Chronic post-surgical pain (CPSP) is a common and serious complication following surgery. It is characterised by persistent pain lasting more than three months or by new pain that develops after surgery, with all other causes, including infection and malignancy, ruled out. The symptoms can vary from mild discomfort to severe, debilitating pain.
Risk Factors:
Surgical factors include the type of surgery (e.g., thoracotomy, mastectomy, hernia repair, amputation), the length and complexity of the surgery, and the possibility of re-doing surgery.
Patient factors encompass pre-existing pain or chronic pain conditions, psychological distress (e.g., anxiety, depression), and poorly managed acute pain post-surgery.
Symptoms:
- Persistent pain around the surgical site.
- Burning, shooting, stabbing, throbbing or electric sensations.
- Numbness, tingling, or weakness in the affected area.
- Increased sensitivity of the localised area to touch or pressure cold
Assessment and Diagnosis:
To effectively manage the symptoms, a thorough evaluation is essential, and this includes the following components:
- A comprehensive history and assessment are vital
- Investigations: MRI, X-ray, CT scan, ultrasound to exclude other causes
- Follow-up for a personalised multimodal management plan
- Review of the agreed-tailored pathway outcomes
Multimodal Treatment:
Treatment varies depending on the underlying cause and may include:
- Initiating oral analgesics, including anti-neuropathic medications
- Physiotherapy improves mobility and reduces stiffness.
- Nerve blocks to relieve localised pain
- Radiofrequency ablation reduces localised pain by disrupting nerve signals.
- Spinal cord stimulation: Modulates pain signals in the spinal cord.
- Psychological support: stress management, cognitive behavioural therapy (CBT)
