Zusammenfassung
Chronische postoperative Schmerzen sind ein klinisch und gesellschaftspolitisch relevantes Problem. Eine Prävention der Chronifizierungsprozesse ist potenziell möglich und könnte schon perioperativ beginnen. Die Evidenz für die Wirksamkeit bestimmter Präventionsmaßnahmen ist aber weitestgehend gering. Wichtige Gründe für dieses Dilemma sind eine fehlende Identifikation von Risikofaktoren sowie effektiven und mechanismenbasierten Präventionsmaßnahmen für den Chronifizierungsprozess, eine fehlende Stratifizierung der Behandlung und eine bisher kaum untersuchte Kombination verschiedener Behandlungsansätze. In diesem Übersichtsbeitrag werden neue Erkenntnisse zur geeigneten Identifikation von Risikopatienten für eine Schmerzchronifizierung nach Operationen vorgestellt, prädiktive Modelle zur validen Einschätzung des individuellen Risikos von Patienten bewertet und Studien zur medikamentösen und regionalanalgetischen Beeinflussung des Schmerzchronifizierungsprozesses diskutiert. Da ein Chronifizierungsprozess komplex und dynamisch ist und im Verlauf des Prozesses auch Anpassungen der Prävention erfordert, haben möglicherweise nur Kombinationstherapien, interdisziplinäre und gegebenenfalls sogar längerfristige Maßnahmen Erfolg. Studien müssen zeigen, mit welchen präventiven Maßnahmen bei welchen Risikopatienten chronische Schmerzen nach Operationen effektiv verhindert werden können.
Abstract
Chronic postoperative pain has been identified as a major medical and socioeconomic problem. A prevention of the chronification processes is potentially possible and preventive treatment could start early (e.g. preoperatively). So far, however, evidence for the effectiveness of preventive strategies is basically low. Important reasons for this dilemma are the lack of appropriate risk assessment as well as effective and mechanism-based preventive (procedure-sepcific) strategies for the chronification process, a lack of stratification of treatment approaches and a so far barely investigated combination of various treatment approaches. In this review article recent findings on the appropriate identification of patients at risk for developing postoperative chronic pain are presented, predictive models for the valid estimation of the individual risk of patients are assessed and studies on pharmaceutical and regional analgesia techniques influencing the pain chronification process are discussed. As a chronification process is, however, extremely complex and dynamic and also necessitates adaptation of the prevention during the course of the process, only combinations of treatment, interdisciplinary and if necessary even longer term approaches might be successful. Future studies are needed to address with which preventive treatment strategies and in which patients chronic pain after surgery can effectively be prevented.
Change history
10 February 2021
Zu diesem Beitrag wurde ein Erratum veröffentlicht: https://doi.org/10.1007/s00482-021-00539-4
Notes
Da die Literatur zu diesem Thema umfassend ist, die Zeitschrift Der Schmerz aber eine Limitierung der Zitate setzt, werden vorwiegend Übersichtsbeiträge, systematische Reviews und Cochrane-Analysen zitiert. Informationen zu Einzelstudien können bei der Autorin erfragt werden.
Literatur
Althaus A, Hinrichs-Rocker A, Chapman R, Arránz Becker O, Lefering R, Simanski C, Weber F, Moser K‑H, Joppich R, Trojan S, Gutzeit N, Neugebauer E (2012) Development of a risk index for the prediction of chronic post-surgical pain. Eur J Pain 16(6):901–910
Andrejeva N, Baumeister D, Eich W et al (2021) Psychosoziale Faktoren in der Prävention von Schmerz. https://doi.org/10.1007/s00482-020-00523-4
Azam MA, Weinrib AZ, Montbriand J, Burns LC, McMillan K, Clarke H, Katz J (2017) Acceptance and commitment therapy to manage pain and opioid use after major surgery: preliminary outcomes from the Toronto General Hospital Transitional Pain Service. Can J Pain 1(1):37–49
Bailey M, Corcoran T, Schug S, Toner A (2018) Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of efficacy and safety. Pain 159(9):1696–1704
Beloeil H, Sion B, Rousseau C, Albaladejo P, Raux M, Aubrun F, Martinez V (2017) SFAR research network. Early postoperative neuropathic pain assessed by the DN4 score predicts an increased risk of persistent postsurgical neuropathic pain. Eur J Anaesthesiol 34(10):652–657
Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P (2014) Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain 155(11):2400–2407
Buys MJ, Bayless K, Romesser J, Anderson Z, Patel S, Zhang C, Presson AP, Brooke BS (2020) Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service. Reg Anesth Pain Med 45(11):847–852. https://doi.org/10.1136/rapm-2020-101797
Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I (2013) Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 7:CD8307
Chapman CR, Vierck CJ (2017) The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. J Pain 18(4):359.e1–359.e38
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL (2016) Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 17(2):131–157
Clarke H, Azargive S, Montbriand J, Nicholls J, Sutherland A, Valeeva L, Boulis S, McMillan K, Ladak SSJ, Ladha K, Katznelson R, McRae K, Tamir D, Lyn S, Huang A, Weinrib A, Katz J (2018) Opioid weaning and pain management in postsurgical patients at the Toronto General Hospital Transitional Pain Service. Can J Pain 2(1):236–247
Crombie IK, Davies HT, Macrae WA (1998) Cut and thrust: antecedent surgery and trauma among patients attending a chronic pain clinic. Pain 76(1–2):167–171
Deutsche Schmerzgesellschaft (2017) Forschungsagenda – Perspektive Schmerzforschung Deutschland. Version 1 (Available at: https://www.schmerzgesellschaft.de/wissenschaft/forschungsagenda-schmerz-deutschland)
Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, Kranke P, Komann M, Lehman T, Meissner W (2015) Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol 32(10):725–734
Fricton J (2015) The need for preventing chronic pain: the “big elephant in the room” of healthcare. Glob Adv Health Med 4(1):6–7
Gerbershagen HJ, Aduckathil S, van Wijck AJM, Peelen LM, Kalkman CJ, Meissner W (2013) Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology 118(4):934–944
Gesundheitsberichterstattung des Bundes (2020) Operationen und Prozeduren der vollstationären Patientinnen und Patienten in Krankenhäusern (Wohnort/Behandlungsort). Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht. http://www.gbe-bund.de/oowa921-install/servlet/oowa/aw92/WS0100/_XWD_PROC?_XWD_2/1/XWD_CUBE.DRILL/_XWD_30/D.390/43135. Zugegriffen: 7. Sept. 2020
Gilron I, Vandenkerkhof E, Katz J, Kehlet H, Carley M (2017) Evaluating the association between acute and chronic pain after surgery: impact of pain measurement methods. Clin J Pain 33(7):588–594
Glare P, Aubrey KR, Myles PS (2019) Transition from acute to chronic pain after surgery. Lancet 393(10180):1537–1546
Graven-Nielsen T, Aspegren Kendall S, Henriksson KG, Bengtsson M, Sörensen J, Johnson A, Gerdle B, Arendt-Nielsen L (2000) Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients. Pain 85(3):483–491
Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS (2013) The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain 154(1):95–102
Häuser W, Petzke F, Radbruch L (2020) Die US-amerikanische Opioidepidemie bedroht Deutschland. Schmerz 34(1):1–3
Huang A, Azam A, Segal S, Pivovarov K, Katznelson G, Ladak SS, Mu A, Weinrib A, Katz J, Clarke H (2016) Chronic postsurgical pain and persistent opioid use following surgery: the need for a transitional pain service. Pain Manag 6(5):435–443
Hussain N, Shastri U, McCartney CJL, Gilron I, Fillingim RB, Clarke H, Katz J, Juni P, Laupacis A, Wijeysundera D, Abdallah FW (2018) Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. Pain 159(10):1955–1971
Kaiser U, Nagel B, Petzke F et al (2021) Vermeidung chronischer Schmerzen in der deutschen Gesundheitsversorgung. Schmerz.https://doi.org/10.1007/s00482-020-00527-0
Katz J, Weinrib A, Fashler SR, Katznelzon R, Shah BR, Ladak SS, Jiang J, Li Q, McMillan K, Santa Mina D, Wentlandt K, McRae K, Tamir D, Lyn S, de Perrot M, Rao V, Grant D, Roche-Nagle G, Cleary SP, Hofer SO, Gilbert R, Wijeysundera D, Ritvo P, Janmohamed T, O’Leary G, Clarke H (2015) The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res 8:695–702
Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y (2019) Duloxetine reduces pain and improves quality of recovery following total knee arthroplasty in centrally sensitized patients: a prospective, randomized controlled study. J Bone Joint Surg Am 101(1):64–73
Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, Eberhart LHJ, Poepping DM, Weibel S (2015) Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev 7:CD9642
Lavand’homme P (2017) ‘Why me?’ The problem of chronic pain after surgery. Br J Pain 11(4):162–165
Lavand’homme PM, Grosu I, France M‑N, Thienpont E (2014) Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res 472(5):1409–1415
Levene JL, Weinstein EJ, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH (2019) Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. J Clin Anesth 55:116–127
Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, Beach ML (2010) Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology 113(3):639–646
Martinez V, Ammar BS, Judet T, Bouhassira D, Chauvin M, Fletcher D (2012) Risk factors predictive of chronic postsurgical neuropathic pain: the value of the iliac crest bone harvest model. Pain 153(7):1478–1483
Martinez V, Pichard X, Fletcher D (2017) Perioperative pregabalin administration does not prevent chronic postoperative pain: systematic review with a meta-analysis of randomized trials. Pain 158(5):775–783
Martucci KT, Mackey SC (2018) Neuroimaging of pain: human evidence and clinical relevance of central nervous system processes and modulation. Anesthesiology 128(6):1241–1254
Mathes T, Pape-Köhler C, Moerders L, Lux E, Neugebauer EAM (2018) External validation and update of the RICP‑A multivariate model to predict chronic postoperative pain. Pain Med 19(8):1674–1682
McNicol ED, Schumann R, Haroutounian S (2014) A systematic review and meta-analysis of ketamine for the prevention of persistent post-surgical pain. Acta Anaesthesiol Scand 58(10):1199–1213
Meretoja TJ, Andersen KG, Bruce J, Haasio L, Sipilä R, Scott NW, Ripatti S, Kehlet H, Kalso E (2017) Clinical prediction model and tool for assessing risk of persistent pain after breast cancer surgery. J Clin Oncol 35(15):1660–1667
Montes A, Roca G, Cantillo J, Sabate S (2020) Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation. Pain 161(11):2611–2618
Montes A, Roca G, Sabate S, Lao JI, Navarro A, Cantillo J, Canet J (2015) Genetic and clinical factors associated with chronic postsurgical pain after hernia repair, hysterectomy, and thoracotomy: a two-year multicenter cohort study. Anesthesiology 122(5):1123–1141
Neuman MD, Bateman BT, Wunsch H (2019) Inappropriate opioid prescription after surgery. Lancet 393(10180):1547–1557
Nielsen RV, Fomsgaard JS, Nikolajsen L, Dahl JB, Mathiesen O (2019) Intraoperative S‑ketamine for the reduction of opioid consumption and pain one year after spine surgery: a randomized clinical trial of opioid-dependent patients. Eur J Pain 23(3):455–460
Pogatzki-Zahn E, Segelcke D, Zahn P (2018) Mechanisms of acute and chronic pain after surgery: update from findings in experimental animal models. Curr Opin Anaesthesiol 31(5):575–585
Pogatzki-Zahn EM, Meissner W (2015) Postoperative pain therapy in Germany. Status quo. Schmerz 29(5):503–509
Pogatzki-Zahn EM, Segelcke D, Schug SA (2017) Postoperative pain-from mechanisms to treatment. Pain Rep 2(2):e588
Powell R, Scott NW, Manyande A, Bruce J, Vögele C, Byrne-Davis LMT, Unsworth M, Osmer C, Johnston M (2016) Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 5:CD8646
Richebé P, Capdevila X, Rivat C (2018) Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology 129(3):590–607
Ronaldson A, Poole L, Kidd T, Leigh E, Jahangiri M, Steptoe A (2014) Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery. J Psychosom Res 77(4):278–282
Ruscheweyh R, Viehoff A, Tio J, Pogatzki-Zahn EM (2017) Psychophysical and psychological predictors of acute pain after breast surgery differ in patients with and without pre-existing chronic pain. Pain 158(6):1030–1038
Sangesland A, Støren C, Vaegter HB (2017) Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Scand J Pain 15:44–52
Schnabel A, Pogatzki-Zahn E (2010) Predictors of chronic pain following surgery. What do we know? Schmerz 24(5):517–531 (quiz 532–533)
Schnabel A, Yahiaoui-Doktor M, Meissner W, Zahn PK, Pogatzki-Zahn EM (2020) Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Rep 5(4):e831
Schug SA, Bruce J (2017) Risk stratification for the development of chronic postsurgical pain. Pain Rep 2(6):e627
Schug SA, Bruce J (2018) Risikostratifizierung bezüglich der Entwicklung von chronischem postoperativem Schmerz. Schmerz 32(6):471–476
Schug SA, Lavand’homme P, Barke A, Korwisi B, Rief W, Treede R‑D (2019) The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain 160(1):45–52
Schug SA, Peyton P (2017) Does perioperative ketamine have a role in the prevention of chronic postsurgical pain: the ROCKet trial. Br J Pain 11(4):166–168
Schwenk ES, Viscusi ER, Buvanendran A, Hurley RW, Wasan AD, Narouze S, Bhatia A, Davis FN, Hooten WM, Cohen SP (2018) Consensus guidelines on the use of intravenous ketamine infusions for acute pain management from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med 43(5):456–466
Searle RD, Simpson MP, Simpson KH, Milton R, Bennett MI (2009) Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period? Interact Cardiovasc Thorac Surg 9(6):999–1002
Steyaert A, Lavand’homme P (2018) Prevention and treatment of chronic postsurgical pain: a narrative review. Drugs 78(3):339–354
Theunissen M, Peters ML, Bruce J, Gramke H‑F, Marcus MA (2012) Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain 28(9):819–841
Tiippana E, Hamunen K, Heiskanen T, Nieminen T, Kalso E, Kontinen VK (2016) New approach for treatment of prolonged postoperative pain: APS out-patient clinic. Scand J Pain 12:19–24
Weinrib AZ, Azam MA, Birnie KA, Burns LC, Clarke H, Katz J (2017) The psychology of chronic post-surgical pain: new frontiers in risk factor identification, prevention and management. Br J Pain 11(4):169–177
Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH (2018) Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Cochrane Database Syst Rev 4(4):CD7105
Wong K, Phelan R, Kalso E, Galvin I, Goldstein D, Raja S, Gilron I (2014) Antidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions. Anesthesiology 121(3):591–608
Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152(3 Suppl):S2–S15
Wylde V, Dixon S, Blom AW (2012) The role of preoperative self-efficacy in predicting outcome after total knee replacement. Musculoskelet Care 10(2):110–118
Yarnitsky D, Granot M, Granovsky Y (2014) Pain modulation profile and pain therapy: between pro- and antinociception. Pain 155(4):663–665
Danksagung
Die Autorin des Beitrags bedankt sich bei Herrn Dr. Daniel Segelcke für die Erstellung der Icons in Tab. 2 und bei Frau Dr. Kathrin Schnabel für das äußerst konstruktive Korrekturlesen des Beitrags.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
E. Pogatzki-Zahn gibt an, dass kein Interessenkonflikt besteht. Frau Prof. Pogatzki-Zahn hat in den letzten 3 Jahren im Rahmen von Advisory-Board-Aktivitäten und Vorträgen von folgenden Firmen Geld erhalten: Mundipharma und Grünenthal GmbH. Die Gelder gingen an Frau Pogatzki-Zahn (zuletzt vor 3 Jahren) und danach ausschließlich an die Einrichtung, an der Frau Pogatzki-Zahn tätig ist (Universitätsklinik Münster und Westfälische Wilhelms-Universität Münster). Ihre Forschungstätigkeiten der letzten 3 Jahre so wie momentan werden unterstützt von der Deutschen Forschungsgemeinschaft (DFG; PO1319/3‑1, PO1319/4‑1 und PO1319/5-1), dem Bundesministerium für Bildung und Forschung (BMBF), dem IZKF Münster und dem Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777500. Dieses Gemeinschaftsunternehmen wird unterstützt von Horizon 2020, einem Förderprogramm der Europäischen Union für Forschung und Innovation, sowie von der European Federation of Pharmaceutical Industries and Associations (EFPIA).
Für diesen Beitrag wurden von der Autorin keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Die ursprüngliche Online-Version dieses Artikels wurde überarbeitet: Die Referenz [25] wurde korrigiert.
Rights and permissions
About this article
Cite this article
Pogatzki-Zahn, E. Prädiktion und Prävention chronischer postoperativer Schmerzen. Schmerz 35, 30–43 (2021). https://doi.org/10.1007/s00482-020-00525-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00482-020-00525-2
Schlüsselwörter
- Risikostratifizierung
- Schmerzchronifizierung
- Präventive Analgesie
- Biopsychosoziale Aspekte
- Multimodale Therapie