Risk Factors for Chronic Post-surgical Pain Following Orthopedic Surgery “Who’s at Risk”

This review article examines the development of chronic post-surgical pain (CPSP), approaching the subject in a temporal manner. It provides an overview of pre-operative, intraoperative, and perioperative risk factors, as well as some effective risk reduction strategies identified in prior literature.

Our understanding of CPSP has rapidly evolved. Pre-surgical risk factors include body mass, psychiatric comorbidities, and potential genomic factors. Pre-operative interventions such as pharmacological and regional anesthetic approaches can mitigate some CPSP risks. Intraoperative strategies include local anesthetic filtration, careful dissection, and minimized procedure time. Postoperatively, controlling pain trajectories and achieving an earlier return to function are crucial in preventing CPSP.

A multimodal approach targeting psychiatric, surgical, anesthetic, analgesic, and rehabilitative factors is likely required to effectively mitigate CPSP following orthopedic surgery.