MONTREAL, Feb. 24, 2014 /CNW Telbec/ - About 10% of patients who have
had cardiac surgery suffer from persistent postoperative pain 2 years
after surgery, according to a large, multicentre study designed to
assess risk factors for this pain published in CMAJ (Canadian Medical
Cardiac surgeries, including coronary artery bypass grafting (CABG) and
valve replacement, are performed frequently around the world but can
result in residual pain after the operation that may affect quality of
A study of 1247 patients aged 18 years or older in cardiac surgery
centres in 4 Canadian cities (Montréal, Quebec City, Toronto and
Halifax) looked at the prevalence of ongoing postoperative pain up to 2
years after surgery and risk factors associated with this pain. About
40% of patients felt postoperative pain after 3 months, with a
significant decrease over time, to 22% at 6 months, 17% at 12 months
and 10% at 24 months.
"These prevalence rates are not negligible given that more than 400 000
patients undergo CABGs annually in the US," writes Dr. Manon Choinière,
researcher with the Centre hospitalier de l'Université de Montréal
Research Centre and professor, Department of Anesthesiology, Faculty of
Medicine, Université de Montréal. Dr. Choinière and her coauthors also
note that the presence of persistent postoperative pain after cardiac
surgery is not insignificant, and patients should be informed about
this possibility before surgery.
Several risk factors emerged for persistent pain in the 2 years
following cardiac surgery:
Age: Younger patients were more likely to report persistent
postoperative pain than older people.
Pre-existing chronic pain: Patients with chronic nonanginal pain before
surgery had a greater risk of persistent postoperative pain.
Pre-surgery anxiety: Greater anxiety before surgery was linked to a
higher likelihood of persistent pain.
Pain severity during the first week after surgery: The more intense the
pain during the first few days after surgery and the more it interfered
with functioning, the more likely patients were to report persistent
pain in the following months or years.
The following factors predicted the severity of pain in the 2 years
following cardiac surgery:
Sex: Female patients were more likely to report more intense persistent
Acute pain: The amount of pain felt in the first week after surgery
predicted not only the presence of long-term pain but also its
Time in hospital: Earlier discharge from hospital was associated with
persistent pain of greater intensity.
"It is noteworthy that acute pain levels (observed in the first few days
after surgery) were quite high in this study," state the authors. "It
is troublesome that similar observations have been made over and over
again in the past 3 decades and that postoperative pain continues to be
undertreated despite numerous awareness campaigns, pain care guidelines
and educational efforts."
The authors note that two risk factors of persistent pain after cardiac
surgery are modifiable — pre-surgical anxiety and acute pain severity
in the first few days after surgery.
The authors urge that there needs to be more research into how to
prevent or minimize pain to help eliminate unnecessary suffering and
reduced quality of life in the months or years after surgery.
About the CRCHUM
The CRCHUM improves the health of adults through a high-quality academic
research continuum which, by improving our understanding of etiological
and pathogenic mechanisms, fosters the development, implementation and
assessment of new preventive, diagnostic and therapeutic strategies.
The CRCHUM provides a training environment to ensure the development of
new generations of researchers committed to research excellence.
SOURCE: Centre hospitalier de l'Université de Montréal
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