- Postsurgical pain
- Chronic pain
- Surgery
Pain after surgery that won't go away: what chronic postsurgical pain is
About 1 in 10 people who have surgery develop pain that lasts months afterward. We explain what it is, which surgeries carry the highest rates, and what the options are.
PainManagement ER Published 3 min read
Pain after an operation is expected. According to a review published in The Lancet in 2019, acute pain is almost universal after surgery, but it can be controlled and mostly resolves within a week.[1] But for some people the pain persists beyond the usual time of tissue healing and becomes chronic.[1]
What exactly is it?
The International Association for the Study of Pain (IASP), in the classification that is part of the WHO’s ICD-11, defines chronic postsurgical pain as pain that develops or increases in intensity after a surgical procedure and persists beyond the healing process — at least 3 months after the operation. Other causes, such as infection or a tumor, must be ruled out first.[2]
How common is it?
According to The Lancet:[1]
- Chronic postsurgical pain bad enough to cause substantial functional impairment occurs in approximately 10% of people who have surgery.
- It is considered intolerable in about 1%.
- An estimated 20% of children have this kind of pain one year after surgery.
- More than 320 million people have surgery worldwide every year, which makes it a growing public health problem.
Which surgeries carry the highest rates
Rates vary widely by type of operation:[1]
| Surgery | Chronic pain (any intensity) | Moderate to severe pain |
|---|---|---|
| Limb amputation | 30–85% | 5–10% |
| Thoracotomy (chest surgery) | 5–65% | 10% |
| Mastectomy | 11–57% | 5–10% |
| Caesarean section | 6–55% | 5–10% |
| Inguinal hernia repair | 5–63% | 2–4% |
| Coronary artery bypass | 30–50% | 5–10% |
| Knee replacement | 13–44% | 15% |
Source: Glare P, Aubrey KR, Myles PS. The Lancet 2019 (table 1).[1] The ranges are wide because studies use different definitions and follow-up times.
Risk factors
The Lancet review groups risk factors into five domains: demographic, genetic, clinical, surgery-related and psychological, and explains that they are interlinked. For example, chronic pain before surgery is more common in women, and greater pain sensitivity often comes with anxiety or depression.[1]
Some factors can be modified, especially when surgery is elective: body-mass index, pain before the operation and some other health conditions. Others, such as demographics, genetics or pain sensitivity, cannot.[1] Nerve injury during surgery probably contributes in some cases.[1]
Can it be prevented?
Optimizing pain management around surgery should help, but the evidence is still inconclusive: most medications studied to prevent it have been disappointing.[1] That’s why it makes sense to:
- Talk to your surgeon before the operation if you already have chronic pain, anxiety or depression.
- Treat existing pain when surgery is planned.
- Follow up on pain in the weeks after surgery, instead of waiting for it to “go away on its own.”
Treatment once the pain is chronic
According to The Lancet, the most successful treatments target the nerve component of pain: gabapentin and pregabalin, and SNRI antidepressants such as duloxetine and venlafaxine. Their effect is variable, and they don’t work the same way for everyone.[1]
One important point: the review notes that people who have had surgery are at increased risk of long-term opioid use.[1] The CDC’s 2022 guideline recommends favoring nonopioid therapies for subacute and chronic pain.[3]
No medication should be taken without medical advice: each one has contraindications and side effects.
When to see a doctor
If 3 months or more have passed since your operation and the pain continues, gets worse, or keeps you from your normal life, it’s not something to accept as “normal.” It deserves an assessment.
A specialized pain management approach can help identify the source of postsurgical pain and combine treatments to restore your quality of life.
Sources
- Transition from acute to chronic pain after surgery . Glare P, Aubrey KR, Myles PS. The Lancet 2019;393(10180):1537–1546 , April 2019.
- The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain . Schug SA, Lavand’homme P, Barke A, et al. Pain 2019;160(1):45–52 , 2019.
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022 . Dowell D, et al. MMWR Recomm Rep 2022;71(No. RR-3):1–95, CDC , November 2022.
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