Schnabel A, Pogatzki-Zahn E
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Münster.
Schmerz. 2010 Sep;24(5):517-31; quiz 532-3. doi: 10.1007/s00482-010-0932-0.
Chronic postoperative pain is known to be a significant clinical and economic problem. The estimated mean incidence is high and varies between 10 and 50%, with variations mostly related to procedure-specific conditions. High-risk types of surgeries are e.g. thoracotomy, breast or inguinal hernia surgery and amputations. Although there is increasing knowledge about the incidence of chronic postoperative pain after certain types of surgical procedures, there are only limited data related to the mechanisms and pathophysiology leading to chronic pain after surgery. Neuropathic pain components have been discussed, especially following operations with a high incidence of nerve damage (for example axillary lymphadenectomy). Besides surgical factors it seems that there are a number of other factors which likely increase the risk of chronic postoperative pain. These predictors for the development of chronic postoperative pain are multiple and include individual genetic factors, age and sex of the individual patient, preoperative chronic pain, psychosocial factors, neurophysiological factors, intraoperative nerve and muscle damage, postoperative complications and acute pain in the early postoperative period. Quantitative sensory testing including tests of inhibitory circuits like DNIC might help to predict the risk of individual patients even before surgery has started. The perioperative identification of patients who are at high risk for developing chronic pain after surgery is therefore a major goal for the future. This may help to develop preventive treatment strategies and avoid treatments with side effects for patients who are not at risk for developing chronic pain after surgery. Due to a lack of appropriate data for sufficient preventive approaches an effective postoperative acute pain management and a nerve-conserving surgical technique are the major keys in the prophylaxis of chronic postoperative pain.
慢性术后疼痛是一个重大的临床和经济问题。据估计，其平均发病率较高，在10%至50%之间波动，这种波动主要与特定手术的情况有关。高风险的手术类型包括开胸手术、乳房或腹股沟疝修补术以及截肢手术。尽管对于某些类型手术之后慢性术后疼痛的发病率已有越来越多的了解，但关于导致术后慢性疼痛的机制和病理生理学的数据仍然有限。神经病理性疼痛成分已被讨论过，尤其是在神经损伤发生率较高的手术（例如腋窝淋巴结清扫术）之后。除了手术因素外，似乎还有许多其他因素可能增加慢性术后疼痛的风险。这些慢性术后疼痛发生的预测因素是多方面的，包括个体遗传因素、患者的年龄和性别、术前慢性疼痛、心理社会因素、神经生理因素、术中神经和肌肉损伤、术后并发症以及术后早期的急性疼痛。包括对像下行性抑制性控制（DNIC）这样的抑制性回路测试在内的定量感觉测试甚至可能在手术开始前就有助于预测个体患者的风险。因此，围手术期识别术后发生慢性疼痛高风险患者是未来的一个主要目标。这可能有助于制定预防性治疗策略，并避免对术后不会发生慢性疼痛风险的患者进行有副作用的治疗。由于缺乏足够的预防性方法的适当数据，有效的术后急性疼痛管理和保留神经的手术技术是预防慢性术后疼痛的主要关键。
