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13/11/2024 - Press release

They demonstrate that women suffer more chronic postoperative pain than men

• Conversely, women tolerate it better than men, according to a multicenter study led by Hospital del Mar and its research institute, published in the Journal of Cardiothoracic and Vascular Anesthesia.

• The study analyzed the outcomes of more than 200 people who underwent a thoracotomy, a type of open surgery that requires separating the ribs to reach the lungs. The differences between men and women are not due to physiological or genetic factors but to a worse initial situation for women regarding their quality of life prior to surgery.

• The researchers highlight the need to consider this and introduce the idea of addressing psychological components before surgery as part of a personalized approach to pain management.

Women have a higher risk of experiencing chronic postoperative pain after surgery, according to a study published in the Journal of Cardiothoracic and Vascular Anesthesia, led by the Pain Unit of the Anesthesia Department at Hospital del Mar and the Hospital del Mar Research Institute. The study included data from 96 women and 137 men who underwent thoracotomy, an open surgery involving the rib cage and rib separation, at around ten hospitals across Spain between 2017 and 2019.

"In general, a person's gender increases the risk of chronic postoperative pain," says Dr. Antonio Montes, head of the Pain Unit at Hospital del Mar and a researcher at its institute. But, he notes, the reason is not due to a genetic or hormonal factor but rather to the patient's initial condition. Women who develop chronic pain after surgery tend to be in poorer health prior to surgery, with higher levels of depression and lower quality of life than men.

Follow-up Four Months After Surgery

The patients in the study underwent thoracotomy, a procedure increasingly performed on women due to a rise in tobacco-related lung diseases among them. All participants completed various tests to assess their physical and mental health and quality of life before surgery. One month after the procedure, they were contacted, and those reporting continued pain were called again three months later. Patients with ongoing pain were examined to confirm its intensity, characteristics, and impact on their quality of life.

This analysis revealed that 53% of women developed chronic postoperative pain, compared to only 38% of men. Women reported worse initial pain in other body areas, lower quality of life, and higher levels of depression. They also suffered more pre-existing pain, twice as much as men. "Before surgery, women experience more pain, higher levels of depression, and greater skepticism about surgery outcomes than men. They also have a lower quality of life," explains Dr. Montes. On the other hand, "women adapt better to their new condition. They arrive at surgery in poorer health, which makes chronic pain more likely, but despite experiencing chronic pain, they tolerate it better than men," he adds.

Both men and women experience a worsening of physical health in the presence of chronic pain. However, women's mental health improves while men's worsens, according to the study results. This indicates that both chronicity variables and those associated with pain becoming chronic and its progression differ based on the patient's gender. Therefore, studies on this issue should consider this factor, and there should be an emphasis on units dedicated to preventing acute pain from becoming chronic, known as transitional pain units. In this regard, Dr. Juan Castaño, attending physician in the Psychiatry Department at Hospital del Mar, explains that "persistent postsurgical pain and associated disability can be reduced or prevented through a specific psychological intervention during the perioperative period that addresses modifiable psychological variables associated with predicting postsurgical pain."

The study team has already validated a method to predict chronic postoperative pain for certain surgeries . This study included Hospital del Mar, Hospital de Bellvitge, Hospital Clínic, Germans Trias i Pujol, Sant Pau, and Vall d'Hebron in Catalonia; Gregorio Marañón and 12 de Octubre in Madrid; La Fe in Valencia; and General Hospital of Alicante.

This study received support from the Carlos III Health Institute grant PI16/00279 and the European Regional Development Fund (FEDER) through the Ministry of Economy, Industry, and Competitiveness.

Reference Article

Roca G, Sabate S, Serrano A, Benito MC, Pérez M, Revuelta M, Lorenzo A, Busquets J, Rodríguez G, Sanz D, Jiménez A, Parera A, de la Gala F, Montes A. Sex Differences in Chronic Postsurgical Pain after Open Thoracotomy. J Cardiothorac Vasc Anesth. 2024 Sep 4

(24)00587-1. doi: 10.1053/j.jvca.2024.08.039. Epub ahead of print. PMID: 39322441.

Other Articles

• Montes, Antonio M.D., Ph.D.; Roca, Gisela M.D., Ph.D.; Jordi, Cantillo BSc; Sabate, Sergi M.D., Ph.D. for the GENDOLCAT Study Group. Presurgical risk model for chronic postsurgical pain based on six clinical predictors, PAIN: November 2020;161:2611-2618. doi: 10.1097/j.pain.0000000000001945

• Montes A, Roca G, Sabaté S, Lao JI, Navarro A, Cantillo J, Canet J; for the GENDOLCAT Study Group. Genetic and clinical factors associated with Chronic PostSurgical Pain after hernia repair, hysterectomy, and thoracotomy. A two-year multicenter cohort study. Anesthesiology 2015;122:1123-41.

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Communications Department at Hospital del Mar. Tel. 932483537.dcollantes@hospitaldelmar.cat / comunicacio@hospitaldelmar.cat

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