You are here

  • Home
  • Online First
  • Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder

Article Text

Article menu

other Versions

Download PDFPDF
Special article
Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder
  1. David M Dickerson1,2,
  2. Edward R Mariano3,4,
  3. Joseph W Szokol5,
  4. Michael Harned6,
  5. Randall M Clark7,
  6. Jeffrey T Mueller8,
  7. Ashley M Shilling9,
  8. Mercy A Udoji10,11,
  9. S Bobby Mukkamala12,
  10. Lisa Doan13,
  11. Karla E K Wyatt14,
  12. Jason M Schwalb15,
  13. Nabil M Elkassabany9,
  14. Jean D Eloy16,
  15. Stacy L Beck17,
  16. Lisa Wiechmann18,
  17. Franklin Chiao19,
  18. Steven G Halle20,
  19. Deepak G Krishnan21,22,
  20. John D Cramer23,
  21. Wael Ali Sakr Esa24,
  22. Iyabo O Muse25,26,
  23. Jaime Baratta27,
  24. Richard Rosenquist24,
  25. Padma Gulur28,
  26. Shalini Shah29,
  27. Lynn Kohan30,
  28. Jennifer Robles31,32,
  29. Eric S Schwenk33,
  30. Brian F S Allen34,
  31. Stephen Yang35,
  32. Josef G Hadeed36,
  33. Gary Schwartz37,38,
  34. Michael J Englesbe39,
  35. Michael Sprintz40,
  36. Kenneth L Urish41,
  37. Ashley Walton42,
  38. Lauren Keith7 and
  39. Asokumar Buvanendran43
  1. 1Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
  2. 2Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
  3. 3Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
  4. 4Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, 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. 7American Society of Anesthesiologists, Park Ridge, Illinois, USA
  8. 8Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
  9. 9Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
  10. 10Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
  11. 11Atlanta VA Health Care System, Decatur, Georgia, USA
  12. 12American Medical Association, Chicago, Illinois, USA
  13. 13Department of Anesthesiology, PerioperativeCare and Pain Medicine, New York University School of Medicine, New York, New York, USA
  14. 14Department of Anesthesiology, Perioperativeand Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
  15. 15Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan, USA
  16. 16Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
  17. 17Department of Obstetrics, Gynecology, and Reproductive Sciences, Maternal Fetal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
  18. 18Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
  19. 19Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
  20. 20Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, 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 Otolaryngology – Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
  24. 24Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
  25. 25Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA
  26. 26Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, New York, USA
  27. 27Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
  28. 28Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
  29. 29Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California, USA
  30. 30Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
  31. 31Department of Urology Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  32. 32Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
  33. 33Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  34. 34Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  35. 35Department of Surgery, Division of Thoracic Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
  36. 36Hadeed Plastic Surgery, Beverly Hills, California, USA
  37. 37AABP Integrative Pain Care, Melville, New York, USA
  38. 38Maimonides Medical Center, Brooklyn, New York, USA
  39. 39Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  40. 40Sprintz Center for Pain and Recovery, Shenandoah, Texas, USA
  41. 41Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  42. 42American Society of Anesthesiologists, Washington, District of Columbia, USA
  43. 43Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr David M Dickerson, Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, IL 60201, USA; ddickerson{at}northshore.org

Abstract

Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of ‘complex’ patients as they undergo surgical procedures.

  • acute pain
  • analgesics, opioid
  • pain management
  • opioid-related disorders
  • chronic pain

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All data from the principle development process is available on request. The data have been shared in the text and supporting materials in its entirety.

https://doi.org/10.1136/rapm-2023-104435

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All data from the principle development process is available on request. The data have been shared in the text and supporting materials in its entirety.

    View Full Text

    Footnotes

    • Twitter @DMdickersonMD, @EMARIANOMD, @ShaliniShahMD, @ESchwenkMD, @garyschwartzmd

    • Correction notice This article has been corrected since it published Online First and in print. A typographical error in figure 1 has been amended in the online version only.

    • Contributors DMD, ERM, JWS, MH, JTM, 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. All other authors contributed to data interpretation, Pain Summit participation, writing and revising of the manuscript, and final approval of the submitted manuscript. As guarantor, DMD accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding Logistical support was provided by the American Society of Anesthesiologists.

    • Competing interests DMD receives research support from Abbott and SPR therapeutics; speaker and/or consulting fees from Abbott, SPR Therapeutics, Vertos, Pfizer, Myovant, Nalu, and Biotronik; NME receives consulting fees for legal case review and from Pacira; SS receives consulting fees from SPR Therapeutics, Masimo Corp, and Allergan. GS receives consulting fees from Pacira and holds minor stake equity (stock options) in Dorsal Health; MS receives consulting fees and research support from Saluda Medical, consulting fees from Patch technologies, Witness, etc and iVitalie, and holds stock and/or receives consulting fees from Cellarian, Spark Biomedical, Nanomedical Systems, Full Spectrum Healthcare Management, MedAnswers, Reveliance solutions, and Assurance Med Management

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Linked Articles