Predisposing Factors for Chronic Post-Surgical Pain After Thoracic Surgery: A Scoping Review with Quantitative...

Area of Science:

• Pain Medicine
• Surgical Outcomes
• Psychosomatic Medicine

Background:

• Chronic post-surgical pain (CPSP) is a significant complication following thoracic and cardiothoracic procedures.
• Existing research on CPSP risk factors presents heterogeneous and inconsistent findings.

Purpose of the Study:

• To systematically review and synthesize identified risk factors for CPSP after thoracic and cardiac surgery.
• To evaluate the strength of evidence supporting each identified predictor category.

Main Methods:

• An exploratory review adhering to PRISMA-ScR guidelines was conducted.
• Searches across PubMed, Scopus, and Web of Science yielded 20 eligible studies.
• A qualitative synthesis involved extracting significant p-values and categorizing predictors by evidence strength.

Main Results:

• Severe acute postoperative pain and psychological distress (anxiety, depression, catastrophizing) were the strongest predictors of CPSP.
• Moderate evidence linked younger age, female sex, low BMI, and pre-existing chronic pain to CPSP.
• Surgical and anesthetic factors showed variable associations, with limited evidence for S-ketamine and regional blocks.

Conclusions:

• CPSP arises from a complex interplay of nociceptive, psychological, procedural, and biological factors.
• Prioritizing early postoperative pain control and screening for psychological vulnerability are essential perioperative strategies.
• Standardized, prospective, and biomarker-informed research is needed to further elucidate CPSP mechanisms.