Prevention and Management of Persistent Postoperative Pain - A Review of Literature and A Proposal of Therapeutic Strategy

Recent studies have indicated a high prevalence of persistent postoperative pain (PPP) in patients who undergo various surgical procedures. Patient suffering from PPP and the cost to manage this pain are substantial socioeconomic burdens. Although recent studies have revealed various underlying mechanisms of PPP, prevention and management remains unsatisfactory. In this review, we briefly summarize the current understanding of etiology and pathophysiology, which include neuropathic, nociceptive, inflammatory, and myofascial pains as well as psychological or psychiatric factors, and advances in the prevention and management of PPP over the last decade. In addition to the literature review, we present findings from our observation studies of patients with post-thoracotomy pain syndrome, which indicate myofascial pain as a major pathophysiological cause of PPP. Based on the literature review and our recent clinical studies, we propose a comprehensive practical strategy for the prevention and management of PPP.

Keywords: Myofascial pain, Neuropathic pain, Persistent postoperative pain, Post-thoracotomy pain syndrome, Sensitization of nociceptive neurons.