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Transition from acute to chronic pain after surgery

Glare P, Aubrey KR, Myles PS. Lancet. 2019 Apr 13;393(10180):1537–46

Following on from surgery, for some patients, pain continues beyond the usual time frame that is expected, potentially leading to chronic post-surgical pain. Typically, this involves pain that becomes increasingly difficult to control and eventually evolves to a neuropathic pathology becoming unresponsive to conventional opioid treatments. In a Lancet Series, Glare et al. discuss prescription opioid use, misuse and abuse steadily rising globally over the last decade, and how the same is true in the post-surgical period for many patients. This has led to opioid-induced hyperalgesia, causing opioids to become ineffective at doses in which they would usually elicit an analgesic response.

In conjunction with this, there has also been a subsequent increase in the number of opioid-related deaths worldwide. Hence, it has been suggested that a comprehensive biopsychosocial approach be adopted in the treatment of pain. The idea is that this will incorporate opioid-sparing analgesic regimens, non-pharmacological interventions, and more selective and careful use of opioids, with the aim to eliminate overprescription of opioids after surgery.