Uncontrolled postoperative pain may result in significant clinical, psychological, and socioeconomic consequences. Not only does inadequate pain management following surgery result in increased morbidity and mortality but it also may delay recovery, result in unanticipated readmissions, decrease patient satisfaction, and lead to chronic persistent postsurgical pain. Pain is multifactorial in nature, and understanding both the complexity of pain and its side effects is imperative to achieving a successful surgical outcome. In this section, we review the consequences of pain as they pertain to plastic surgery with a focus on the impact of pain on the surgical stress response and risk of wound infections and the effect of improved pain control on flap surgery. Uncontrolled acute postoperative pain may lead to chronic persistent postsurgical pain, which has a high incidence in patients undergoing breast cancer surgery. To achieve optimal postoperative analgesia, one must recognize the barriers to effective pain management, including both physician/nursing-related barriers and patient-related barriers, as well as the increasingly common appearance of opioid-tolerant patients.

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.

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