UNDERSTANDING PAIN: Chronic surgical pain often remains difficult for seniors to understand and deal with both physically and mentally.
UNDERSTANDING PAIN: Chronic surgical pain often remains difficult for seniors to understand and deal with both physically and mentally. Dean Mitchell

Chronic post-surgery pain: Overcome notorious condition

BECOMING better informed on why post-surgery chronic pain occurs could assist you in ensuring this notoriously difficult to treat condition can be managed more effectively.

There are three types of post-surgical pain - acute, chronic and intermediate.

Not unsurprisingly after the trauma of a surgeon cutting into you, it's highly likely your body will react with acute pain in the first three, five or seven days after that surgery.

Pain expert and director of pain medicine at the Royal Perth Hospital, Professor Stephan Schug said this is primarily caused by nerve injury. "That's why bigger and more interventional and traumatic surgery like total knee joint replacement causes so much more chronic pain than hip joint replacement," Dr Schug said.

The ongoing or chronic pain, which affects between five and 10 per cent of anyone who has been through surgery, often remains difficult for seniors to understand and deal with both physically and mentally.

Pre-operative risks

The risk of chronic pain can depend on several factors -

  • The type of surgery such as total knee replacement. "Up to 15 per cent of people who have had this operation can have severe chronic post-surgical pain," Dr Schug said. "It's much less for a total hip replacement; possibly under five per cent. The reason is most likely there is much less tissue and nerve trauma when you replace a hip then when you replace a knee."
  • Repeat surgery.
  • Once you have an injury or ongoing moderate to severe pain, acute pain after surgery can become chronic.
  • Females have a higher risk of developing chronic pain. "We don't know why exactly," Dr Schug said. "There is a lot of thinking that this has to do with the hormones."
  • Younger age patients due to the plasticity of the nervous system. "A 30-year-old, the same surgery causes more pain than for a 70-year-old," Dr Schug said.
  • If you have long-term chronic pain before an operation, the risk of that pain remaining increases. "Most people who have a knee or hip replacement, already have chronic pain which has made them have the operation," Dr Schug said. Their nervous system is already sensitised to pain and they have a much higher risk of developing chronic pain afterwards."
  • Psycho-social factors such as re-operative anxiety or a person who is a significant catastrophiser, can increase the risk of post-surgical chronic pain.

Post-operation actions

Often the post-operative pain is in response to injury to nerves. Nerve pain is continuously there, but Dr Schug said it can become more obvious when you are lying bed and without the distractions of the day around you.

"Taking a good post-operative analgesic can reduce the risk of post-operative pain and with joint replacement, getting proper rehabilitation," Dr Schug added. "It will improve the function of the joint, improve the nerve function and reduce the risk of developing chronic pain."

Intermediate pain

"There are more and more pain clinics, but because there is so much chronic pain, the waiting lists are relatively long," Dr Schug said. "That is why we are trying to fast track people who come out of surgery with a problem so that they don't go on the waitlist and have to suffer in chronic pain.

The new approach is to provide a transitional or intermediate pain medicine service, between acute and chronic, which is aimed at recognising and treating developing nerve pain before a person becomes a chronic pain out-patient.

"If we notice after the initial post-surgery acute pain period there are problems, and we are offering an in-patient acute pain service, then we can offer for a patient to come back to a chronic pain appointment later," Dr Schug said.

He noted this new approach will be discussed further during this month's Australian Pain Society annual conference.

How can you help yourself?

Start with talking with your GP, many of whom are receiving training in recognising and treating chronic pain. The GP may also refer you to a chronic pain clinic.

If you are visiting your surgeon immediately post-surgery, you should voice your concerns directly to the surgeon so he/she can exclude infection and prothesis issues.

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