Postoperative pain in chronic pain patients - treatment and prevention

作者：Pogatzki Zahn E^*

来源：Anasthesiologie & Intensivmedizin, 2011, 52: 388-+.

• Acute Pain
• Chronic Pain Patient
• Opioids
• Hyperalgesia
• Prevention of Chronic Pain

The perioperative treatment of chronic pain patients is often a problem and is becoming more relevant with increasing numbers of such patients and those pretreated with analgesics. Chronic pain patients have an elevated symptom-related risk for severe postoperative pain which is often augmented by additional disease and such factors as prior opioid medication and polypharmacy.
For treatment planning and implementation, this means that certain factors - such as the risk of exacerbating postoperative pain or opioid resistance in the acute postoperative phase, the way the patient handles pain, his expectations and prior experience of perioperative pain treatment, pemedication, and possible changes to other medication or routes of administration need to he considered when selecting the most suitable form of analgesia. However, the current state of our knowledge indicates that management of acute perioperative pain in the chronic pain patient is not the sole aim. Rather, measures aimed at preventing exacerbated postoperative pain, opioid resistance and opioid-induced hyperalgesia or tolerance must also be considered. Last, but not least, specific preventive measures can also influence chronic postoperative pain in these patients. This is of major clinical relevance since preoperative chronic pain in combination with other factors, are important predictors of chronification of acute pain. Although the number of relevant studies so far published is still small, evidence is accumulating that certain options (e.g. regional analgesia, preoperative ketamine) can prevent severe acute and chronic postoperative pain. Careful planning, involvement of the patient and the implementation of special treatment concepts can help improve pain management in these patients.

• 出版日期2011-6