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A public-private partnership was initiated by the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force and reported in 2019.


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 was emphasized.


Specialty organizations were encouraged to work together to develop evidence-based guidelines and a consortium of 14 professional health care societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. Following a live virtual event in February 2021, seven common guiding principles were established for acute perioperative pain management to provide help to clinical practice, as follows:


* 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.


* Clinicians should use a validated pain assessment tool to track responses to postoperative pain treatments and adjust treatment plans accordingly.


* 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.


* 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.


* 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.


* Clinicians should adjust the pain management plan based on adequacy of pain relief and presence of adverse events.


* 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, history of substance use disorder).



The lead author is Edward R. Mariano, MD, MAS, FASA, a professor of anesthesiology and perioperative pain management at Stanford University School of Medicine.


Mariano noted that "the fact that 14 professional health care organizations could agree on these seven principles means that the bar for acute perioperative pain management has been reset. Moreover, the product of this consortium can now form the basis of all future guidelines and influence the products of legislation and regulation that affect pain management for surgical patients. It is a critical first step to widespread quality improvement in perioperative pain management for surgical patients. Despite all the evidence generated across anesthesiology, pain medicine, and surgical specialties supporting the effectiveness of multimodal pain management, there continues to be unwarranted variation in the pain care that actual surgical patients receive."




1. Mariano ER, Dickerson DM, Szokol JW, et al A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anes Pain Med. 2022: 47:2:118-27.


Adapted from an article published online first by Anesthesiology News: Used with permission.