Chronic postsurgical pain after nonarthroplasty orthopedic surgery

Chronic postsurgical pain (CPSP) following nonarthroplasty orthopedic surgery has a variable incidence and results in significant morbidity in patients. The etiology of this persisting pain could be because of a variety of insults during surgery including injuries to nerves and release of inflammatory mediators. Trauma is well known to result in complex regional pain syndrome (CRPS). Phantom limb pain frequently follows both traumatic and ischemic amputations. Both these conditions are well known to result in debilitating pain. Management of CPSP is not only dependent on careful planning of acute pain management but also the treatment of established pain. Preventive strategies include use of multimodal analgesia, preventing opioid-induced hyperalgesia, and use of regional blocks. Treatment of established CPSP will depend on its etiology. Phantom pain and CRPS can be difficult to treat once established. Many therapeutic interventions have been tried with variable success.