Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Department of Anesthesiology, School of Medicine, Louisiana State University, New Orleans, LA, 70112, USA.
Curr Pain Headache Rep. 2018 Feb 5;22(2):9. doi: 10.1007/s11916-018-0666-8.
The development of acute to chronic pain involves distinct pathophysiological changes in the peripheral and central nervous systems. This article reviews the mechanisms, etiologies, and management of chronic pain syndromes with updates from recent findings in the literature.
Chronic post-surgical pain (CPSP) is not limited to major surgeries and can develop after smaller procedures such as hernia repairs. While nerve injury has traditionally been thought to be the culprit for CPSP, it is evident that nerve-sparing surgical techniques are not completely preventative. Regional analgesia and agents such as ketamine, gabapentinoids, and COX-2 inhibitors have also been found to decrease the risks of developing chronic pain to varying degrees. Yet, given the correlation of central sensitization with the development of chronic pain, it is reasonable to utilize aggressive multimodal analgesia whenever possible. Development of chronic pain is typically a result of peripheral and central sensitization, with CPSP being one of the most common presentations. Using minimally invasive surgical techniques may reduce the risk of CPSP. Regional anesthetic techniques and preemptive analgesia should also be utilized when appropriate to reduce the intensity and duration of acute post-operative pain, which has been correlated with higher incidences of chronic pain.
急性痛向慢性痛的发展涉及外周和中枢神经系统的明显病理生理变化。本文综述了慢性疼痛综合征的发病机制、病因和治疗方法，并根据文献中的最新发现进行了更新。
慢性手术后疼痛（CPSP）不仅限于大手术，在疝修补等较小的手术后也会发生。虽然神经损伤传统上被认为是 CPSP 的罪魁祸首，但很明显，神经保护手术技术并不能完全预防 CPSP。区域镇痛和氯胺酮、加巴喷丁类药物和 COX-2 抑制剂等药物也被发现可以在不同程度上降低慢性疼痛的发生风险。然而，鉴于中枢敏化与慢性疼痛的发展相关，只要有可能，就应合理使用积极的多模式镇痛。慢性疼痛的发展通常是外周和中枢敏化的结果，CPSP 是最常见的表现之一。使用微创外科技术可能会降低 CPSP 的风险。在适当情况下，还应使用区域麻醉技术和预防性镇痛，以减轻急性术后疼痛的强度和持续时间，因为急性术后疼痛与慢性疼痛的发生率较高有关。
