Chronic post surgical pain (CPSP) is pain localized to the surgical site or a referred area persisting 3 months after surgery. To diagnose CPSP pain should have been absent before surgery or should have different characteristics from preoperative pain. Other possible causes of the pain such as infection, recurrence of original problem etc need to be excluded.

CPSP is a common complication of surgery and rates up to 80 % in adults have been reported in some studies. CPSP is also reported in children although the incidence is less than in adults. It can have significant consequences for the individual and the World Health Organisation plans to include this as a separate diagnosis in the upcoming version of the International Classification of Diseases, ICD-11. Type of surgery influences not only the risk of development but also the severity of CPSP. Some surgeries are more prone to develop CPSP such as amputations, thoracotomy, and mastectomy. It is observed after commonly performed operations such as hernia repair, caesarean sections, knee replacement etc. Risk factors for developing CPSP include having pain before surgery, severity of acute pain immediately after surgery, multiple surgeries younger age and site of surgery. Genetic and psychological factors are also thought to play a role. A significant proportion of the cases are attributed to nerve damage.

Management of CPSP required multi-modal approach focussing on

Patient and family education
Optimization of medications
Interventional approaches such as injections and neuromodulation.
Psychological interventions such as cognitive behavioural therapy

Author's Bio: 

Dr. Amod Manocha is a Senior Consultant and Head of Pain Management Services at Max Multispecialty Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals.