Canadian Journal of Anesthesia

, Volume 53, Issue 12, pp 1190–1199

Brief review: Perioperative management of the patient with chronic non-cancer pain

  • Ibrahim Hadi
  • Patricia K. Morley-Forster
  • Steven Dain
  • Kim Horrill
  • Dwight E. Moulin
Regional Anesthesia and Pain

Abstract

Purpose

Both opioid and non-opioid medications are being utilized increasingly in the treatment of chronic non-cancer pain, and the number of surgical patients receiving large regular doses of opioids is ever-expanding. The perioperative pain control of these patients is often challenging, and is broadening the role of the anesthesiologist as ‘perioperative physician’. These patients need to be identified before surgery to plan optimal pain control postoperatively. The purpose of this review is to provide an update on the important considerations in managing the chronic non-cancer pain patient receiving high dose opioids and other adjunctive medications/analgesics.

Source

English language articles published between June 1980 and May 2006 were identified by a computerized Medline search using keywords “chronic pain”, “opioid dependent” and “perioperative”. This same search strategy was repeated and updated using both Medline and Embase. All relevant publications were retrieved and their bibliographies were scanned for additional sources.

Principal findings

Although an increasingly common problem for the acute pain service, there is very little published on this topic. Key points include the concept of opioid equivalency, tolerance, the role of adjunctive medications, and the need for good communication between the surgical team, the acute pain service and the patient who is often anxious about the upcoming procedure due to previous unpleasant experiences with poor pain control in hospital.

Conclusion

Clinical care of the opioid-dependent patient in the perioperative period can be a daunting task. Education to all staff involved in this area needs to be enhanced to improve outcome and patient satisfaction.

Article de synthèse court: Prise en charge periopératoire des patients souffrant de douleur chronique non cancéreuse

Résumé

Objectif

On traite de plus en plus les douleurs non cancéreuses avec des substances opiacées ou non opiacées et, en chirurgie, on retrouve un nombre croissant de patients prenant de fortes doses d’opiacés. Dans ce contexte, la prise en charge de la douleur représente souvent un défi et contribue au rôle grandissant de l’anesthésiologiste en « médecine périopératoire ». Ces patients doivent être identifiés avant la chirurgie pour planifier la prise en charge de la douleur en période postopératoire. l’objectif de cet article est de mettre à jour les éléments importants dans la prise en charge de la douleur non cancéreuse chez les patients qui reçoivent des doses élevées d’opiacés et d’autres médicaments/analgésiques adjuvants.

Source

Les articles publiés en langue anglaise de juin 1980 et mai 2006 ont été identifiés grâce à une recherche informatisée dans Medline avec les mots-clés « chronic pain », « opiod dependent » et « perioperative ». La même stratégie de recherche a été répétée et mise à jour avec Medline et Embase. Toutes les publications ont été retrouvées et leur liste de références a été fouillée pour repérer des documents additionnels.

Constatations principales

Même s’il s’agit d’un problème fréquent pour les services de douleur aiguë, il y a peu de publications sur ce sujet. Les thèmes principaux sont le concept d’équivalence pour les opiacés, la tolérance et le rôle des médicaments adjuvants. On retrouve aussi l’importance de la communication entre l’équipe chirurgicale, le service de douleur aiguë et le patient, qui est souvent inquiet de la chirurgie annoncée à cause d’expériences antérieures déplaisantes à l’hôpital où la prise en charge de la douleur laissait à désirer.

Conclusion

Les soins cliniques aux patients avec une dépendance aux opiacés peut constituer une tâche décourageante en période périopératoire. La formation des intervenants dans ce domaine doit être développée pour améliorer le pronostic et la satisfaction du patient.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Ibrahim Hadi
    • 1
  • Patricia K. Morley-Forster
    • 1
  • Steven Dain
    • 1
  • Kim Horrill
    • 2
  • Dwight E. Moulin
    • 3
  1. 1.Department of Anesthesia and Perioperative MedicineInterdisciplinary Pain Program, University of Western OntarioLondonCanada
  2. 2.School of NursingInterdisciplinary Pain Program, University of Western OntarioLondonCanada
  3. 3.Faculty of Health Sciences, and the Departments of Oncology and Clinical Neurological SciencesInterdisciplinary Pain Program, University of Western OntarioLondonCanada
  4. 4.St Joseph’s Health CareLondonCanada

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