Advances in Modern Medicine

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Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those ...
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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

Abstract

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.

Keywords:

Myofascial pain, Neuropathic pain, Persistent postoperative pain, Post-thoracotomy pain syndrome, Sensitization of nociceptive neurons.

Affiliation:

National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-Cho, Kure 737-0023, Japan.