Transition from acute to chronic pain after surgery

Area of Science:

• Pain Management
• Pharmacology
• Public Health

Background:

• Increasing reliance on opioids for acute and chronic pain has led to a significant rise in misuse, abuse, and overdose deaths.
• Inappropriate opioid prescribing post-surgery, especially upon discharge, is a major contributor to the opioid epidemic.
• Chronic postsurgical pain affects ~10% of patients, often transitioning from acute postoperative pain into opioid-resistant neuropathic conditions.

Purpose of the Study:

• To provide an overview of the epidemiology, societal impact, and basic science of persistent postsurgical pain.
• To discuss current recommendations and advances in managing persistent postsurgical pain.
• To promote safer analgesic regimens for acute and chronic pain management and prevent opioid-induced hyperalgesia.

Main Methods:

• Review of current literature on opioid use in pain management.
• Analysis of epidemiological data on postsurgical pain and opioid-related deaths.
• Synthesis of research on opioid-induced hyperalgesia and alternative pain management strategies.

Main Results:

• Opioid misuse and overdose deaths have quadrupled in the USA since 1999, with a global parallel trend.
• Persistent postsurgical pain often develops from poorly controlled acute postoperative pain and exhibits neuropathic features.
• Research highlights opioid-induced hyperalgesia as a factor in treatment-resistant pain and emphasizes the need for opioid-sparing approaches.

Conclusions:

• Effective management of persistent postsurgical pain requires understanding the transition from acute to chronic pain states.
• Developing and implementing safer, opioid-sparing analgesic regimens and non-pharmacological interventions are critical.
• Preventing the development of chronic postsurgical pain is essential to mitigate the broader opioid crisis.