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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


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.


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

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