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Mechanisms of chronic postsurgical pain
Adrien Tassou1,2, Philippe Richebe3,4, Cyril Rivat5,6
1Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Regional Anesthesia and Pain Medicine
|February 5, 2025
Summary
Chronic postsurgical pain (CPSP) involves nerve hyperexcitability and central nervous system changes. Understanding these mechanisms is key to managing persistent pain after surgery.
Area of Science:
- Pain research
- Neuroscience
- Surgical outcomes
Background:
- Chronic postsurgical pain (CPSP) is a major public health concern with significant medical and economic impacts.
- Both peripheral and central sensitization mechanisms are crucial in the development and persistence of CPSP.
- Peripheral sensitization involves nerve fiber hyperexcitability at the injury site, increasing pain signal transmission.
Purpose of the Study:
- To review clinical factors contributing to CPSP in patients.
- To examine preclinical mechanisms explaining the transition from acute to chronic postsurgical pain.
- To elucidate the roles of peripheral and central sensitization in CPSP.
Main Methods:
- Review of existing clinical data on CPSP.
- Analysis of preclinical models of CPSP.
- Examination of molecular and cellular mechanisms of pain sensitization.
Main Results:
- Peripheral sensitization involves ion channels (e.g., TRP, ASIC) and inflammatory mediators.
- Central sensitization involves spinal neuron hyperexcitability mediated by NMDA and AMPA receptors and glial activation.
- Dysfunction of antinociceptive systems may also contribute to CPSP.
Conclusions:
- CPSP arises from complex interactions between peripheral and central sensitization pathways.
- Understanding these mechanisms is vital for developing effective strategies to prevent and treat CPSP.
- Further research integrating clinical and preclinical findings is needed to address the challenges of CPSP.
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