Postoperative chronic pain (POCP) is common and is expected to become increasingly prevalent. This type of pain, however, which specifically arises following surgery, independent of any infection or surgical failure, remains poorly understood. Facilities dedicated to treating it are nearly nonexistent.
At the 2024 congress of the French Society of Anesthesia and Resuscitation, anesthesiologists specializing in pain management advocated for improved management of POCP. They put themselves forward as essential interlocutors and actors in this effort. The anesthesiologists also called for better recognition of postoperative pain by patients, general practitioners, and surgeons to enable early intervention and reduce the risk for chronicity.
Underrecognized, Poorly Managed
POCP is defined as persistent pain lasting more than 3 months after surgery, unrelated to preoperative pain, and not associated with surgical complications. It can manifest in various forms, but the most typical scenario involves a patient complaining of persistent pain that developed following a surgical procedure. Normal radiological and biologic assessments rule out infectious complications. The persistence of pain long after surgery contrasts with what is often considered a successful surgical outcome by the surgeon.
“Of the 10 million patients operated on each year in France, it is estimated that about 10% will develop POCP, equating to 1.2 million patients,” explained Cyril Quémeneur, a specialist in anesthesiology and pain management at Pitié-Salpêtrière Hospital in Paris, France.
Because of the increasing number of surgical interventions in recent years, POCP has become a major concern. “Currently, there are 275 facilities dedicated to chronic pain across the country, capable of accommodating between 300,000 and 400,000 patients. Given that knee replacement surgery — the incidence of which is rising sharply — results in postoperative pain for 20%-30% of operated patients, the question of managing this type of pain will become even more pressing in the future,” said Quémeneur.
Moreover, specialized facilities for transitional pain management are not widespread in France, unlike in Canada, which has been developing them for about a decade, he noted.
France’s pain treatment centers “are overwhelmed,” said Gilles Lebuffe, a specialist in anesthesiology and pain management at Lille University Hospital in Lille, France. “Thus, the time between when the patient is operated on and when we discuss chronic pain allows the painful condition to establish itself, leading to central sensitization at the neurological level.” Once established, this pain is difficult to treat. “The later a patient arrives at a pain center, the more challenging the situation is to manage,” said Lebuffe.
Risk Factors
It is therefore crucial to identify patients at higher risk for postoperative pain during the anesthesia consultation, thus allowing for monitoring during the postoperative period. These pains can be highly debilitating because of their intensity, chronicity, and impact on quality of life.
To target these patients, it is essential to understand which surgeries and patient types constitute risk factors, as well as the characteristics of the pain experienced.
While all surgeries can lead to POCP, certain procedures are more likely to result in chronic pain. They include breast surgery with mastectomy, thoracic and spinal surgery, amputations, and knee replacement surgery. Notably, surgical repair of inguinal hernias, considered routine surgery, is emblematic of the risk for POCP. Its incidence after this procedure is 10% or more in the literature.
In addition, POCP often has neuropathic characteristics. Patients frequently describe their pain using terms like “burning” or “electric shock.” These pains are often associated with strange sensations such as tingling, prickling, itching, or numbness. “This describes neuropathic pain, which increases the risk of chronicity,” said Lebuffe.