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A multisociety organizational consensus process to define guiding principles for acute perioperative pain management
  1. Edward R Mariano1,2,
  2. David M Dickerson3,4,
  3. Joseph W Szokol5,
  4. Michael Harned6,
  5. Jeffrey T Mueller7,
  6. Beverly K Philip8,9,
  7. Jaime L Baratta10,
  8. Padma Gulur11,
  9. Jennifer Robles12,13,
  10. Kristopher M Schroeder14,
  11. Karla E K Wyatt15,16,
  12. Jason M Schwalb17,
  13. Eric S Schwenk10,
  14. Richa Wardhan18,
  15. Todd S Kim19,
  16. Kent K Higdon20,
  17. Deepak G Krishnan21,22,
  18. Ashley M Shilling23,
  19. Gary Schwartz24,25,
  20. Lisa Wiechmann26,
  21. Lisa V Doan27,
  22. Nabil M Elkassabany28,
  23. Stephen C Yang29,
  24. Iyabo O Muse30,
  25. Jean D Eloy31,
  26. Vikas Mehta32,
  27. Shalini Shah33,
  28. Rebecca L Johnson34,
  29. Michael J Englesbe35,
  30. Amanda Kallen36,
  31. S Bobby Mukkamala37,
  32. Ashley Walton38 and
  33. Asokumar Buvanendran39
  1. 1Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  2. 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  3. 3Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
  4. 4Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
  5. 5Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
  6. 6Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
  7. 7Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
  8. 8American Society of Anesthesiologists, Schaumburg, Illinois, USA
  9. 9Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  10. 10Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  11. 11Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
  12. 12Department of Urology, Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  13. 13Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  14. 14Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
  15. 15Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA
  16. 16Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA
  17. 17Department of Neurological Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
  18. 18Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  19. 19Department of Orthopedic Surgery, Palo Alto Medical Foundation, Burlingame, California, USA
  20. 20Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  21. 21Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
  22. 22Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  23. 23Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
  24. 24AABP Integrative Pain Care, Brooklyn, New York, USA
  25. 25Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
  26. 26Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
  27. 27Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, New York, USA
  28. 28Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
  29. 29Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  30. 30Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
  31. 31Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  32. 32Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
  33. 33Department of Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Orange, California, USA
  34. 34Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  35. 35Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  36. 36Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
  37. 37American Medical Association, Chicago, Illinois, USA
  38. 38American Society of Anesthesiologists, Washington, District of Columbia, USA
  39. 39Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Edward R Mariano, Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA; emariano{at}


The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public–private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report’s recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.

  • analgesics
  • opioid
  • pain
  • postoperative
  • pain management
  • acute pain

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Twitter @EMARIANOMD, @KristopherSchr6, @ESchwenkMD, @roxysingward, @garyschwartzmd, @ShaliniShahMD, @rljohnsonmd

  • Contributors ERM, DMD, JWS, JTM, MH, AW, and AB planned the project and Pain Summit, solicited volunteer participants, designed the survey instruments, contributed to data collection and interpretation, writing and revising of the manuscript, and final approval of the submitted manuscript. JTM, BKP, JB, PG, JR, KMS, KW, JMS, ESS, RW, TSK, KKKH, DGK, AMS, GS, LW, LD, NE, SY, IOM, JDE, VM, SS, RLJ, MJE, AK, and SBM contributed to data interpretation, Pain Summit participation, writing and revising of the manuscript, and final approval of the submitted manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Logistical support was provided by the American Society of Anesthesiologists.

  • Competing interests JMS declares salary support from Blue Cross Blue Shield of Michigan; research funding from Neuros Medical (Willoughby, OH, USA), Setpoint Medical (Valencia, CA, USA), and Medtronic (Dublin, Ireland; legal consulting for Yates, McLamb and Weyher, LLP (Raleigh, NC, USA). KKKH is a consultant for True Digital Surgery (Goleta, CA, USA). GS is an advisory board member for Dorsal Health (New York, NY, USA) and consultant for Pacira Biosciences (Parsippany-Troy Hills, NJ, USA). SS is a consultant for Masimo (Irvine, CA, USA), Allergan (Dublin, Ireland), and SPR Therapeutics (Cleveland, OH, USA). These companies had absolutely no input into any aspect of the project design, Pain Summit, or manuscript preparation. None of the other authors has any financial interests to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.