Advertisement

Risk of Pain and Gastrointestinal Complaints at 6Months After Elective Abdominal Surgery

Published:August 11, 2018DOI:https://doi.org/10.1016/j.jpain.2018.07.010

      Highlights

      • One in 3 patients will have chronic postoperative abdominal pain 6 months after elective abdominal surgery.
      • Pain-related factors and adhesions at the incision were associated with chronic postoperative abdominal pain.
      • A higher preoperative mental health score were associated with a lower risk of chronic postoperative abdominal pain.

      Abstract

      The incidence of chronic postoperative abdominal pain (CPAP) after abdominal surgery is substantial and decreases overall quality of life. One in 3 patients report pain-related interference with mood, sleep, and enjoyment of life and 12% visit the emergency department for pain-related symptoms. Previous studies lack data on preoperative health and pain status or are limited by small patient samples. The aim of this study was to assess risk factors for CPAP and gastrointestinal complaints 6 months after surgery. A prospective cohort study was performed including patients undergoing an elective laparotomy or laparoscopy at a tertiary referral center. Relevant patient, pain, surgical, and medical data as well as the Gastrointestinal Symptom Rating Scale (GSRS) were assessed before, during, and after hospital stay and at the outpatient clinic until 6 months after discharge. Linear and logistic regression analysis were used to assess risk factors. Of 518 included patients, 184 (36%) had CPAP. The median GSRS score was 5 (interquartile range = 3–10). The presence of preoperative pain for <3 months (odds ratio [OR] = 2.69, P = .016) or >3 months (OR = 3.99, P = .000), use of opioid analgesia preoperatively (OR = 3.54, P = .001), severe adhesions underneath the incision (OR = 1.63, P = .040), and the numeric rating scale pain score on postoperative day 2 (OR = 1.23, P = .004) independently increased the risk for chronic abdominal pain. Chronic pancreatitis as indication for surgery (B = 4.20, P = .03), ≥3 previous abdominal operations (B = 1.03, P = .03), presence of pain >3 months before surgery (B = 1.61, P < .01), upper gastrointestinal tract as the anatomic location of surgery (B = 1.43, P = .03), and a higher preoperative GSRS score (B = .36, P < .01) independently increased the GSRS score 6 months after surgery. The duration and severity of preoperative pain and more severe acute postoperative pain were the most relevant risk factors for CPAP. The number of operations and the anatomic location of the operation showed to be important risk factors for increasing the number of gastrointestinal complaints.
      Perspective: This prospective observational study shows the incidence and risk factors for CPAP after major abdominal surgery. Preoperative pain-related factors were associated with the occurrence of CPAP.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alper I
        • Yuksel E
        Comparison of acute and chronic pain after open nephrectomy versus laparoscopic nephrectomy: A prospective clinical trial.
        Medicine (Baltimore). 2016; 95: e3433
        • Andreae MH
        • Andreae DA
        Regional anaesthesia to prevent chronic pain after surgery: A Cochrane systematic review and meta-analysis.
        Br J Anaesth. 2013; 111: 711-720
        • Brandsborg B
        • Nikolajsen L
        • Hansen CT
        • Kehlet H
        • Jensen TS
        Risk factors for chronic pain after hysterectomy: A nationwide questionnaire and database study.
        Anesthesiology. 2007; 106: 1003-1012
        • Brazier JE
        • Harper R
        • Jones NM
        • O'Cathain A
        • Thomas KJ
        • Usherwood T
        • Westlake L
        Validating the SF-36 health survey questionnaire: New outcome measure for primary care.
        BMJ. 1992; 305: 160-164
        • Bruce J
        • Krukowski ZH
        Quality of life and chronic pain four years after gastrointestinal surgery.
        Dis Colon Rectum. 2006; 49: 1362-1370
        • Chaparro LE
        • Smith SA
        • Moore RA
        • Wiffen PJ
        • Gilron I
        Pharmacotherapy for the prevention of chronic pain after surgery in adults.
        Cochrane Database Syst Rev. 2013; CD008307
        • Chegini N
        • Kotseos K
        • Zhao Y
        • Bennett B
        • McLean FW
        • Diamond MP
        • Holmdahl L
        • Burns J
        Differential expression of TGF-beta1 and TGF-beta3 in serosal tissues of human intraperitoneal organs and peritoneal adhesions.
        Hum Reprod. 2001; 16: 1291-1300
        • Dworkin RH
        • Turk DC
        • Farrar JT
        • Haythornthwaite JA
        • Jensen MP
        • Katz NP
        • Kerns RD
        • Stucki G
        • Allen RR
        • Bellamy N
        • Carr DB
        • Chandler J
        • Cowan P
        • Dionne R
        • Galer BS
        • Hertz S
        • Jadad AR
        • Kramer LD
        • Manning DC
        • Martin S
        • McCormick CG
        • McDermott MP
        • McGrath P
        • Quessy S
        • Rappaport BA
        • Robbins W
        • Robinson JP
        • Rothman M
        • Royal MA
        • Simon L
        • Stauffer JW
        • Stein W
        • Tollett J
        • Wernicke J
        • Witter J
        IMMPACT: Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 9-19
        • Groenwold RH
        • Donders AR
        • Roes KC
        • Harrell Jr, FE
        • Moons KG
        Dealing with missing outcome data in randomized trials and observational studies.
        Am J Epidemiol. 2012; 175: 210-217
        • Haroutiunian S
        • Nikolajsen L
        • Finnerup NB
        • Jensen TS
        The neuropathic component in persistent postsurgical pain: A systematic literature review.
        Pain. 2013; 154: 95-102
        • Hayes A
        • Gearon E
        • Backholer K
        • Bauman A
        • Peeters A
        Age-specific changes in BMI and BMI distribution among Australian adults using cross-sectional surveys from 1980 to 2008.
        Int J Obes (Lond). 2015; 39: 1209-1216
        • Hinrichs-Rocker A
        • Schulz K
        • Jarvinen I
        • Lefering R
        • Simanski C
        • Neugebauer EA
        Psychosocial predictors and correlates for chronic post-surgical pain (CPSP): A systematic review.
        Eur J Pain. 2009; 13: 719-730
        • Holmdahl L
        • Kotseos K
        • Bergstrom M
        • Falk P
        • Ivarsson ML
        • Chegini N
        Overproduction of transforming growth factor-beta1 (TGF-beta1) is associated with adhesion formation and peritoneal fibrinolytic impairment.
        Surgery. 2001; 129: 626-632
        • Jarrar A
        • Church J
        Treating symptomatic adhesions to the sigmoid colon: Colectomy improves quality of life.
        Int J Colorectal Dis. 2013; 28: 1407-1411
        • Joris JL
        • Georges MJ
        • Medjahed K
        • Ledoux D
        • Damilot G
        • Ramquet CC
        • Coimbra CI
        • Kohnen LP
        • Brichant JF
        Prevalence, characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery: Retrospective analysis.
        Eur J Anaesthesiol. 2015; 32: 712-717
        • Katz J
        • Seltzer Z
        Transition from acute to chronic postsurgical pain: Risk factors and protective factors.
        Expert Rev Neurother. 2009; 9: 723-744
        • Kauppila JH
        • Xie S
        • Johar A
        • Markar SR
        • Lagergren P
        Meta-analysis of health-related quality of life after minimally invasive versus open oesophagectomy for oesophageal cancer.
        Br J Surg. 2017; 104: 1131-1140
        • Kehlet H
        • Jensen TS
        • Woolf CJ
        Persistent postsurgical pain: Risk factors and prevention.
        Lancet. 2006; 367: 1618-1625
        • Macrae WA
        Chronic post-surgical pain: 10 years on.
        Br J Anaesth. 2008; 101: 77-86
        • Munafo MR
        • Stevenson J
        Anxiety and surgical recovery. Reinterpreting the literature.
        J Psychosom Res. 2001; 51: 589-596
      1. World Health Organization (WHO): Cancer pain ladder for adults. Available at: http://www.who.int/cancer/palliative/painladder/en/ Accessed February 11, 2018.

        • Peters ML
        • Sommer M
        • de Rijke JM
        • Kessels F
        • Heineman E
        • Patijn J
        • Marcus MA
        • Vlaeyen JW
        • van Kleef M
        Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention.
        Ann Surg. 2007; 245: 487-494
        • Pinto PR
        • McIntyre T
        • Nogueira-Silva C
        • Almeida A
        • Araujo-Soares V
        Risk factors for persistent postsurgical pain in women undergoing hysterectomy due to benign causes: A prospective predictive study.
        J Pain. 2012; 13: 1045-1057
        • Rao A
        • Rao G
        • Ahmed I
        Laparoscopic vs. open liver resection for malignant liver disease: A systematic review.
        Surgeon. 2012; 10: 194-201
        • Reza MM
        • Blasco JA
        • Andradas E
        • Cantero R
        • Mayol J
        Systematic review of laparoscopic versus open surgery for colorectal cancer.
        Br J Surg. 2006; 93: 921-928
        • Sperber AD
        • Morris CB
        • Greemberg L
        • Bangdiwala SI
        • Goldstein D
        • Sheiner E
        • Rusabrov Y
        • Hu Y
        • Katz M
        • Freud T
        • Neville A
        • Drossman DA
        Development of abdominal pain and IBS following gynecological surgery: A prospective, controlled study.
        Gastroenterology. 2008; 134: 75-84
        • Stommel MWJ
        • ten Broek RPG
        • Strik C
        • Slooter GD
        • Verhoef C
        • Grunhagen DJ
        • van Duijvendijk P
        • Bemelmans MHA
        • den Dulk M
        • Sietses C
        • van Heek TNT
        • van den Boezem PB
        • de Wilt JHW
        • van Goor H
        Multicenter observational study of adhesion formation after open-and laparoscopic surgery for colorectal cancer.
        Ann Surg. 2018; 267: 743-748
        • Strik C
        • Stommel MW
        • Schipper LJ
        • van Goor H
        • ten Broek RP
        Risk factors for future repeat abdominal surgery.
        Langenbecks Arch Surg. 2016; 401: 829-837
        • Strik C
        • Stommel MW
        • ten Broek RP
        • van Goor H
        Adhesiolysis in patients undergoing a repeat median laparotomy.
        Dis Colon Rectum. 2015; 58: 792-798
        • Svedlund J
        • Sjodin I
        • Dotevall G
        GSRS: A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease.
        Dig Dis Sci. 1988; 33: 129-134
        • Swank DJ
        • Swank-Bordewijk SC
        • Hop WC
        • van Erp WF
        • Janssen IM
        • Bonjer HJ
        • Jeekel J
        Laparoscopic adhesiolysis in patients with chronic abdominal pain: A blinded randomised controlled multi-centre trial.
        Lancet. 2003; 361: 1247-1251
        • ten Broek RP
        • Issa Y
        • van Santbrink EJ
        • Bouvy ND
        • Kruitwagen RF
        • Jeekel J
        • Bakkum EA
        • Rovers MM
        • van Goor H
        Burden of adhesions in abdominal and pelvic surgery: Systematic review and met-analysis.
        BMJ. 2013; 347: f5588
        • ten Broek RP
        • Strik C
        • Issa Y
        • Bleichrodt RP
        • van Goor H
        Adhesiolysis-related morbidity in abdominal surgery.
        Ann Surg. 2013; 258: 98-106
        • Turk DC
        Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain.
        Clin J Pain. 2002; 18: 355-365
        • van den Beukel BA
        • de Ree R
        • van Leuven S
        • Bakkum EA
        • Strik C
        • van Goor H
        • ten Broek RPG
        Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: A systematic review and meta-analysis.
        Hum Reprod Update. 2017; 23: 276-288
        • VanDenKerkhof EG
        • Hopman WM
        • Reitsma ML
        • Goldstein DH
        • Wilson RA
        • Belliveau P
        • Gilron I
        Chronic pain, healthcare utilization, and quality of life following gastrointestinal surgery.
        Can J Anaesth. 2012; 59: 670-680
        • VanDenKerkhof EG
        • Peters ML
        • Bruce J
        Chronic pain after surgery: Time for standardization? A framework to establish core risk factor and outcome domains for epidemiological studies.
        Clin J Pain. 2013; 29: 2-8