Long term pain
Hundreds of thousands suffer long-term pain after surgery
May 4, 2014 – 6:47PM, The age.
Hundreds of thousands of Australians are suffering chronic pain for months and years after surgery, particularly after breast, heart and amputation procedures, doctors say.
Experts in pain management estimate 20 per cent of the 2.3 million Australians having surgery each year are experiencing persistent pain at the site of their operation one year after surgery, and that about 5 per cent of those people have severe ongoing pain.
A meeting of pain management specialists has heard that while there are many possible reasons for this long-term pain, including nerve damage during surgery and genetic predisposition to pain, it may be possible to predict some of the people who will experience chronic pain after surgery with a range of tests.
Audun Stubhaug, a pain medicine specialist at Oslo University Hospital, told the Australian and New Zealand College of Anaesthetists? Faculty of Pain Medicine conference in Singapore on Sunday that people who were more sensitive to painful stimuli in tests before surgery had a higher chance of post-operative chronic pain. There was also evidence that people with a high or low body mass index, smokers and those who have already experienced chronic pain, depression and anxiety, were at greater risk.
Professor Stubhaug said tests that ask people about these factors could predict about 80 per cent of the people who will experience chronic pain after surgery, suggesting more could be done to screen patients before their operation. This could assist doctors in their anaesthetic techniques and management of pain after surgery, he said.
But Professor Stubhaug said people should be wary of surgeons recommending procedures when there was a less invasive alternative that could work just as well, if not better, for them without the risk of more pain. He said a study of knee surgery, during which half the patients had sham surgery with just an incision in their knee, found that they did much better than patients who had the surgery.
??They had the best results because surgery was only bad for people with small meniscal tears or small cartilage problems. They shouldn?t have surgery, they should just have rehabilitation,?? he said. ??If you make all surgeries a hammer, then every problem is a nail.??
Professor Stubhaug said another study in Norway recently found that when patients waiting for shoulder surgery were put into a four-month-long rehabilitation program, about 70 per cent no longer required surgery.
Mick Vagg, a pain medicine specialist at Geelong Hospital, said many people with osteoarthritis who have knee replacement surgery were not aware that 20 per cent would continue to have pain after surgery and that 5 per cent would be less mobile than before the surgery.
??It?s not a cure all … Some of these people are actually worse off,?? said Dr Vagg, who is also a senior lecturer at Deakin University.
Comment: The causes of the post-surgery pain is multifactoral. The foremost important one factor is pre-surgery misdiagnosis – wrong target of the operation. From my experience I believe the post-surgery pain is the sum of pre-surgery pain and the surgery-induced new pain plus the frustration of the patient.