Open Access Open Access  Restricted Access Subscription or Fee Access

Review of perioperative pain management of opioid-dependent patients

Nalini Vadivelu, MD, Sukanya Mitra, MD, MAMS, Alice M. Kai, BA, Gopal Kodumudi, MS, Karina Gritsenko, MD

Abstract


Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudo-addiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process. Multimodal options include pharmacological and nonpharmacological approaches, psychological support, and interventional pain procedures, all focused toward providing optimal pain control while preventing undertreatment, withdrawal symptoms, and other complications.


Keywords


chronic pain, opioid dependence, prescription opioids, multimodal analgesia, opioid abuse

Full Text:

PDF

References


Von Korff M, Kolodny A, Deyo RA, et al.: Long-term opioid therapy reconsidered. Ann Internal Med. 2011; 155(5): 325-328.

Passik SD: Issues in long-term opioid therapy: Unmet needs, risks, and solutions. Mayo Clin Proc. 2009; 84(7): 593-601.

Juurlink DN, Dhalla IA: Dependence and addiction during chronic opioid therapy. J Med Toxicol. 2012; 8(4): 393-399.

Ballantyne JC: Opioid analgesia: Perspectives on right use and utility. Pain Phys. 2007; 10(3): 479-491.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15): 1624-1645.

Dahl JB, Nielsen RV, Wetterslev J, et al.: Post-operative analgesic effects of paracetamol, NSAIDs, glucocorticoids, gabapentinoids and their combinations: A topical review. Acta Anaesthesiol Scan. 2014;58(10):1165-1181.

McDaid C, Maund E, Rice S, et al.: Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: A systematic review. Health Technol Assess. 2010; 14(17): 1-153, iii-iv.

Elia N, Lysakowski C, Tramer MR: Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005; 103(6): 1296-1304.

Zhang J, Ho KY , Wang Y : Efficacy of pregabalin in acute postoperative pain: A meta-analysis . Br J Anaesth. 2011; 106 (4): 454-462 .

Hadi I, Morley-Forster PK, Dain S, et al.: Brief review: Perioperative management of the patient with chronic non-cancer pain. Can J Anaesth. 2006; 53(12): 1190-1199.

Mehta V, Langford RM: Acute pain management for opioid dependent patients. Anaesthesia. 2006; 61(3): 269-276.

Booth M: Opium—A History. London, UK: Simon & Schuster,1996.

Towns CB, Lambert A: Habits that Handicap: The Menace of Opium, Alcohol, and Tobacco, and the Remedy. New York, NY: Century, 1915.

AAPM Council on Ethics: Ethics charter from American Academy of Pain Medicine. Pain Med. 2005; 6(3): 203-212.

Brennan TJ, Kehlet H: Preventive analgesia to reduce wound hyperalgesia and persistent postsurgical pain: Not an easy path. Anesthesiology. 2005; 103(4): 681-683.

Carr DB, Goudas LC: Acute pain. Lancet. 1999; 353(9169): 2051-2058.

Kehlet H, Dahl JB: Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003; 362(9399): 1921-1928.

Dubois MY: The birth of an ethics charter for pain medicine. Pain Med. 2005; 6(3): 201-202.

Joranson DE, Gilson AM, Dahl JL, et al.: Pain management, controlled substances, and state medical board policy: A decade of change. J Pain Symptom Manage. 2002; 23(2): 138-147.

American Pain Society Quality of Care Committee: Quality improvement guidelines for the treatment of acute pain and cancer pain American Pain Society Quality of Care Committee. JAMA. 1995; 274(23): 1874-1880.

Kuehn BM: Opioid prescriptions soar: Increase in legitimate use as well as abuse. JAMA. 2007; 297(3): 249-251.

The Lancet: US drug overdose deaths: A global challenge. Lancet. 387(10017): 404.

Volkow ND, McLellan TA, Cotto JH, et al.: Characteristics of opioid prescriptions in 2009. JAMA. 2011; 305(13): 1299-1301.

Rozen D, Grass GW: Perioperative and intraoperative pain and anesthetic care of the chronic pain and cancer pain patient receiving chronic opioid therapy. Pain Pract. 2005; 5(1): 18-32.

Kahan M, Srivastava A, Wilson L, et al.: Misuse of and dependence on opioids: Study of chronic pain patients. Can Family Phys Medecin Famille Can. 2006; 52(9): 1081-1087.

Weaver M, Schnoll S: Abuse liability in opioid therapy for pain treatment in patients with an addiction history. Clin J Pain. 2002; 18(4)(suppl): S61-S69.

Passik SD, Kirsh KL, McDonald MV, et al.: A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients. J Pain Symptom Manage. 2000; 19(4): 274-286.

Angst MS, Clark JD: Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology. 2006; 104(3): 570-587.

Carroll IR, Angst MS, Clark JD: Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004; 29(6): 576-591.

Comelon M, Raeder J, Stubhaug A, et al.: Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia. Br J Anaesth. 2016; 116(4): 524-530.

Gordon D, Inturrisi CE, Greensmith JE, et al.: Perioperative pain management in the opioid-tolerant individual. J Pain. 2008; 9(5): 383-387.

Inturrisi CE: Clinical pharmacology of opioids for pain. Clin J Pain. 2002; 18(4)(suppl): S3-S13.

Janke EA, Collins A, Kozak AT: Overview of the relationship between pain and obesity: What do we know?. Where do we go next? J Rehabil Res Dev. 2007; 44(2): 245-262.

Olorunto WA, Galandiuk S: Managing the spectrum of surgical pain: Acute management of the chronic pain patient. J Am Coll Surg. 2006; 202(1): 169-175.

Rapp SE, Ready LB, Nessly ML: Acute pain management in patients with prior opioid consumption: A case-controlled retrospective review. Pain. 1995; 61(2): 195-201.

Vickers A, Bali S, Baxter A, et al.: Consensus statement on the anticipation and prevention of acute postoperative pain: Multidisciplinary RADAR approach. Curr Med Res Opin. 2009; 25(10): 2557-2569.

Vlaeyen JW, Linton SJ: Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain. 2012; 153(6): 1144-1147.

Riddle DL, Wade JB, Jiranek WA, et al.: Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res. 2010; 468(3): 798-806.

Arnold RM, Han PK, Seltzer D: Opioid contracts in chronic nonmalignant pain management: Objectives and uncertainties. Am J Med. 2006; 119(4): 292-296.

Fishbain DA: Polypharmacy treatment approaches to the psychiatric and somatic comorbidities found in patients with chronic pain. Am J Phys Med Rehabil. 2005; 84(3)(suppl): S56-S63.

LeBlanc DM, McGinn MA, Itoga CA, et al.: The affective dimension of pain as a risk factor for drug and alcohol addiction. Alcohol. 2015; 49(8): 803-809.

Martin P, Weinberg BA, Bealer BK: Healing Addiction: An Integrated Pharmacopsychosocial Approach to Treatment. Hoboken, NJ: John Wiley & Sons, 2007.

Edwards RR, Dolman AJ, Michna E, et al.: Changes in pain sensitivity and pain modulation during oral opioid treatment: The impact of negative affect. Pain Med. 2016 (in press).

Furlan AD, Reardon R, Salach L: The opioid manager: A point-of-care tool to facilitate the use of the Canadian Opioid Guideline. J Opioid Manag. 2012; 8(1): 57-61.

Richebe P, Beaulieu P: Perioperative pain management in the patient treated with opioids: Continuing professional development. Can J Anaesth. 2009; 56(12): 969-981.

Peng PW, Tumber PS, Gourlay D: Review article: Perioperative pain management of patients on methadone therapy. Can J Anaesth. 2005; 52(5): 513-523.

Chapman CR, Davis J, Donaldson GW, et al.: Postoperative pain trajectories in chronic pain patients undergoing surgery: The effects of chronic opioid pharmacotherapy on acute pain. J Pain. 2011; 12(12): 1240-1246.

Zywiel MG, Stroh DA, Lee SY, et al.: Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am. 2011; 93(21): 1988-1993.

Lawrence JTR, London N, Bohlman HH, et al.: Preoperative narcotic use as a predictor of clinical outcome: Results following anterior cervical arthrodesis. Spine. 2008; 33(19): 2074-2078.

Devin CJ, Lee DS, Armaghani SJ, et al.: Approach to pain management in chronic opioid users undergoing orthopaedic surgery. J Am Acad Orthop Surg. 2014; 22(10): 614-622.

Kelly DJ, Ahmad M, Brull SJ: Preemptive analgesia II: Recent advances and current trends. Can J Anaesth. 2001; 48(11): 1091-1101.

Kashefi P, Honarmand A, Safavi M: Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res. 2012; 1: 66.

Seib RK, Paul JE: Preoperative gabapentin for postoperative analgesia: A meta-analysis. Can J Anaesth. 2006; 53(5): 461-469.

Peng PW, Wijeysundera DN, Li CC: Use of gabapentin for perioperative pain control—A meta-analysis. Pain Res Manage. 2007; 12(2): 85-92.

Tumber PS: Optimizing perioperative analgesia for the complex pain patient: Medical and interventional strategies. Can J Anaesth. 2014; 61(2): 131-140.

Blaudszun G, Lysakowski C, Elia N, et al.: Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: Systematic review and meta-analysis of randomized controlled trials. Anesthesiology. 2012; 116(6): 1312-1322.

Chan AK, Cheung CW, Chong YK: Alpha-2 agonists in acute pain management. Expert Opin Pharmacother. 2010; 11(17): 2849-2868.

Barreveld A, Witte J, Chahal H, et al.: Preventive analgesia by local anesthetics: The reduction of postoperative pain by peripheral nerve blocks and intravenous drugs. Anesth Analg. 2013; 116(5): 1141-1161.

Pyati S, Gan TJ: Perioperative pain management. CNS Drugs. 2007; 21(3): 185-211.

Souzdalnitski D, Halaszynski TM, Faclier G: Regional anesthesia and co-existing chronic pain. Curr Opin Anaesthesiol. 2010; 23(5): 662-670.

Oppenheimer AJ, Fiala TG, Oppenheimer DC: Direct transversus abdominis plane blocks with exparel during abdominoplasty. Ann Plast Surg. 2016 (in press).

Dahl JB, Mathiesen O, Kehlet H: An expert opinion on postoperative pain management, with special reference to new developments. Expert Opin Pharmacother. 2010; 11(15): 2459-2470.

Pogatzki-Zahn EM, Englbrecht JS, Schug SA: Acute pain management in patients with fibromyalgia and other diffuse chronic pain syndromes. Curr Opin Anaesthesiol. 2009; 22(5): 627-633.

Bell RF, Dahl JB, Moore RA, et al.: Peri-operative ketamine for acute post-operative pain: A quantitative and qualitative systematic review (Cochrane review). Acta Anaesthesiol Scand. 2005; 49(10): 1405-1428.

Loftus RW, Yeager MP, Clark JA, et al.: Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010; 113(3): 639-646.

Albrecht E, Kirkham KR, Liu SS, et al.: Peri-operative intravenous administration of magnesium sulphate and postoperative pain: A meta-analysis. Anaesthesia. 2013; 68(1): 79-90.

Lui F, Ng KF: Adjuvant analgesics in acute pain. Expert Opin Pharmacother. 2011; 12(3): 363-385.

Waldron NH, Jones CA, Gan TJ, et al.: Impact of perioperative dexamethasone on postoperative analgesia and side-effects: Systematic review and meta-analysis. Br J Anaesth. 2013; 110(2): 191-200.

Karanicolas PJ, Smith SE, Kanbur B, et al.: The impact of prophylactic dexamethasone on nausea and vomiting after laparoscopic cholecystectomy: A systematic review and meta-analysis. Ann Surg. 2008; 248(5): 751-762.

Salerno A, Hermann R: Efficacy and safety of steroid use for postoperative pain relief. Update and review of the medical literature. J Bone Joint Surg Am. 2006; 88(6): 1361-1372.

Turan A, Sessler DI: Steroids to ameliorate postoperative pain. Anesthesiology. 2011; 115(3): 457-459.

Bigat Z, Boztug N, Hadimioglu N, et al.: Does dexamethasone improve the quality of intravenous regional anesthesia and analgesia?. A randomized, controlled clinical study. Anesth Analg. 2006; 102(2): 605-609.

Gritsenko K, Khelemsky Y, Kaye AD, et al.: Multimodal therapy in perioperative analgesia. Best Pract Res Clin Anaesthesiol. 2014; 28(1): 59-79.

White PF, Raeder J, Kehlet H: Ketorolac: Its role as part of a multimodal analgesic regimen. Anesth Analg. 2012; 114(2): 250-254.

Mitra S, Sinatra RS: Perioperative management of acute pain in the opioid-dependent patient. Anesthesiology. 2004; 101(1): 212-227.

Apfelbaum JL, Chen C, Mehta SS, et al.: Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97(2): 534-540.

Hasenbring M, Hallner D, Klasen B: Psychological mechanisms in the transition from acute to chronic pain: Over- or underrated? Schmerz. 2001; 15(6): 442-447.

Katz J, Jackson M, Kavanagh BP, et al.: Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996; 12(1): 50-55.

Kehlet H, Wilmore DW: Multimodal strategies to improve surgical outcome. Am J Surg. 2002; 183(6): 630-641.

Clarke H, Bonin RP, Orser BA, et al.: The prevention of chronic postsurgical pain using gabapentin and pregabalin: A combined systematic review and meta-analysis. Anesth Analg. 2012; 115(2): 428-442.

White PF: Multimodal pain management—The future is now! Curr Opin Investig Drugs. 2007; 8(7): 517-518.

Marret E, Rolin M, Beaussier M, et al.: Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008; 95(11): 1331-1338.

McCarthy GC, Megalla SA, Habib AS: Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: A systematic review of randomized controlled trials. Drugs. 2010; 70(9): 1149-1163.

Vandermeulen E: Systemic analgesia and co-analgesia. Acta Anaesthesiol Belgica. 2006; 57(2): 113-120.

Raffa RB, Pergolizzi JV Jr: Opioid-induced hyperalgesia: Is it clinically relevant for the treatment of pain patients? Pain Manage Nurs. 2013; 14(3): e67-83.

McDowall RH: Anesthesia considerations for pediatric cancer. Semin Surg Oncol. 1993; 9(6): 478-488.

Karl HW, Rosenberger JL, Larach MG, et al.: Transmucosal administration of midazolam for premedication of pediatric patients. Comparison of the nasal and sublingual routes. Anesthesiology. 1993; 78(5): 885-891.

Herd D, Salehi B: Palatability of two forms of paracetamol (acetaminophen) suspension: A randomised trial. Paediatr Perinat Drug Ther. 2006; 7(4): 189-193.

Merry AF, Anderson BJ: Medication errors—New approaches to prevention. Paediatr Anaesth. 2011; 21(7): 743-753.

Zernikow B, Schiessl C, Wamsler C, et al.: Long-term pediatric opioid based pain control. Case reports. Schmerz. 2005; 19(5): 418-425.

Wokovich AM, Prodduturi S, Doub WH, et al.: Transdermal drug delivery system (TDDS) adhesion as a critical safety, efficacy and quality attribute. Eur J Pharmaceut Biopharmaceut. 2006; 64(1): 1-8.

American Academy of Pediatrics, Committee on Drugs: Alternative routes of drug administration—Advantages and disadvantages (subject review). 1997; 100(1): 143-152.

Geary T, Negus A, Anderson BJ, et al.: Perioperative management of the child on long-term opioids. Paediatr Anaesth. 2012; 22(3): 189-202.

Hutchinson TA, Flegel KM, Kramer MS, et al.: Frequency, severity and risk factors for adverse drug reactions in adult out-patients: A prospective study. J Chronic Dis. 1986; 39(7): 533-542.




DOI: https://doi.org/10.5055/jom.2016.0344

Refbacks

  • There are currently no refbacks.