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Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study
Open accessAbstract
BACKGROUND: Persistent postoperative pain continues to be an underrecognized complication. We examined the prevalence of and risk factors for this type of pain after cardiac surgery. METHODS: We enrolled patients scheduled for coronary artery bypass grafting or valve replacement, or both, from Feb. 8, 2005, to Sept. 1, 2009. Validated measures were used to assess (a) preoperative anxiety and depression, tendency to catastrophize in the face of pain, health-related quality of life and presence of persistent pain; (b) pain intensity and interference in the first postoperative week; and (c) presence and intensity of persistent postoperative pain at 3, 6, 12 and 24 months after surgery. The primary outcome was the presence of persistent postoperative pain during 24 months of follow-up. RESULTS: A total of 1247 patients completed the preoperative assessment. Follow-up retention rates at 3 and 24 months were 84% and 78%, respectively. The prevalence of persistent postoperative pain decreased significantly over time, from 40.1% at 3 months to 22.1% at 6 months, 16.5% at 12 months and 9.5% at 24 months; the pain was rated as moderate to severe in 3.6% at 24 months. Acute postoperative pain predicted both the presence and severity of persistent postoperative pain. The more intense the pain during the first week after surgery and the more it interfered with functioning, the more likely the patients were to report persistent postoperative pain. Pre-existing persistent pain and increased preoperative anxiety also predicted the presence of persistent postoperative pain. INTERPRETATION: Persistent postoperative pain of nonanginal origin after cardiac surgery affected a substantial proportion of the study population. Future research is needed to determine whether interventions to modify certain risk factors, such as preoperative anxiety and the severity of pain before and immediately after surgery, may help to minimize or prevent persistent postoperative pain.
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“The data clearly show that the presence32 and intensity of preoperative chronic pain,6,33–35 the intensity of acute postoperative pain,6,23,32,33,36 the time spent in severe pain after surgery,6 pain intensity in the weeks after surgery,35,37,38 and pain in other body parts32,34,39 reliably predict CPSP across a range of surgical procedures.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [35]
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“The data clearly show that the presence32 and intensity of preoperative chronic pain,6,33–35 the intensity of acute postoperative pain,6,23,32,33,36 the time spent in severe pain after surgery,6 pain intensity in the weeks after surgery,35,37,38 and pain in other body parts32,34,39 reliably predict CPSP across a range of surgical procedures.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [35]
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“Negative cognitive–affective states including perioperative depression,42,43 anxiety,25,32,35,43,44 pain catastrophizing,18,44 and posttraumatic stress symptoms45 also predict the development of CPSP.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [35]
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Citations
Cites
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Flagged first, then by citations
1 of the 44 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- [12]12. Kalso E, Mennander S, Tasmuth T, et al. Chronic post-ster- notomy pain. Acta Anaesthesiol Scand 2001;45:935-9.
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Yao, J., Shen, F., Chen, Y., Cai, W., Lu, X., Wang, Z., Li, B., Xie, J., Tan, X., & Sun, J. (2026) · Trials · doi:10.1186/s13063-026-09462-4
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Elnahas, M., Zidan, M., Abusamra, Y., Hassan, M., Saravi, B., Hochrein, S., & Lang, P. (2026) · Medicina · doi:10.3390/medicina62101890
Metadata
- Authors
- Choinière, M., Watt-Watson, J., Victor, J. C., Baskett, R. J. F., Bussières, J. S., Carrier, M., Cogan, J., Costello, J., Feindel, C., Guertin, M.-C., Racine, M., & Taillefer, M.-C.
- Affiliations
- Dalhousie University (CA)
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Joule Inc.
- Published
- 2014-02-24
- Volume
- 186
- Issue
- 7
- Pages
- E213-E223
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC3986330
- OpenAlex
- W2104465167
- Semantic Scholar
- 448591f3aab35bc040bc84f243defd9fb4d12855
- Cited by
- 206
- References
- 44
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 10 · 2023: 18 · 2022: 24 · 2021: 18 · 2020: 17 · 2019: 21 · 2018: 14 · 2017: 16 · 2016: 16 · 2015: 16 · 2014: 12
- FWCI
- 19.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (69065_1)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- chronic postoperative pain, cardiac surgery complications, coronary artery bypass grafting, heart valve replacement, risk factors, preoperative anxiety, preoperative depression, pain catastrophizing, health-related quality of life, acute postoperative pain, prevalence
- MeSH terms
- Adult, Aged, Aged, 80 and over, Coronary Artery Bypass, Canada, Female, Follow-Up Studies, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Pain Measurement, Postoperative Pain, Prospective Studies, Quality of Life, Risk Factors, Severity of Illness Index, Time Factors, Prevalence, Risk Assessment, Young Adult
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