Persistent postsurgical pain

Persistent postsurgical pain (PPP) is an important cause of pain morbidity following surgery for almost any cause, but there is a greater evidence base for pain after cancer surgery. Historically, both patients and practitioners have struggled to recognize and accept this growing problem. This review will seek to highlight the awareness of this increasing epidemic and will discuss evidence base for diagnosis, risk factors and current strategies for prevention and treatment, especially after cancer surgery.

Given the potential size of the problems of PPP, there is a relative paucity of recent data, especially as regards effective treatments. The review will synthesize current and existing evidence to give a balanced up-to-date view. There is a clear need for more high-quality randomized trials.

An estimated 40,000 patients in the UK will develop PPP, of whom at least 5-10% will have severe pain. Lack of clear definition and lack of awareness have been barriers to diagnosis and access to treatment. Several risk factors associated with PPP have been identified and reduction of these factors may prevent its development. At present, there are large gaps in the evidence base and more large controlled trials are warranted.