Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review

Abstract

Perioperative pain management is a unique challenge in patients undergoing spine surgery due to the increased incidence of both pre-existing chronic pain conditions and chronic postsurgical pain. Peri-operative planning and counseling in spine surgery should involve an interdisciplinary approach that includes consideration of patient-level risk factors, as well as pharmacologic and nonpharmacologic pain management techniques. Consideration of psychological factors and patient focused education as an adjunct to these measures is paramount in developing a personalized perioperative pain management plan. Understanding the currently available body of knowledge surrounding perioperative opioid management, management of opioid use disorder, regional/neuraxial anesthetic techniques, ketamine/lidocaine infusions, non-opioid oral analgesics, and behavioral interventions can be useful in developing a comprehensive, multi-modal treatment plan among patients undergoing spine surgery. Although many of these techniques have proved efficacious in the immediate postoperative period, long-term follow-up is needed to define the impact of such approaches on persistent pain and opioid use. Future techniques involving the use of precision medicine may help identify phenotypic and physiologic characteristics that can identify patients that are most at risk of developing persistent postoperative pain after spine surgery.

A Turkish Study to Identify the Discharge Learning Needs of Spinal Surgery Patients

“…Inadequate pain management may result with various complications, which, in turn, may increase anxiety and influence patient outcomes and satisfaction. 7,9 In our study, there was no statistically significant relationship between learning needs and the VAS scores of the participants. Similarly, Fischbeck et al 7 did not find a significant relationship between pain and learning needs.…”

“…Pain in these patients may be the continuation of preoperative pain or a newly developed one. Inadequate pain management may result with various complications, which, in turn, may increase anxiety and influence patient outcomes and satisfaction 7,9. In our study, there was no statistically significant relationship between learning needs and the VAS scores of the participants.…”

“…Because patients are stressed and anxious before surgery, they may not understand or find it difficult to remember what is taught or hesitate to ask questions because of preoperative anxiety 7,8. Unfulfilled information needs of the patients may further increase anxiety and the severity of postoperative pain or even result with permanent pain 7,9. Because of this reason, standard preoperative patient education is not considered as sufficient 7.…”

In-Fracture Pedicular Screw Placement During Ligamentotaxis Following Traumatic Spine Injuries, a Randomized Clinical Trial on Outcomes

“…However, drug side effects, especially in older adults, can interfere with the optimal benefits of analgesics. 1 21) To date, no study has compared postoperative pain related to different surgical techniques for ligamentotaxis following spinal injury. Our study showed that the postoperative VAS score in the case group was significantly lower than that in the control group ( p =0.004).…”

Team Approach: Use of Opioids in Orthopaedic Practice

“…Orthopaedic surgeons and their teams are responsible for educating patients about the use of opioids and their risks. Indeed, patient education has been associated with a decrease in the use of opioids [55][56][57][58] . In addition, orthopaedic surgeons should discuss in detail the expected outcomes of surgery to establish realistic expectations.…”