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Published byMonica Emerald Stewart Modified over 9 years ago
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CPSP is the MC and serious complication post surgery No universally agreed definition >4 million people undergo Sx in UK
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↑ analgesic use Restriction of activities of daily living Sig effects on QOL ↑ health care utilization
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What do you understand by the term CPSP ? (10 %)
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CPSP is a type of neuropathic pain
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What types of Surgical procedures does it most commonly follows? (10%)
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Type of surgery Incidence of chronic pain (%) › Amputation 30–85 › Thoracotomy 5–67 › Mastectomy 11–57 › Inguinal hernia repair 0–63 › Sternotomy 28–56 › Cholecystectomy 3–56 › Knee arthroplasty 19–43 › Breast augmentation 13–38
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It may be related to the nerve injury, but not all patients with nerve injury get CPSP and not all patients with CPSP have nerve injuries
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Central sensitization Peripheral nerve injury ↑ Na+ channel expression ↑ Spont activity and discharge, ↑ Glutamate release from nerve endings Acts on Glutamate receptors, Intracellular changes Sustained Central sensitization
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What are the risk factors for the development of CPSP? (30%)
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Preop › Severe, long-term preop pain › ↓ with increase in age › Genetic susseptibility › Psychosocial factors e.g. fear of surgery
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Intra op › Longer, more complicated operation › Open (rather than laparoscopic) › Repeat surgery e.g. Hernia
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Post op › Adjuvant interventions e.g.Radiotherapy › Severe post-op pain
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What can be done to prevent it? (20%)
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Good post-op pain relief itself eg. Epidural/ Paravertebral Gabapentin and IV Ketamine are being used Targinact ®(newer agents) Oxycodone +Naloxone in fastrack colorectal surgery No evidence for pre-emptive RA
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What is the management of CPSP ? (30%)
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Multimodal Multidisciplinary approach with rational use of polypharmacy Pharmacological- WHO, Antidepressants, anticonvulsants, NMDA Non-pharmacological Psychotherapy (CBT, PMP) Complementary therapies (Acu, TENS) Functional rehabilitation Others
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WHO analgesic ladder › Simple analgesics to Strong opiods › Anti depressants eg Amitryptilline › Anti convulsants eg. Carbamazapine › Calcium channel blockers eg. gabapentin › Directly acting eg clonidine › Nerve blocks › Acupuncture › Heat/cold, TENS
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