Dr Jose Antonio San Juan   Consultant Orthopedic Surgeon, Chong Hua Hospital, Phillipines

When Adam underwent a hernia surgery sometime ago, he expected a certain amount of pain post-surgery. After all, pain after surgery is normal. However when the pain persisted for several months, he suspected something amiss and consulted his doctor. What he thought was a typical after-effect of surgery was actually persistent post-operative pain.

Which is which?

Like Adam, many people have initially chalked up their persistent post-operative pain to something unimportant and tried tolerating it as long as possible. This only increased their suffering and decreased their quality of life. So, it begets the question: Where is the fine line separating normal post-operative pain from persistent post-operative pain?

Dr Jose Antonio San Juan explains, “Persistent post-operative pain is pain which persists beyond the patient’s expected recovery period and is most common in thoracic, abdominal and orthopaedic surgeries. It mustn’t be confused with acute post-operative pain which occurs immediately post-surgery. It typically lingers for days to weeks which is an expected outcome of surgery.”

Elaborating further, he says, “Common causes of persistent post-operative pain include inefficient acute post-operative pain control, inadequate post-surgery analgesia, soft-tissue injury (possibly due to poor surgical technique) and patient-related factors which have been inadequately addressed pre-surgery (eg, anxiety, depression or chronic pain disorders).”

Ignorance isn’t bliss

“Patients respond differently to persistent post-operative pain for various reasons which may include their own expectations of the surgery and cultural beliefs. There are some who tend to brush it off because they expect pain post-surgery but what they don’t realize is this pain can become persistent and is actually treatable.”

Prevention is key

When asked if persistent post-operative pain is preventable, Dr Jose says, “Yes, it’s possible if risk factors are properly addressed peri-operatively (before, during and after surgery). Patient education is crucial pre-surgery. Also, the surgeon must employ methods of preventive or preemptive analgesia. The patient should be given medication that’s tailored for their needs. Doses should be adjusted according to the patient’s pain score.”

When treating persistent post-operative pain, a multimodal approach is used – meaning treatments are combined to offer maximum relief. “Various types of medication are used like NSAIDS, opioids and anticonvulsants. Anticonvulsants can effectively control post-surgery pain. For instance, in total knee replacement surgeries where the neuropathic pain incidence is as high as 12%, the incidence was reduced to 0 when anticonvulsants were used peri-operatively.”

Dr Jose concludes, “While the condition can’t be cured, it can be controlled and kept to a minimum. If you suspect you’ve a problem, get yourself checked. Treatment can improve your quality of life significantly.”

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