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are seen in patients with underlying psychiatric disorders and chronic functional
abdominal pain syndromes.
the literature regarding operative pain
control in this population is scarce, it is
reasonable to assume that, as in other
subsets of chronic pain patients, postoperative pain control and opioid withdrawal
may be challenging, and adverse effects
can be mitigated through proper assessment and counseling. The surgeon should
be diligent and educate the patient both
preoperatively to discuss realistic expectations of postoperative symptoms, as
well as prior to discharge to discuss the
following: weaning the patient off of opioids; managing opioid use; caring for
unpredictable gastrointestinal function
frequently encountered with IBD; and
how to contact their provider if problems
arise in the outpatient setting. Postoperative opioid use should also be discussed at
follow-up appointments and may involve
a joint approach between the surgeon and
Tools of the trade and
Making patient educational tools and information available in patient waiting rooms
and the office setting can provide an icebreaker to start the conversation about
opioids. It is ideal to include culturally sensitive, inclusive images in these materials, as
well as figures and text that are easy to comprehend. Table 1, page 18, is an example of
a basic chart with commonly used opioids
that physicians can use to develop a pain
management plan with a patient.
Implementation of a system-wide initiative within the U.S. Department of
Veterans Affairs (VA) has been associated
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