Hadzic's Regional Anesthesia > Part XIII. Regional Anesthesia & Acute Pain Management > Chapter 76. Preemptive Analgesia, Regional Anesthesia, & the Prevention of Chronic Postoperative Pain Scott. S. Reuben, MD, Jeffrey Gadsden, MD

Chronic Pain Syndromes Following Surgery

"Despite its prevalence, our understanding of chronic postoperative pain and the potential means of risk reduction are somewhat deficient. We need to classify these chronic pain syndromes according to symptoms and mechanisms and greater emphasis needs to be placed on preventing its development. Preemptive analgesic techniques may play a role in reducing the incidence of certain chronic postsurgical pain syndromes,⁸² and future large-scale randomized controlled trials are necessary to support these initial findings. Four chronic pain syndromes that are important clinically to the anesthesiologist are complex regional pain syndrome, phantom limb pain, chronic donor site pain, and postthoracotomy pain syndrome.Complex regional pain syndrome (CRPS) is a disorder characterized by the presence, following a noxious event, of regional pain and sensory changes such as temperature alterations, abnormal skin color, abnormal sudomotor activity, or edema.⁸³ Its onset is associated with a history of trauma (that is often innocuous) or immobilization, and there is typically no correlation between the severity of the initial injury and the ensuing painful syndrome.⁸⁴ The Consensus Conference of the International Association for the Study of Pain (IASP) has identified two forms of CRPS: CRPS type I (formerly known as reflex sympathetic dystrophy) and CRPS type II (formerly known as causalgia).⁸⁵ The characteristics of each are summarized in Table 76–2.At least one symptom in each of the..."