Chronic Postoperative Pain: Comprehending It to Intervene

Abstract

It is estimated that between 266.2 and 359.5 million operations were performed in 2012 worldwide, and this number is on the rise. Chronic postoperative pain (CPOP) is the most important and still neglected postoperative complication, with a multifactorial causality, leading to a major impact on morbidity rates, high costs for the public health system, and direct and negative effects on the quality of life of the patients. The present systematic literature review aimed to elucidate the processes of postoperative pain chronification, biopsychosocial factors, risk factors, management of pain, and types of surgical procedures mainly associated with it. The review was based on the methodological recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following databases were consulted: the Medical Literature, Analysis, and Retrieval System Online (MEDLINE), the Latin American and Caribbean Health Sciences Literature (LILACS), the Scientific Electronic Library Online (SciELO), and the Cochrane Central Register of Controlled Trials (CENTRAL). After reading the selected articles, the following surgical specialties were chosen to be addressed: general, orthopedics, breast cancer, gynecology, obstetrics, and thoracic. In conclusion, a deficient management of acute postoperative pain is the main risk factor for the development of CPOP. To prevent CPOP, training programs for healthcare professionals should be implemented to improve their skills and knowledge of the management of pain before, during, and after surgeries. It is also necessary to conduct more in-depth studies on the evaluation and management of this condition.

Resumo

Estima-se que entre 266,2 e 359,5 milhões de cirurgias tenham sido realizadas em 2012 no mundo todo, e este número tende a crescer. A dor crônica pós-operatória (DCPO) é a complicação pós-cirúrgica mais importante e ainda negligenciada, com causalidade multifatorial, resultando em grande impacto nas taxas de morbidade, altos custos para o sistema de saúde, e efeitos diretos e negativos na qualidade de vida dos pacientes. Esta revisão sistemática da literatura teve por objetivo elucidar os processos de cronificação da dor pós-operatória, os fatores biopsicossociais, os fatores de risco, o manejo da dor, e os principais tipos de intervenção cirúrgica associados a ela. A revisão foi realizada com base nas recomendações de “Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)”. As bases de dados consultadas foram: Medical Literature, Analysis, and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e Cochrane Central Register of Controlled Trials (CENTRAL). Após a leitura dos artigos selecionados, as seguintes especialidades cirúrgicas foram escolhidas para abordagem: geral, ortopédica, mastológica, ginecológica, obstétrica e torácica. Em conclusão, o manejo deficiente da dor aguda pós-operatória é o principal fator de risco para o desenvolvimento da DCPO. Para prevenir a DCPO, é aconselhável implementar programas de treinamento para os profissionais da saúde de modo a melhorar suas habilidades e conhecimentos no que concerne o manejo da dor antes, durante e após procedimentos cirúrgicos. Também é necessário desenvolver estudos mais aprofundados acerca da avaliação e do manejo da DCPO.

Keywords

postoperative pain - chronic pain - pain management

Palavras-chave

dor pós-operatória - dor crônica - manejo da dor

Publikationsverlauf

Eingereicht: 07. Juni 2019

Angenommen: 22. Oktober 2019

Artikel online veröffentlicht:
07. Februar 2020

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