The expanding role of chronic pain interventions in multimodal perioperative pain management: a narrative review

ABSTRACT

Surgery is a risk factor for chronic pain and long-term opioid use. As perioperative pain management continues to evolve, treatment modalities traditionally used for chronic pain therapy may provide additional benefit to patients undergoing surgery. Interventions such as radiofrequency ablation, cryoneurolysis, and neuromodulation may potentially be used in conjunction with acute pain procedures such as nerve blocks and multimodal analgesia. Pharmacological agents associated with chronic pain medicine, including gabapentinoids, ketamine, and selective serotonin reuptake inhibitors, may be useful adjuncts in perioperative pain management when indicated. There may also be a role for acupuncture, music therapy, and other integrative medicine therapies. A transitional pain service can help coordinate outpatient care with inpatient perioperative pain management and promote a more personalized and comprehensive approach that can improve postoperative outcomes.

KEYWORDS:

• Chronic pain
• acute pain
• perioperative
• multimodal analgesia
• interventional pain
• transitional pain
• integrative medicine

Declaration of financial/other disclosures

RAG’s university has received research funding and product support for research projects from Epimed International (Farmers Branch, TX, USA), Infutronics (Natick, MA, USA), and SPR Therapeutics (Cleveland, OH, USA). RAG serves on the advisory board for Avanos (Alpharetta, GA, USA). These companies had no input into any aspect of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Veterans Affairs (VA) Palo Alto Health Care System (Palo Alto, CA, USA). The contents do not represent the views of the Department of Veterans Affairs or the United States Government.

Additional information

Funding

No funding was obtained for this article.