Chronic postsurgical pain and cancer: the catch of surviving the unsurvivable
Abstract
Purpose of review: Chronic postsurgical pain (CPSP) is an important and well recognized cause of much long-term suffering, which in some cases may be preventable and affects many people living with cancer. Unfortunately, general consensus is lacking as to how best reduce the risk of developing CPSP. Recent findings: Cancer is now not always a short-lived, fatal disease and is now moving towards a chronic illness. Poorly managed perioperative pain is the greatest risk factor for CPSP. Recent trials have examined preventive strategies for CPSP associated with breast surgery and thoracotomy, two operations used in cancer treatment. Standard antinociceptive drugs, 5% lidocaine patches and ketamine do not prevent CPSP. The evidence for gabapentinoids is conflicting. Intravenous lidocaine and, separately, regional anaesthesia appear beneficial. Summary: Well-managed pain, irrespective of technique, reduces the risk of CPSP. The literature is inconclusive regarding an ‘optimal approach.’ Regional anaesthesia, intravenous lidocaine and the aggressive management of perioperative pain using multimodal analgesia including antineuropathic pain agents such as gabapentinoids and certain antidepressants are recommended. Clinicians should not rely on general anaesthesia, opioids, NSAIDs and ketamine to prevent CPSP. A blanket approach using gabapentinoids for all patients undergoing major surgery is not indicated. Instead, the presence of perioperative neuropathic pain should be checked for regularly.
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Persistent breast pain is common among women who have had breast cancer.
“Persistent breast pain (PBP) is prevalent among breast cancer survivors”
The prevalence of persistent breast pain is relatively high compared with other types of surgery.
“1) the prevalence of persistent breast pain (PBP) is relatively high compared to other types of surgery [9];”
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Bovbjerg, D. H., Keefe, F. J., Soo, M. S., Manculich, J., Van Denburg, A., Zuley, M. L., Ahrendt, G. M., Skinner, C. S., Edmond, S. N., & Shelby, R. A. (2019) · Acta Oncologica · doi:10.1080/0284186x.2019.1574023 · Cited by 44 · see citing works
- Authors
- Humble, S. R., Varela, N., Jayaweera, A., & Bhaskar, A.
- Affiliations
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Humble, Stephen R.
- Venue
- Current Opinion in Supportive & Palliative Care
- Published
- 2018-06
- Volume
- 12
- Issue
- 2
- Pages
- 118-123
- ISSN
- 1751-4258 (ISSN-L)
- 1751-4266
- OpenAlex
- W2794290051
- Cited by
- 11
- References
- 72
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 2 · 2019: 1
- FWCI
- 0.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Supportive and Palliative Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- chronic postoperative pain, cancer patients, perioperative pain management, breast surgery, thoracotomy, regional anesthesia, intravenous lidocaine, gabapentinoids, multimodal analgesia, neuropathic pain, ketamine, opioids, nonsteroidal anti-inflammatory drugs
- MeSH terms
- Cancer Pain, Gabapentin, Analgesics, Analgesics, Opioid, Drug Therapy, Combination, Humans, Ketamine, Lidocaine, Pain, Postoperative, Postoperative Pain, Palliative Care, Risk Factors, Sex Factors, Socioeconomic Factors, Perioperative Care, Genetic Predisposition to Disease, Chronic Pain
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