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. 2020 Dec;35(6):564-573.
doi: 10.1016/j.jopan.2020.03.002. Epub 2020 Jul 11.

A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients

Edwin N Aroke  1 , Susan P McMullan  2 , Katie O Woodfin  2 , Ryan Richey  2 , Jordan Doss  3 , Bryan A Wilbanks  2
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A Practical Approach to Acute Postoperative Pain Management in Chronic Pain Patients

Edwin N Aroke et al. J Perianesth Nurs. 2020 Dec.

Abstract

In the United States, more than 100 million people suffer from chronic pain. Among patients presenting for surgery, about one in four have chronic pain. Acute perioperative pain management in this population is challenging because many patients with chronic pain require long-term opioids for the management of this pain, which may result in tolerance, physical dependence, addiction, and opioid-induced hyperalgesia. These challenges are compounded by the ongoing opioid epidemic that has resulted in calls for a reduction in opioid use, with a concurrent increase in the number of patients with chronic opioid exposure presenting for surgery. This article aims to summarize practical considerations for acute postoperative pain management in patients with chronic pain conditions. A patient-centered acute pain management plan, including nonopioid analgesics, regional anesthesia, and careful selection of opioid medications, can lead to adequate analgesia and satisfaction with care. Also, a meticulous rotation from one opioid to another may decrease opioid requirement, increase analgesic effectiveness, and improve satisfaction with care.

Keywords: chronic pain; opioid rotation; opioid tolerance; pain management; postoperative pain.

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Conflict of interest statement

Conflict of Interest- The authors have no financial conflicts of interest.

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