Seven Principles to Guide Multimodal Perioperative Pain Management
Multiple studies have shown that multimodal pain plans not only decrease the reliance on opioids but increase patient satisfaction.
Following a 2019 report from the Health and Human Services Pain Management Best Practice Inter-Agency Task Force, a group of 14 professional organizations have released a consensus statement of 7 principles to guide providers and institutions in offering multimodal and individualized pain treatment to patients. These principles should form a basis for improved patient care of a complication that to date has been inadequately addressed.
The 7 principles are as follows:
1. Clinicians should conduct a preoperative evaluation, including assessment of medical and psychological conditions, concomitant medications, history of chronic pain, substance use disorder, and previous postoperative treatment regimens and responses, to guide the perioperative pain management plan.
2. Clinicians should use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.
3. Clinicians should offer multimodal analgesia, or the use of a variety of analgesic medications and techniques combined with nonpharmacologic interventions, for the treatment of postoperative pain in adults.
4. Clinicians should provide patient- and family-centered, individually tailored education to the patient (and/or responsible caregiver), including information on treatment options for managing postoperative pain, and document the plan and goals for postoperative pain management.
5. Clinicians should provide education to all patients (adult) and primary caregivers on the pain treatment plan, including proper storage and disposal of opioids and tapering of analgesics after hospital discharge.
6. Clinicians should adjust the pain management plan based on adequacy of pain relief and presence of adverse events.
7. Clinicians should have access to consultation with a pain specialist for patients who have inadequately controlled postoperative pain or are at high risk for inadequately controlled postoperative pain at their facilities (eg, long-term opioid therapy and history of substance use disorder).
Subsequent statements have addressed other issues such as those that pertain to the continuation of buprenorphine perioperatively for patients with opioid use disorder.
The authors note that application of these principles should be a critical first step to widespread quality improvement in perioperative pain management for surgical patients. Despite the evidence generated across many specialties, there continues to be wide variation in pain care afforded postsurgical patients, the authors concluded. (See Mariano ER, Dickerson DM, Szoko JW. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med. 2022;47(2):118-127. doi:10.1136/rapm-2021-103083.)