Mononeuropathies Caused by Surgery: From Anatomy to Prevention

Although the concept of chronic postsurgical pain (CPSP) involves a number of different pathophysiological contexts, it appears that injury to a peripheral nerve trunk (mononeuropathy) is a major causal factor. A binary process to separate out these mechanisms as far as possible would seem to be useful in order to gain more knowledge about the mechanisms involved, since the key challenge is to develop preventative measures. Some types of surgery are considered to be associated with specific types of nerve trunk damage, which at least account for the neurological deficits found during assessments in the medium term but are not necessarily associated with neuropathic-type pain symptoms. Nerve injury thus appears to be an essential but not sufficient factor for the development of CPSP, while other factors, mostly genetic and biographical in nature, are superimposed upon it.