Analgesic management of acute pain in the opioid-tolerant patient

Shah, S.; Kapoor, Shruti; Durkin, Brian

doi:10.1097/aco.0000000000000218

Cited by 33 publications

(16 citation statements)

References 32 publications

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“…Nonetheless, a multimodal approach is recommended. 38 When regional analgesia is not applicable, a PCA system can be considered especially for those who are unable to maintain their oral opioids in the perioperative period. 39 Pain scores in opioid-tolerant patients are higher and decrease more slowly.…”

Section: Prejudice and Misconceptions That Limit Postoperative Pain Tmentioning

confidence: 99%

The challenge of perioperative pain management in opioid-tolerant patients

Coluzzi¹,

Bifulco²,

Cuomo³

et al. 2017

TCRM

117

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The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone.

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Section: Prejudice and Misconceptions That Limit Postoperative Pain Tmentioning

confidence: 99%

The challenge of perioperative pain management in opioid-tolerant patients

Coluzzi¹,

Bifulco²,

Cuomo³

et al. 2017

TCRM

117

View full text Add to dashboard Cite

show abstract

“…Unfortunately, these hypotheses cannot be confirmed (or disproved), on the basis of the present study, where postoperative hyperalgesia was not assessed. Since subjects exposed to chronic opioids require distinct protocols for POP management, 8,49 patients undergoing surgery should be carefully questioned about the use of opioid-analgesics prior to surgery.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry

Polanco-García

García-Lopez

Fàbregas

et al. 2017

The Journal of Pain

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We analyzed postoperative outcomes and analgesic management in patients from tertiary care Spanish hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (numeric rating scale score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients' pain participation in decision-making was inadequate and should be improved in Spanish hospitals.

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“…This task becomes all the more challenging in patients with chronic opioid use and opioid tolerance, which are associated with increased postoperative pain and analgesic requirement. 11,12…”

mentioning

confidence: 99%

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

Kim¹,

Kacker²,

Kutler³

et al. 2020

Otolaryngol.--head neck surg.

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Objective To quantify pain and opioid use after otorhinolaryngologic surgery. To determine the effect of patient and surgical factors on primary outcomes. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods Patients undergoing elective otorhinolaryngologic surgery were prospectively enrolled. Patients completed demographic surveys and psychometric questionnaires assessing attitudes toward pain and baseline anxiety and depression before surgery. After surgery, patients documented peak pain levels (0-100 mm, visual analog scale) and daily prescription and nonprescription analgesic requirements over a 2-week period. Average daily and cumulative pain and opioid use were calculated and compared among patient cohorts stratified by procedure and preoperative factors. Results A total of 134 patients were enrolled. Total tonsillectomy was associated with significantly higher pain scores and opioid consumption, as compared to all other procedures. There was moderate correlation between average cumulative pain and opioid use. Older patients required significantly fewer doses of opioids. There was no effect of sex, marital status, or education level on postoperative pain or opioid use. Psychometric instrument scores and chronic pain or analgesic use were not associated with significant differences in pain or opioid requirements. Most patients were prescribed substantially more opioids than they actually required. Conclusion Postoperative pain following elective otorhinolaryngologic surgery decreases dramatically within the first week and requires only few days of opioid analgesia, with the exception of tonsillectomy. Almost all patients required fewer than 15 doses of opioids.

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Analgesic management of acute pain in the opioid-tolerant patient

Abstract: There is a need for more high-level evidence-based guidelines to help practitioners achieve the best care of this growing high-risk population of patients.

Cited by 33 publications

References 32 publications

The challenge of perioperative pain management in opioid-tolerant patients

The challenge of perioperative pain management in opioid-tolerant patients

Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry

Pain and Opioid Analgesic Use After Otorhinolaryngologic Surgery

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