I was kindly invited to the recent Royal Australian and New Zealand College of Surgeons meeting last week in Auckland to speak about pain related to surgery. My session was concurrent and the other talks in my session included a superb one on central sensitisation by a rheumatologist and one by a psychologist on anxiety and wound healing.
About 1200 surgeons were in attendance and it was an honour to be invited especially as I am not “in the trade”. I was quite chuffed and I was enjoying the preparation of the talk…
The excitement builds…
I was aware of recent papers on the problem of post-surgical pain. Just out was Johansen A et al 2012 reporting that of 2043 surgical patients in the last 3-36 months in northern Norway, around 40% still had symptoms in the area of surgery, around 20% above 3 on a Visual Analogue Scale. Similar results have been reported in the literature for 12 years. In the Norwegian study, there were strong links between hypoesthesia (possibly suggesting nerve cutting) and hyperesthesia (suggesting peripheral and central sensitisation). Some surgeries, such as thoracotomies, sternotomies, breast surgery, spinal surgery and amputation were more likely to lead to lingering pain.
But what was really exciting were recent papers taking serious looks at both peripheral and central mechanisms of post incisional allodynia (e.g. Granat, I et al. 2012) and even one on mechanisms and systems approaches to post-surgical pain ( Deumans R et al 2013). I was thinking “wow – an awareness of the problem and of central sensitisation must be happening”. In a recent commentary in the journal Pain, calls have been made for better pre-emptive therapies, for putting the likelihood of chronic pain on the informed consent form (Schug SA 2012) and I would also add – why not seek ways of treating it.
I thought – surgeons must be ready to take it on!
Only 11 turned up – 3 of those were other speakers, two were friends and another 2 were only interested in medicolegal issues and pain. I guess the surgical world, for many reasons, are not ready or do not want to confront the problem. Or perhaps it was just me?
– David Butler
What are your experiences with post-surgical pain?
Johansen, A. et al 2012 Pain:153:1390
Granat, I. et al. 2012 Eur J Pain:257:255
Deumans, R. et al 2013 Prog Neurobiol:104: 1
Schug, SA. 2012 Pain:153:1344