Thapa Parineeta, Euasobhon Pramote
Department of Anaesthesiology and Critical Care, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Anesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Korean J Pain. 2018 Jul;31(3):155-173. doi: 10.3344/kjp.2018.31.3.155. Epub 2018 Jul 2.
Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.
慢性术后疼痛（CPSP）是任何手术中都可能出现的不良事件。它会给患者带来功能限制和心理创伤，也会让手术团队产生挫败感和羞辱感。因此，在高风险手术中考虑CPSP的预防策略至关重要。人们已经采用了各种技术来降低风险，但效果各异。识别每个患者的风险因素并及时采取预防策略，可能有助于患者避免慢性疼痛的困扰。预防策略包括改进手术技术、在围手术期全程做好疼痛控制，以及针对心理社会和认知风险因素进行术前心理干预。对CPSP患者进行适当管理以减轻他们的痛苦也很有必要。CPSP通常具有神经性疼痛成分；因此，目前的建议基于慢性神经性疼痛的数据。因此，电压依赖性钙通道拮抗剂、抗抑郁药、外用利多卡因和外用辣椒素是主要的药物治疗方法。对乙酰氨基酚、非甾体抗炎药和弱阿片类药物可根据症状严重程度使用，但强阿片类药物应谨慎使用，不建议使用。其他可能有帮助的药物包括氯胺酮、可乐定和静脉输注利多卡因。对于药物治疗无效的患者，应考虑采取疼痛干预措施；例如经皮电刺激神经疗法、肉毒毒素注射、脉冲射频、神经阻滞、神经消融、神经调节和手术治疗。物理治疗、认知行为疗法和生活方式改变也有助于缓解CPSP患者所经历的疼痛和困扰。
