Should “Pain Clearance” Be Routine for Elective Surgery?

Abstract

For elective surgery, preoperative planning for patients with comorbidities tends to address risk stratification, cardiac clearance, and anticoagulation. This commentary suggests that chronic opioid use should be normalized as a comorbidity requiring "pain clearance" prior to elective surgery. Doing so would likely enhance team communication, optimize patient care, decrease stigma, and facilitate care transitioning and long-term planning. Case A 58-year-old construction worker has long-standing pain and arthritis from a complex ankle fracture sustained in his twenties. His pain has been made tolerable by twice-daily oral opioids, which his primary care physician has been prescribing him for the past 10 years. There have never been concerns about his substance use practices or diversion. This patient also takes warfarin anticoagulation daily for atrial fibrillation. His orthopedic surgeon suggests he undergo ankle fusion surgery to improve his function and help remediate pain.