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Persistent Postsurgical Pain: Current Challenges and Future Prospects

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 3297

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Dr. Asimina Lazaridou

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Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, 850 Boylston St, Suite 302, Chestnut Hill, MA 02467, USA
Interests: chronic pain; chronic low back pain; fibromyalgia pain; migraine; opioid use disorders; mind-body therapies; persistent postsurgical pain; psychosomatic conditions

Special Issue Information

Dear Colleagues,

Chronic Postsurgical Pain (CPSP) poses a significant challenge in the realm of surgical outcomes, impacting the quality of life and function for a considerable number of patients. The current challenges in addressing PPSP revolve around its complex etiology and multifaceted nature, involving an interplay of physiological and psychological factors. A biopsychosocial approach for understanding and coping with chronic pain takes into consideration the biological, psychological, and social factors encompassing a wider variety of treatment options. The interplay between preoperative, intraoperative, and postoperative variables further complicates prediction and prevention efforts. Future prospects in addressing CPSP lie in advancing our understanding through interdisciplinary research, integrating insights from pain medicine, orthopedics, and psychology. Non-pharmacological treatments for postsurgical pain play a crucial role in providing holistic and multimodal pain management strategies. The implementation of personalized medicine approaches, such as predictive modeling, holds promise in identifying patients at higher risk for developing CPSP and tailoring interventions accordingly.

Dr. Asimina Lazaridou
Guest Editor

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Keywords

chronic pain
psychological factors
chronic low back pain
osteoarthritis, prevention
diagnosis
treatment
management
postsurgical pain
clinical outcomes

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Research

12 pages, 1154 KiB

Open AccessArticle

Do Psychological Factors Affect Life Satisfaction and Pain Interference in Spine Surgery Patients? A 12-Month Follow-Up Study

by Emma Lappalainen, Jukka Huttunen, Hannu Kokki, Petri Toroi and Merja Kokki

J. Clin. Med. 2024, 13(23), 7007; https://doi.org/10.3390/jcm13237007 - 21 Nov 2024

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Abstract

Background/Objectives: Psychological factors impact patient-reported outcome measures (PROMs). This study assessed the influence of preoperative anxiety, depression, and resilience on postoperative pain interference and life satisfaction one year after spine surgery. Methods: This study was a secondary analysis of a study involving 120 patients who underwent elective spine surgery and were randomly assigned to receive either tramadol–paracetamol (37.5 mg/325 mg; two tablets; n = 61) or placebo (n = 59) twice per day for pain management during the first five postoperative days. Patients completed the Life Satisfaction Scale-4, Brief Pain Inventory, Hospital Anxiety and Depression Scale, and Resilience Scale-14 questionnaires before surgery and at 28 days and 52 weeks post surgery. The primary outcomes were life satisfaction and pain interference at 12 months after spine surgery and their associations with preoperative anxiety, depression, and resilience. Results: Data from 113 patients (94% response rate) were collected at 52 weeks postoperatively. The number of patients reporting satisfaction with their life increased from three (5%) and two (3%) before surgery to 23 (41%) and 19 (34%), while pain interference decreased from a median of 4.1 to 1.2 and from 4.4 to 1.9 on a scale of 0–10 at 12 months in the placebo and tramadol–paracetamol groups, respectively. The linear regression analysis revealed no statistically significant predictive value for preoperative anxiety, depression, or resilience score for life satisfaction and pain interference at 12 months after spine surgery. Conclusions: These results highlight that psychological factors, anxiety, depression, and resilience did not have an impact on postoperative pain outcomes and life satisfaction in patients undergoing spine surgery. Full article

(This article belongs to the Special Issue Persistent Postsurgical Pain: Current Challenges and Future Prospects)

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12 pages, 456 KiB

Open AccessArticle

Beyond the Surgery: The Impact of Coping Strategies on Persistent Pain After Rotator Cuff Repair

by Daniela Brune, David Endell, Steven Z. George, Robert Edwards, Markus Scheibel and Asimina Lazaridou

J. Clin. Med. 2024, 13(21), 6584; https://doi.org/10.3390/jcm13216584 - 1 Nov 2024

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Abstract

Background: Rotator cuff repair is widely recognized as one of the most painful orthopedic surgeries, yet postoperative pain management in these patients is often underexplored. This study aimed to explore the relationship between pain outcomes and functional recovery six months after arthroscopic rotator cuff repair (ARCR), with a focus on the role of different pain coping mechanisms as mediators. Methods: This study included 83 patients that underwent rotator cuff repair. Pain levels were assessed using the Brief Pain Inventory (BPI-SF), while shoulder function was evaluated using the Oxford Shoulder Score (OSS). Coping strategies, including self-statements, ignoring pain, distraction, and praying, were examined in relation to pain severity and interference and were assessed with the Coping Strategies Questionnaire-Revised (CSQ-R). Simple and parallel mediation analyses were performed using the PROCESS macro to assess the mediating effects of coping mechanisms on the relationship between pain intensity, pain interference, and postoperative OSS. Results: Post-surgery, patients showed a significant improvement in OSS (from 29 ± 9 to 42 ± 6). At six months, 24% of patients reported chronic postsurgical pain (CPSP), defined as a pain severity score of 3 or higher. Correlation analyses revealed that OSS was negatively associated with pain catastrophizing (r = −0.35, p < 0.01) and praying (r = −0.28, p < 0.01). OSS was significantly negatively associated with pain severity (r = −0.54; p < 0.01) and pain interference (r = −0.51, p < 0.01). Mediation analysis demonstrated that coping self-statements significantly mediated the relationship between pain interference and shoulder function (a*b = 0.5266 (BootSE = 0.2691, 95% CI [0.1010, 1.1470]), emphasizing the important role of cognitive strategies in supporting recovery outcomes. Conclusion: Patients engaging in adaptive coping strategies, particularly coping self-statements, reported better functional outcomes. The findings underscore the importance of targeted interventions focusing on effective pain coping mechanisms to improve recovery post-ARCR. Full article

(This article belongs to the Special Issue Persistent Postsurgical Pain: Current Challenges and Future Prospects)

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14 pages, 1291 KiB

Open AccessArticle

Prospective Study of Preoperative Negative Affect and Postoperative Pain in Patients Undergoing Thoracic Surgery: The Moderating Role of Sex

by Angelina R. Franqueiro, Jenna M. Wilson, Jingui He, Desiree R. Azizoddin, Sergey Karamnov, James P. Rathmell, Mieke Soens and Kristin L. Schreiber

J. Clin. Med. 2024, 13(19), 5722; https://doi.org/10.3390/jcm13195722 - 25 Sep 2024

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Abstract

Objective: Preoperative negative affect is a risk factor for worse postoperative pain, but research investigating this association among patients undergoing thoracic surgery is inconsistent. Additionally, female patients often report greater negative affect and postoperative pain than males. This prospective observational study investigated the association between preoperative negative affect and postoperative pain after thoracic surgery and whether this association differed by sex. Methods: Patients (n = 105) undergoing thoracic surgery completed preoperative assessments of pain and negative affect (PROMIS anxiety and depression short forms). Patients reported their daily worst pain over the first 7 postoperative days, and an index score of acute postoperative pain was created. Six months after surgery, a subsample of patients (n = 60) reported their worst pain. Results: Higher levels of preoperative anxiety (r = 0.25, p = 0.011) and depression (r = 0.20, p = 0.042) were associated with greater acute postoperative pain, but preoperative negative affect was not related to chronic postsurgical pain (anxiety: r = 0.19, p = 0.16; depression: r = −0.01, p = 0.94). Moderation analyses revealed that the associations between both preoperative anxiety (b = 0.12, 95% CI [0.04, 0.21], p = 0.004) and depression (b = 0.15, 95% CI [0.04, 0.26], p = 0.008) with acute postoperative pain were stronger among females than males. Similarly, the association between preoperative anxiety and chronic postsurgical pain was stronger among females (b = 0.11, 95% CI [0.02, 0.20], p = 0.022), but the association between preoperative depression and chronic pain did not differ based on sex (b = 0.13, 95% CI [−0.07, 0.34], p = 0.201]). Conclusions: Our findings suggest that negative affect may be especially important to the experience of pain following thoracic surgery among female patients, whose degree of preoperative anxiety may indicate vulnerability to progress to a chronic pain state. Preoperative interventions aimed at reducing negative affect and pain may be particularly useful among females with high negative affect before thoracic surgery. Full article

(This article belongs to the Special Issue Persistent Postsurgical Pain: Current Challenges and Future Prospects)

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