Complexities of Perioperative Pain Management in Orthopedic Trauma

  • Daniel H. Wiznia
  • Theodore Zaki
  • Michael P. Leslie
  • Thomas M. HalaszynskiEmail author
Other Pain (A Kaye and N Vadivelu, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Other Pain


Purpose of Review

This review discusses both obvious and hidden barriers in trauma patient access to pain management specialists and provides some suggestions focusing on outcome optimization in the perioperative period.

Recent Findings

Orthopedic trauma surgeons strive to provide patients the best possible perioperative pain management, while balancing against potential risks of opioid abuse and addiction. Surgeons often find they are ill-prepared to effectively manage postoperative pain in patients returning several months following trauma surgery, many times still dependent on opioids for pain control. Some individuals from this trauma patient population may also require the care of pain management specialists and/or consultation with drug addiction specialists. As the US opioid epidemic continues to worsen, orthopedic trauma surgeons can find it difficult to obtain access to pain management specialists for those patients requiring complex pain medication management and substance abuse counseling.


The current state of perioperative pain management for orthopedic trauma patients remains troubling due to reliance on only opioid analgesics, society-associated risks of opioid medication addiction, an “underground” prescription drug marketplace, and an uncertain legal atmosphere related to opioid pain medication management that can deter pain management physicians from accepting narcotic-addicted patients and discourage future physicians from pursuing advanced training in the specialty of pain management. Additionally, barriers continue to exist among Medicaid patients that deter this patient population from access to pain medicine subspecialty care, diminishing medication management reimbursement rates make it increasingly difficult for trauma patients to receive proper opioid analgesic pain medication management, and a lack of proper opioid analgesic medication management training among PCPs and orthopedic trauma surgeons further contributes to an environment ill-prepared to provide effective perioperative pain management for orthopedic trauma patients.


Opioids Opioid medications Pain management Perioperative pain management 


Author Contributions

All authors have read the manuscript, agree that the work is ready for submission, and accept responsibility for the manuscript’s contents. Each author is a major contributor, analyzed the published literature, prepared and edited the manuscript, and approved the final version of the paper. In addition, all authors agree to be accountable for every aspect of the work, ensuring that questions related to its accuracy or integrity of any part of the work has been investigated and resolved.

Compliance with Ethical Standards

Conflict of Interest

Daniel H. Wiznia, Theodore Zaki, Michael P Leslie, and Thomas M. Halaszynski declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


The manuscript is original work, has not been previously published, and is not under consideration for publication elsewhere.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniel H. Wiznia
    • 1
  • Theodore Zaki
    • 1
  • Michael P. Leslie
    • 1
  • Thomas M. Halaszynski
    • 2
    • 3
    Email author
  1. 1.Department of Orthopedics and RehabilitationYale University School of MedicineNew HavenUSA
  2. 2.Yale AnesthesiologyYale-New Haven HospitalNew HavenUSA
  3. 3.Department of Adult and Perioperative AnesthesiologyYale University School of MedicineNew HavenUSA

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