Abstract
Treating patients with chronic opioid use is challenging in the acute postoperative period, which often leads to inadequate pain control. Factors including altered patient physiology requiring higher analgesic dosages, possible bias and mistrust from healthcare providers, and lack of treatment consensus contribute to the challenges that healthcare providers and patients face in finding adequate treatment for pain. It is important to understand these factors to formulate effective treatment plans as suboptimal postoperative pain management has significant ramifications including increased morbidity, increased recovery time, prolonged opioid use during and after hospitalizations, and increase cost of care. This chapter will provide a brief summary of the literature and expert opinions regarding postoperative analgesia in patients with chronic opioid use prior to surgery.
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References
Yang MMH, Hartley RL, Leung AA, Ronksley PE, Jette N, Casha S, et al. Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis. BMJ Open. 2019;9(4):e025091. https://doi.org/10.1136/bmjopen-2018-025091.
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016;17(2):131–57. https://doi.org/10.1016/j.jpain.2015.12.008.
Cahill CM, Walwyn W, Taylor AMW, Pradhan AAA, Evans CJ. Allostatic mechanisms of opioid tolerance beyond desensitization and downregulation. Trends Pharmacol Sci. 2016;37(11):963–76. https://doi.org/10.1016/j.tips.2016.08.002.
Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011;14(2):145–61.
Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991–1004. https://doi.org/10.1093/bja/aeu137.
Hayhurst CJ, Durieux ME. Differential opioid tolerance and opioid-induced hyperalgesia: a clinical reality. Anesthesiology. 2016;124(2):483–8. https://doi.org/10.1097/ALN.0000000000000963.
O’Brien C. Addiction and dependence in DSM-V. Addiction. 2011;106(5):866–7. https://doi.org/10.1111/j.1360-0443.2010.03144.x.
Peppin JF. The marginalization of chronic pain patients on chronic opioid therapy. Pain Physician. 2009;12(3):493–8.
Alford DP, Compton P, Samet JH. Acute pain management for patients receiving maintenance methadone or buprenorphine therapy. Ann Intern Med. 2006;144(2):127–34. https://doi.org/10.7326/0003-4819-144-2-200601170-00010.
Mitra S, Sinatra RS. Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology. 2004;101(1):212–27. https://doi.org/10.1097/00000542-200407000-00032.
Coluzzi F, Bifulco F, Cuomo A, Dauri M, Leonardi C, Melotti RM, et al. The challenge of perioperative pain management in opioid-tolerant patients. Ther Clin Risk Manag. 2017;13:1163–73. https://doi.org/10.2147/TCRM.S141332.
Merrill JO, Rhodes LA, Deyo RA, Marlatt GA, Bradley KA. Mutual mistrust in the medical care of drug users: the keys to the “narc” cabinet. J Gen Intern Med. 2002;17(5):327–33.
Chapman CR, Donaldson G, Davis J, Ericson D, Billharz J. Postoperative pain patterns in chronic pain patients: a pilot study. Pain Med. 2009;10(3):481–7. https://doi.org/10.1111/j.1526-4637.2008.00522.x.
Doverty M, Somogyi AA, White JM, Bochner F, Beare CH, Menelaou A, et al. Methadone maintenance patients are cross-tolerant to the antinociceptive effects of morphine. Pain. 2001;93(2):155–63. https://doi.org/10.1016/s0304-3959(01)00306-2.
Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To stop or not, that is the question: acute pain management for the patient on chronic buprenorphine. Anesthesiology. 2017;126(6):1180–6. https://doi.org/10.1097/ALN.0000000000001633.
Moore KT, Sathyan G, Richarz U, Natarajan J, Vandenbossche J. Randomized 5-treatment crossover study to assess the effects of external heat on serum fentanyl concentrations during treatment with transdermal fentanyl systems. J Clin Pharmacol. 2012;52(8):1174–85. https://doi.org/10.1177/0091270011411710.
Nadherny W, Anderson B, Abd-Elsayed A. Perioperative and periprocedural care of patients with intrathecal pump therapy. Neuromodulation. 2019;22(7):775–80. https://doi.org/10.1111/ner.12880.
Sylvester RK, Lindsay SM, Schauer C. The conversion challenge: from intrathecal to oral morphine. Am J Hosp Palliat Care. 2004;21(2):143–7. https://doi.org/10.1177/104990910402100214.
Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98.
Grass JA. Patient-controlled analgesia. Anesth Analg. 2005;101(5 Suppl):S44–61.
Momeni M. Patient-controlled analgesia in the management of postoperative pain. Drugs. 2006;66(18):2321–37. ISSN: 0012-6667
Jonan A. Buprenorphine formulations: clinical best practice strategies recommendations for perioperative management of patients undergoing surgical or interventional pain procedures. Pain Physician. 2018;21(1):E1–E12. ISSN: 1533-3159
Anderson. To stop or not, that is the question: acute pain management for the patient on chronic buprenorphine. Anesthesiology. 2017;126(6):1180–6. ISSN: 0003-3022
Smith HS, Peppin JF. Toward a systematic approach to opioid rotation. J Pain Res. 2014;7:589–608.
“CDC guideline for prescribing opioids for chronic pain”. CDC. https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf
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Barinsky, G.L., Jones, E.M., Pashkova, A.A., Thai, C.P. (2021). Postoperative Analgesia for the Chronic Pain Patient. In: Svider, P.F., Pashkova, A.A., Johnson, A.P. (eds) Perioperative Pain Control: Tools for Surgeons. Springer, Cham. https://doi.org/10.1007/978-3-030-56081-2_7
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DOI: https://doi.org/10.1007/978-3-030-56081-2_7
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