphine and multimodal analgesia. Since the present evidence of these interventions is inconclusive because of methodological issues, further studies are still needed to develop more effective and evidence-based strategies to prevent CPSP.