Article Commentary: Defining New Directions for More Effective Management of Surgical Pain in the United States: Highlights of the Inaugural Surgical Pain Congress™

Abstract

Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes. To comprehensively address this need, the multidisciplinary Surgical Pain Congress™ has been established. The inaugural meeting of this Congress (March 8 to 10, 2013, Celebration, Florida) evaluated the current surgical pain management paradigm and identified key components of best practices.

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“…For example, patients with serious traumatic injuries who do not receive prompt opioid analgesia appear to be at greater risk of developing post‐traumatic stress disorder than patients who do receive opioid analgesia . Inadequate peri‐operative pain control has been associated with complications such as myocardial infarction, deep vein thrombosis, pneumonia, pulmonary embolism, anxiety and depression . Failure to diagnose and treat depression, post‐traumatic stress disorder and other common psychological sequelae of trauma experiences often results in chronic social dysfunction .…”

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“…Despite greater understanding of the physiology of postsurgical pain and the development of new analgesic modalities and perioperative techniques in recent decades, postsurgical pain continues to be undermanaged 1‐5 . Poorly controlled postsurgical pain affects patient comfort and leads to complications during the immediate postsurgical period 3,4,6,7 .…”

“…Despite greater understanding of the physiology of postsurgical pain and the development of new analgesic modalities and perioperative techniques in recent decades, postsurgical pain continues to be undermanaged 1‐5 . Poorly controlled postsurgical pain affects patient comfort and leads to complications during the immediate postsurgical period 3,4,6,7 . In some cases, severe pain after surgery can lead to chronic postsurgical pain that may not develop until several months after surgery, and can impose additional burdens on the individual and society 3,4,7,8 …”

“…Poorly controlled postsurgical pain affects patient comfort and leads to complications during the immediate postsurgical period 3,4,6,7 . In some cases, severe pain after surgery can lead to chronic postsurgical pain that may not develop until several months after surgery, and can impose additional burdens on the individual and society 3,4,7,8 …”

“…Clinicians are advised to use multimodal analgesia whenever possible, around the clock, in the perioperative setting 6,9 . Multiple physiologic pathways contribute to acute postsurgical pain; thus, optimal pain control involves a balanced approach, using multiple therapies that disrupt different aspects of pain and inflammatory pathways 4,5,7,9‐12 . In contrast to unimodal analgesia, multimodal analgesia combines two or more pharmacologic agents or techniques with different mechanisms of action working synergistically to reduce postsurgical pain 4‐7,13,14 .…”