management of these conditions. These studies and others like
them provide promising information, but strategies for effective
opioid management training require further study.
A general approach to improved
treatment of surgical pain
Surgeons striving to improve patients’ postoperative pain while
minimizing opioid use should consider the following strategies:
•Preoperative discussion regarding the expected postoperative
pain and treatment
•Preoperative review of the risks of opioid therapy
•Early referral to a pain management specialist for patients
with prolonged or atypical pain, and preoperative collaboration
with a pain management specialist for patients who are already
receiving chronic opioid therapy
•Use of opioid-sparing regimens in the perioperative period (for
example, ERAS protocol via ISCR collaboration)
•Review of the expected postoperative pain course at the postop-
erative visit with an emphasis on the appropriate time at which
the patient should no longer be requiring opioids
Pain is a necessary but undesirable consequence of surgery.
Consequently, surgeons are responsible for understanding
effective treatment of acute pain as well as the care of surgical
patients with an acute exacerbation of chronic pain. Internal
implicit biases about level and degree of postoperative pain from
both surgeons and patients must be reconciled. The presence of
chronic opioid use must be accounted for when tailoring postop-
erative analgesia, with an emphasis on early collaboration with
pain management specialists. We must use our best judgment
to provide appropriate therapy and should implement strate-
gies such as ERAS protocols to reduce prescribing of narcotic
medications. Expansion and standardization of resident educa-
tion may aid in a physician-led attempt to address the growing
opioid epidemic in the U.S. ♦
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