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Br J Surg. 2017 Sep;104(10):1293-1306. doi: 10.1002/bjs.10601. Epub 2017 Jul 6.

Systematic review of management of chronic pain after surgery.

Author information

1
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
2
Warwick Clinical Trials Unit, University of Warwick, Warwick, UK.
3
Centre for Pain Research, University of Bath, Bath, UK.
4
Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
5
Avon Orthopaedic Centre, Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, UK.

Abstract

BACKGROUND:

Pain present for at least 3 months after a surgical procedure is considered chronic postsurgical pain (CPSP) and affects 10-50 per cent of patients. Interventions for CPSP may focus on the underlying condition that indicated surgery, the aetiology of new-onset pain or be multifactorial in recognition of the diverse causes of this pain. The aim of this systematic review was to identify RCTs of interventions for the management of CPSP, and synthesize data across treatment type to estimate their effectiveness and safety.

METHODS:

MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library were searched from inception to March 2016. Trials of pain interventions received by patients at 3 months or more after surgery were included. Risk of bias was assessed using the Cochrane risk-of-bias tool.

RESULTS:

Some 66 trials with data from 3149 participants were included. Most trials included patients with chronic pain after spinal surgery (25 trials) or phantom limb pain (21 trials). Interventions were predominantly pharmacological, including antiepileptics, capsaicin, epidural steroid injections, local anaesthetic, neurotoxins, N-methyl-d-aspartate receptor antagonists and opioids. Other interventions included acupuncture, exercise, postamputation limb liner, spinal cord stimulation, further surgery, laser therapy, magnetic stimulation, mindfulness-based stress reduction, mirror therapy and sensory discrimination training. Opportunities for meta-analysis were limited by heterogeneity. For all interventions, there was insufficient evidence to draw conclusions on effectiveness.

CONCLUSION:

There is a need for more evidence about interventions for CPSP. High-quality trials of multimodal interventions matched to pain characteristics are needed to provide robust evidence to guide management of CPSP.

PMID:
28681962
PMCID:
PMC5599964
DOI:
10.1002/bjs.10601
[Indexed for MEDLINE]
Free PMC Article
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