IntroductionPersistent postoperative pain lasting for more than 3–6 months after a surgical intervention is a largely unrecognized major health problem. Persistent pain can affect up to 50% of patients depending on the surgical procedure (Kehlet et al., ). For instance upwards of 30% of patients that underwent total hip arthroplasty, a common elective procedure, reported persistent pain 12–18 months postoperatively (Nikolajsen et al., ).Arthroplasty patients are an interesting focus group when studying pain chronification and treatment strategies, because arthroplasty (1) is a common surgical procedure, (2) has a high rate of persistent postoperative pain and (3) induces a relatively small amount of direct nerve damage intraoperatively in comparison with other procedures attributed with high rates of persistent postoperative pain (Unwin and Scott, ; Pinto et al., ). Therefore, pain chronification in arthroplasty patients may be the direct result of excessive nociceptive input without the additional complexity of neuropathic pain components (Kehlet et al., ; Nikolajsen et al., ).The current understanding is that persistent postoperative pain may develop due to excessive nociceptive input (Kehlet et al., ). The theory is that intense noxious peripheral stimuli induce synaptic hyperplasticity in the spinal cord, called central sensitization, which increases the responsiveness of nociception processing neurons (Kehlet et al., ). The clinical
European Journal of Pain – Wiley
Published: Jan 1, 2018
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