Education  |   September 2018
Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations
Author Notes
  • From the Department of Anesthesiology and Pain Medicine, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada (P.R.); Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France (X.C.); National Institute of Health and Medical Research, Unit 1051, Institute for Neurosciences of Montpellier, Montpellier, France (X.C., C.R.); and the Department of Biology-Health, University of Montpellier, Montpellier, France (X.C., C.R.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Corresponding article on page 399.
    Corresponding article on page 399.×
  • Submitted for publication February 1, 2017. Accepted for publication March 30, 2018.
    Submitted for publication February 1, 2017. Accepted for publication March 30, 2018.×
  • Address correspondence to Dr. Rivat: Université de Montpellier, Institut des Neurosciences de Montpellier INSERM U1051, Hôpital Saint Eloi, 80, rue Augustin Fliche, 34091 Montpellier-Cedex 5, France. cyril.rivat@umontpellier.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Central and Peripheral Nervous Systems / Pain Medicine / Opioid
Education   |   September 2018
Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations
Anesthesiology 9 2018, Vol.129, 590-607. doi:10.1097/ALN.0000000000002238
Anesthesiology 9 2018, Vol.129, 590-607. doi:10.1097/ALN.0000000000002238
Abstract

The development of chronic pain is considered a major complication after surgery. Basic science research in animal models helps us understand the transition from acute to chronic pain by identifying the numerous molecular and cellular changes that occur in the peripheral and central nervous systems. It is now well recognized that inflammation and nerve injury lead to long-term synaptic plasticity that amplifies and also maintains pain signaling, a phenomenon referred to as pain sensitization. In the context of surgery in humans, pain sensitization is both responsible for an increase in postoperative pain via the expression of wound hyperalgesia and considered a critical factor for the development of persistent postsurgical pain. Using specific drugs that block the processes of pain sensitization reduces postoperative pain and prevents the development of persistent postoperative pain. This narrative review of the literature describes clinical investigations evaluating different preventative pharmacologic strategies that are routinely used by anesthesiologists in their daily clinical practices for preventing persistent postoperative pain. Nevertheless, further efforts are needed in both basic and clinical science research to identify preclinical models and novel therapeutics targets. There remains a need for more patient numbers in clinical research, for more reliable data, and for the development of the safest and the most effective strategies to limit the incidence of persistent postoperative pain.