Prevention and Management of Persistent Postoperative Pain - A Review of Literature and A Proposal of Therapeutic Strategy
Pp. 341-353 (13)
Katsuyuki Moriwaki, Ken Hashimoto, Kazuhisa Shiroyama, Minoru Tajima, Mikako Sanuki and Shigeaki Kurita
Recent studies have indicated a high prevalence of persistent postoperative
pain (PPP) in patients who undergo various surgical procedures. Patient suffering from
PPP and the cost to manage this pain are substantial socioeconomic burdens. Although
recent studies have revealed various underlying mechanisms of PPP, prevention and
management remains unsatisfactory. In this review, we briefly summarize the current
understanding of etiology and pathophysiology, which include neuropathic,
nociceptive, inflammatory, and myofascial pains as well as psychological or psychiatric
factors, and advances in the prevention and management of PPP over the last decade. In
addition to the literature review, we present findings from our observation studies of
patients with post-thoracotomy pain syndrome, which indicate myofascial pain as a
major pathophysiological cause of PPP. Based on the literature review and our recent
clinical studies, we propose a comprehensive practical strategy for the prevention and
management of PPP.
Myofascial pain, Neuropathic pain, Persistent postoperative pain,
Post-thoracotomy pain syndrome, Sensitization of nociceptive neurons.
National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure 737-0023, Japan.