Postoperative chronic pain incidence and etiology in coronary artery bypass graft surgery: a prospective study

Introduction: Post-operative chronic pain (POCP), after updated by Werner-Kongsgaard, is defined as the pain developed after the surgical procedure or increased in intensity after the procedure, as the continuation of acute postoperative pain, localized in the surgical area, lasted at least 3 months, and other causes of pain excluded. In our study, we aimed to prospectively examine the prevalence of POCP and risk factors in the first three months after coronary artery bypass graft surgery (CABGS).

Methods: Between June 2019 and December 2020, a numerical rating scale (NRS) was announced by the study team to evaluate the preoperative pain levels of patients undergoing CABGS in a university hospital. When patients came for the control on the 15th postoperative day, physical examinations were performed, pain status was evaluated, and followed up by phone for three months (30, 60 and 90 days postoperatively). The study, which started with 158 patients, was completed with 110 patients.

Results: The patients were divided into two groups as the patients with pain (those with POCP) and the painless group (those without POCP). While there were 39 patients (35.5%) in the group of patients with pain, 71 patients (64.5%) were in the painless group. The proportion of female patients in the group of patients with pain was significantly higher than the painless group (p < 0.05).

Conclusions: As a result of our study, postoperative chronic pain is seen in one of every three patients after cardiac surgery. We observed that the risk increased in female patients and in patients with severe preoperative anxiety.

Coronary artery bypass surgery; Postoperative chronic pain; Cardiac surgery

[1] Werner MU, Kongsgaard UE. I. Defining persistent post-surgical pain: is an update required? British Journal of Anaesthesia. 2014; 113: 1–4.

[2] Guimarães-Pereira L, Reis P, Abelha F, Azevedo LF, Castro-Lopes JM. Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain. 2017; 158: 1869–1885.

[3] Kehlet H, Edwards RR, Brennan T. Persistent postoperative pain: pathogenic mechanisms and preventive strategies. Pain 2014-refresher courses (pp. 113–123). In: Raja S, Sommer C (ed). Seattle: International Association for the Study of Pain/IASP press. 2014.

[4] Cregg R, Anwar S, Farquhar-Smith P. Persistent postsurgical pain. Current opinion in supportive and palliative care. 2013; 7: 144–152.

[5] Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. Journal of Cardiothoracic and Vascular Anesthesia. 2011; 25: 1163–1178.

[6] Zubrzycki M, Liebold A, Skrabal C, Reinelt H, Ziegler M, Perdas E, et al. Assessment and pathophysiology of pain in cardiac surgery. Journal of Pain Research. 2018; 11: 1599–1611.

[7] Van Gulik L, Janssen LI, Ahlers Sjgm, Bruins P, Driessen AHG, Van Boven WJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. European Journal of Cardio-Thoracic Surgery. 2011; 40: 1309–1313.

[8] Guertin JR, Pagé MG, Tarride J, Talbot D, Watt-Watson J, Choinière M. Just how much does it cost? A cost study of chronic pain following cardiac surgery. Journal of Pain Research. 2018; 11: 2741–2759.

[9] Mcgillion MH, Henry S, Busse JW, Ouellette C, Katz J, Choinière M, et al. Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study. British Medical Journal Open. 2019; 9: e022995.

[10] Meyerson J, Thelin S, Gordh T, Karlsten R. The incidence of chronic post-sternotomy pain after cardiac surgery—a prospective study. Acta Anaesthesiologica Scandinavica. 2001; 45: 940–944.

[11] Bjørnnes AK, Parry M, Lie I, Fagerland MW, Watt-Watson J, Rustøen T, et al. The impact of an educational pain management booklet intervention on postoperative pain control after cardiac surgery. European Journal of Cardiovascular Nursing. 2017; 16: 18–27.

[12] Choinière M, Watt-Watson J, Victor JC, Baskett RJF, Bussières JS, Carrier M, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. Canadian Medical Association Journa. 2014; 186: e213–e223.

[13] Pesonen A, Suojaranta-Ylinen R, Hammarén E, Kontinen VK, Raivio P, Tarkkila P, et al. Pregabalin has an opioid-sparing effect in elderly patients after cardiac surgery: a randomized placebo-controlled trial. British Journal of Anaesthesia. 2011; 106: 873–881.

[14] Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Chronic postsurgical pain in patients 5 years after cardiac surgery: a prospective cohort study. European Journal of Pain. 2017; 21: 425–433.

[15] Taillefer M, Carrier M, Bélisle S, Levesque S, Lanctôt H, Boisvert A, et al. Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study. Journal of Thoracic and Cardiovascular Surgery. 2006; 131: 1274–1280.

[16] Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJM, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014; 120: 1237–1245.

[17] Gerdle B, Björk J, Cöster L, Henriksson K, Henriksson C, Bengtsson A. Prevalence of widespread pain and associations with work status: a population study. BMC Musculoskeletal Disorders. 2008; 9: 102.

[18] Routledge FS, Tsuyuki RT, Hervas-Malo M, Leblanc P, Mcfetridge-Durdle JA, King KM. The influence of coronary artery bypass graft harvest site on women’s pain, functional status, and health services utilization throughout the first post-operative year: a longitudinal study. International Journal of Nursing Studies. 2009; 46: 1054–1060.

[19] Tasmuth T, Estlanderb A, Kalso E. Effect of present pain and mood on the memory of past postoperative pain in women treated surgically for breast cancer. Pain. 1996; 68: 343–347.

[20] Shi Y, Weingarten TN, Mantilla CB, Hooten WM, Warner DO. Smoking and pain: pathophysiology and clinical implications. Anesthesiology. 2010; 113: 977–992.

[21] Rowley TJ, Payappilly J, Lu J, Flood P. The antinociceptive response to nicotinic agonists in a mouse model of postoperative pain. Anesthesia and Analgesia. 2008; 107: 1052–1057.

[22] Jamner LD, Girdler SS, Shapiro D, Jarvik ME. Pain inhibition, nicotine, and gender. Experimental and Clinical Psychopharmacology. 1998; 6: 96–106.

[23] Bunnelle WH, Dart MJ, Schrimpf MR. Design of ligands for the nicotinic acetylcholine receptors: the quest for selectivity. Current Topics in Medicinal Chemistry. 2004; 4: 299–334.

[24] Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: a meta-analysis. American Journal of Medicine. 2010; 123: 87. e7–35.

[25] Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospec-tive cohort study of 1-year incidence and intensity. Anesthesiology. 2006; 105: 794–800.

[26] Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacother-apy for the prevention of chronic pain after surgery in adults. Cochrane Database of Systematic Reviews. 2013; 2013: cd008307.

[27] Reddi D. Preventing chronic postoperative pain. Anaesthesia. 2016; 71: 64–71.

[28] Doglietto F, Vezzoli M, Biroli A, Saraceno G, Zanin L, Pertichetti M, et al. Anxiety in neurosurgical patients undergoing nonurgent surgery during the covid-19 pandemic. Neurosurgical Focus. 2020; 49: e19.