Ten percent of patients suffer pain up to 2 years after cardiac surgery

by Kim Barnhardt

About 10% of patients who have had cardiac surgery suffer from persistent postoperative pain 2 years after surgery, according to a large, multicentre study designed to assess risk factors for this pain published in CMAJ (Canadian Medical Association Journal).

Cardiac surgeries, including coronary artery bypass grafting (CABG) and valve replacement, are performed frequently around the world but can result in residual after the operation that may affect quality of life.

A study of 1247 patients aged 18 years or older in centres in 4 Canadian cities (Montréal, Quebec City, Toronto and Halifax) looked at the prevalence of ongoing up to 2 years after surgery and associated with this pain. About 40% of patients felt postoperative pain after 3 months, with a significant decrease over time, to 22% at 6 months, 17% at 12 months and 10% at 24 months.

"These prevalence rates are not negligible given that more than 400 000 patients undergo CABGs annually in the US," writes Dr. Manon Choinière, researcher with the Centre hospitalier de l'Université de Montréal Research Centre and professor, Department of Anesthesiology, Faculty of Medicine, l'Université de Montréal. Dr Choinière and her coauthors also note that the presence of persistent postoperative pain after cardiac surgery is not insignificant, and patients should be informed about this possibility before surgery.

Several risk factors emerged for in the 2 years following cardiac surgery:

  • Age: Younger patients were more likely to report persistent postoperative pain than older people.
  • Pre-existing chronic pain: Patients with chronic nonanginal pain before surgery had a greater risk of persistent postoperative pain.
  • Pre-surgery anxiety: Greater anxiety before surgery was linked to a higher likelihood of persistent pain.
  • Pain severity during the first week after surgery : The more intense the pain during the first few days after surgery and the more it interfered with functioning, the more likely patients were to report persistent pain in the following months or years.

The following factors predicted the severity of pain in the 2 years following cardiac surgery:

  • Sex: Female patients were more likely to report more intense persistent pain.
  • Acute pain: The amount of pain felt in the first week after surgery predicted not only the presence of long-term pain but also its severity.
  • Time in hospital: Earlier discharge from hospital was associated with persistent pain of greater intensity.

"It is noteworthy that acute pain levels (observed in the first few days after surgery) were quite high in this study," state the authors. "It is troublesome that similar observations have been made over and over again in the past 3 decades and that postoperative pain continues to be undertreated despite numerous awareness campaigns, pain care guidelines and educational efforts."

The authors note that two risk factors of persistent pain after cardiac surgery are modifiable—pre-surgical anxiety and acute pain severity in the first few days after surgery.

The authors urge more research into how to prevent or minimize pain to help eliminate unnecessary suffering and reduced quality of life in the months or years after .

add to favorites email to friend print save as pdf

Related Stories

Many women suffer persistent pain after mastectomy

Nov 14, 2013

(HealthDay)—Although breast cancer treatments have dramatically improved outcomes for women with the disease, ongoing pain continues to trouble many survivors long after they undergo a mastectomy, a new ...

Recommended for you

Exploring 3-D printing to make organs for transplants

Jul 30, 2014

Printing whole new organs for transplants sounds like something out of a sci-fi movie, but the real-life budding technology could one day make actual kidneys, livers, hearts and other organs for patients ...

High frequency of potential entrapment gaps in hospital beds

Jul 30, 2014

A survey of beds within a large teaching hospital in Ireland has shown than many of them did not comply with dimensional standards put in place to minimise the risk of entrapment. The report, published online in the journal ...

Key element of CPR missing from guidelines

Jul 29, 2014

Removing the head tilt/chin lift component of rescue breaths from the latest cardiopulmonary resuscitation (CPR) guidelines could be a mistake, according to Queen's University professor Anthony Ho.

Burnout impacts transplant surgeons (w/ Video)

Jul 28, 2014

Despite saving thousands of lives yearly, nearly half of organ transplant surgeons report a low sense of personal accomplishment and 40% feel emotionally exhausted, according to a new national study on transplant surgeon ...

User comments

Adjust slider to filter visible comments by rank

Display comments: newest first

thewhitelilyblog
not rated yet Feb 25, 2014
Somehow this article makes it seem as if post-operative pain were the result of pre-operative anxiety. BS. Listen, a year and a half after by-pass surgery, I have wires sticking out of my chest-the surgeon forgot them. From shoulder to shoulder, my whole front aches, and I think, from the burning, that I can feel the inside of my chest where they detached the arterial fabric from which they constructed three of my five bypasses. I feel continually beat up. I would still have the surgery, of course. But things sure have changed. It has made me more timid, and constantly distracted.