Perioperative Care of the Orthopedic Patient with Chronic Pain

  • Faye Rim
  • Seth A. WaldmanEmail author


The management of perioperative pain is a critical component of surgical care. Commonly, acute postoperative pain is easily identified as the region of injury and surgical insult are evident. Effective management of the acute conditions require therapy, which is tailored to the patient’s specific requirements as dictated by surgical site and intervention, as well as the patient’s experiences and expectations. In patients who have been chronically exposed to opioid pain medications, hyperalgesia may alter the level of pain the patient will experience. In addition, patients who are already on high dose opioid therapy may need to be on higher than anticipated doses after surgery, which adds to the risk of adverse events. Chronic opioid use may further be complicated by the concomitant utilization of other licit (such as alcohol or benzodiazepines) and illicit (such as cocaine or heroin) substances. Further, the risks associated with postoperative opioid therapy are increased in the presence of mental health conditions, including substance use disorder (SUD). For these reasons, postoperative pain management begins with preoperative assessment and planning. The anticipated surgery and the patient’s experience with pain therapies, medical conditions, age, and psychological state are factors that need to be considered in order to define an individualized therapy plan. By asking the proper questions preoperatively and providing adequate information, staff members can educate patients on therapeutic options, try to better understand their expectations, and help mitigate any risks. For elective surgeries, preoperative pain evaluation and treatment optimization, including reducing opioids, addressing substance abuse, patterns of misuse, and mental health issues, improves patient outcomes and results in lower cost and improved healthcare utilization.


Preoperative evaluation Opioid management Chronic pain Substance abuse Anxiety Depression 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesiology, Critical Care, and Pain ManagementHospital for Special SurgeryNew YorkUSA
  2. 2.Departments of Anesthesiology and Rehabilitation MedicineWeill Cornell MedicineNew YorkUSA
  3. 3.Division of Pain Management, Department of AnesthesiologyHospital for Special Surgery, Weill Cornell MedicineNew YorkUSA

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