Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Neetu Bansal; Sheanne Ang; Li-Chia Chen

doi:10.1177/20494637231204549

Prevalence and determinants of chronic pain and persistent opioid use after surgery: A review of systematic reviews

Br J Pain. 2024 Feb;18(1):95-103. doi: 10.1177/20494637231204549. Epub 2023 Oct 17.

Authors

Neetu Bansal¹, Sheanne Ang², Li-Chia Chen¹

Affiliations

¹ Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK.
² South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK.

Abstract

Background: Chronic post-surgical pain (CPSP) and persistent post-operative opioid use (PPOU) are inconsistently defined in published literature. This review comprehensively summarised their definitions, prevalence and determinants from existing systematic reviews or meta-analyses.

Methods: Systematic reviews or meta-analyses evaluating the prevalence of CPSP and PPOU in adults after surgeries were retrieved from an electronic database search applying structured search strategies in PubMed, MEDLINE, Embase, CINAHL Plus and Cochrane Database of Systematic Reviews from inception to 31 December 2022. Two reviewers selected systematic reviews, extracted data regarding the definition, prevalence and risk factors of CPSP and PPOU and assessed the quality using the AMSTAR 2 tool.

Results: The study identified 6936 records related to chronic pain and persistent opioid use in patients after surgery, of which 24 articles were identified for full-text review. Eighteen systematic reviews were included in this umbrella review, of which five systematic reviews assessed chronic pain in patients who had undergone a surgical procedure, and 13 reviews assessed persistent opioid use after surgery. Despite considerable variations in patient characteristics (from age ≥18 years), types of surgeries, follow-up duration and the definitions of measures, most reviews were of medium to good quality (fulfilled 9-11/16 AMSTAR 2 criteria). The prevalence of CPSP and PPOU, commonly synthesised at 3, 6 or 12 months after surgeries, varied from 5%-58% and 2%-65%, respectively, despite various terminologies, definitions and timing of measures and associated determinants. The prevalence of neuropathic pain in CPSP was obtainable for four surgeries, with 9%-74%.

Conclusion: To inform future practice and policy to optimise pain management and opioid safety, consensus on standardising measurements and further studies assessing risk factors associated with CPSP, PPOU and adverse outcomes are needed.

Keywords: chronic pain; opioid dependence; persistent post-operative opioid use; post-operative pain; prevalence; surgery.