Chronic Post-Surgical Pain (CPSP)

It is normal to have pain after surgery. Many people will experience some pain during the recovery period after surgery. The intensity of pain can vary from person to person and the type of surgery they had.
 
Pain after surgery usually occurs due to inflammation in the part of the body that was operated on. This type of pain is commonly known as acute post-surgical pain and lasts less than 3 months. Inflammation and acute pain are a natural part of the body’s healing process.
 
Some people may have pain for a longer period of time after surgery. When pain lasts more than three months after surgery, it is a sign that the person may have chronic post-surgical pain (CPSP). About 5 -10% of patients who had major surgery go on to develop CPSP.

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Risk Factors

Clinical studies show that people with certain risk factors have a greater chance of developing CPSP. 
 
CPSP is more likely to occur in people who had a pain condition before surgery. A high intensity of pain and poor pain control after surgery are also known risk factors.
 
Some types of surgery that take longer, use an “open” approach, or cause damage to nerves are also linked to patients having a greater chance of developing CPSP.
 
People with mental health conditions such as anxiety, depression, or post-traumatic stress disorder are also more likely to develop CPSP.
 
Other risk factors for CPSP are:
  • Use of opioid medication before surgery
  • Fear of surgery and pain
  • Catastrophic thinking about pain
  • Lack of social support
  • Female gender
  • Younger age
 
It’s important to keep in mind that not everyone with one or more risk factors will develop chronic pain after surgery.

Diagnosis of Chronic Post-Surgical Pain

Diagnosis of CPSP is usually made during follow-up after surgery or by the primary care provider.
 
There is more and more focus on preventing CPSP by identifying patients who are at risk before or immediately after surgery. The goal is to prevent the transition from acute to chronic pain in these patients by offering transitional pain care.
 
The Transitional Pain Service at Toronto General Hospital offers specialized pain care to patients who are at risk of developing CPSP.
 
Referrals to the Transitional Pain Service can be made through the following referral form: PDF link

Treatment of Acute & Chronic Post-Surgical Pain

Before and/or after your surgery, your doctor will discuss your pain management options with you. Some of the most common acute post-surgical pain management methods include:​
  • Medication: To reduce post-surgical inflammation, your doctor may prescribe anti-inflammatory medication. Depending on your pain severity, you may also be prescribed pain medications.
  • Gentle Exercise and Physiotherapy: Movement and gentle exercise are part of the recovery process after surgery. Regular movement, exercise, and physiotherapy can help boost strength and increase mobility after surgery and help in managing pain.
  • Massage Therapy and Acupuncture: Manual treatments such as Massage Therapy and Acupuncture can help to reduce the intensity and severity of pain following surgery.
  • Clinical Hypnosis and Relaxation: A trained pain psychologist can help patients reduce the severity of pain and cope with the emotional aspects of pain during their recovery by empowering them with pain self-management skills.
For patients who require transitional pain care, the team at the Transitional Pain Service relies on a proven multidisciplinary treatment approach that addresses the medical, psychological, and physical components of pain management. Depending on patient needs, transitional pain care may start before or after surgery and continue following hospital discharge.

Physiotherapy and Exercise

Physiotherapy will help you improve your posture, physical function and quality of life as you become more active.

Active physiotherapy techniques will help with long term relief of pain symptoms. A physiotherapist can advise you about how to start becoming more active.

Active physiotherapy involves using movement-based treatments requiring active participation of the patient such as flexibility, strengthening, breath work.

Passive physiotherapy involves treatments that do not require the patient to use energy. These include massage, therapeutic ultrasound, traction, and the TENS machine.

  1. If you live in the GTA, complete our self-assessment form to see if you can be referred to TAPMI.
  2. Look for a self management group in your community such as this one run by the province Ontario: www.ontarioselfmanagement.ca/RegionalSite
  3. Connect yourself to physiotherapy and exercise groups in your community
    Internet key word search:
    • Fibromyalgia group physiotherapy in [Community]
    • Fibromyalgia exercise groups in [Community]
    • Exercise groups in [Community]
    • Chronic pain self management programs with physiotherapy in [Community]
    When calling clinics or programs ask about
    • Exercise based physiotherapy
    • Self management programs with physiotherapy
    • Graded exposure physiotherapy

Clinical Psychology and Counselling

Psychological approaches to pain management address the emotional aspects of pain, such as feeling sad or depressed, feeling anxious or worried, feeling hopeless and being angry or irritable.

Therapies such as Cognitive Behavioural Therapy, Mindfulness-Based Stress Reduction, and Acceptance and Commitment Therapy can help you focus on how to deal with your pain and the emotions that come with it. These therapies will teach you how making even small changes can start to improve your pain.

  1. If you live in the GTA, complete our self-assessment form to see if you can be referred to TAPMI.
  2. Look for a self management group in your community such as this one run by the province Ontario: www.ontarioselfmanagement.ca/RegionalSite
  3. For free information regarding Mental Health Services in Ontario visit http://www.mentalhealthhelpline.ca/ A referral specialist will answer
  4. Crisis Lines/Mobile Crisis Units (If you are very distressed and need immediate assistance):
    Gerstein Crisis Centre: 416-929-5200 (downtown Toronto, York). Telephone crisis intervention and mobile crisis team.
  5. Visit TAPMI's self help module for chronic pain to help you with strategies to manage your pain.

Self-Management

Self-management is one of the most important treatments in your chronic pain journey. Studies have shown that when people actively manage their pain on a daily basis, they get the best results.

There are many self-management strategies that can help reduce pain.

  • Becoming knowledgeable about chronic pain and what is happening in your body.
  • Staying active every day by stretching and walking to improve your pain levels.
  • Pacing your activities throughout the day to reduce your risk of flare up.
  • Practicing daily relaxation techniques.
  • Learning how to communicate with family, friends, and care providers.
  • Learning how to cope with the emotions of having chronic pain including depression and anxiety.
  • Improving your sleep so you can get more rest and cope better with your pain.
  • Listening to your body to learn which treatments work best for you and to avoid flare ups.

76 Grenville St. Toronto, ON M5S 1B2 Canada

TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday

Administration

Dr. Tania Di Renna, Medical Director Laura Pus, Administrative Director