Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder

David M Dickerson; Edward R Mariano; Joseph W Szokol; Michael Harned; Randall M Clark; Jeffrey T Mueller; Ashley M Shilling; Mercy A Udoji; S Bobby Mukkamala; Lisa Doan; Karla E K Wyatt; Jason M Schwalb; Nabil M Elkassabany; Jean D Eloy; Stacy L Beck; Lisa Wiechmann; Franklin Chiao; Steven G Halle; Deepak G Krishnan; John D Cramer; Wael Ali Sakr Esa; Iyabo O Muse; Jaime Baratta; Richard Rosenquist; Padma Gulur; Shalini Shah; Lynn Kohan; Jennifer Robles; Eric S Schwenk; Brian F S Allen; Stephen Yang; Josef G Hadeed; Gary Schwartz; Michael J Englesbe; Michael Sprintz; Kenneth L Urish; Ashley Walton; Lauren Keith; Asokumar Buvanendran

doi:10.1136/rapm-2023-104435

Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder

Reg Anesth Pain Med. 2024 Oct 8;49(10):716-724. doi: 10.1136/rapm-2023-104435.

Authors

David M Dickerson^{1

2}, Edward R Mariano^{3

4}, Joseph W Szokol⁵, Michael Harned⁶, Randall M Clark⁷, Jeffrey T Mueller⁸, Ashley M Shilling⁹, Mercy A Udoji^{10

11}, S Bobby Mukkamala¹², Lisa Doan¹³, Karla E K Wyatt¹⁴, Jason M Schwalb¹⁵, Nabil M Elkassabany⁹, Jean D Eloy¹⁶, Stacy L Beck¹⁷, Lisa Wiechmann¹⁸, Franklin Chiao¹⁹, Steven G Halle²⁰, Deepak G Krishnan^{21

22}, John D Cramer²³, Wael Ali Sakr Esa²⁴, Iyabo O Muse^{25

26}, Jaime Baratta²⁷, Richard Rosenquist²⁴, Padma Gulur²⁸, Shalini Shah²⁹, Lynn Kohan³⁰, Jennifer Robles^{31

32}, Eric S Schwenk³³, Brian F S Allen³⁴, Stephen Yang³⁵, Josef G Hadeed³⁶, Gary Schwartz^{37

38}, Michael J Englesbe³⁹, Michael Sprintz⁴⁰, Kenneth L Urish⁴¹, Ashley Walton⁴², Lauren Keith⁷, Asokumar Buvanendran⁴³

Affiliations

¹ Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA [email protected].
² Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
³ Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA.
⁴ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
⁵ Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.
⁶ Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA.
⁷ American Society of Anesthesiologists, Park Ridge, Illinois, USA.
⁸ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
⁹ Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA.
¹⁰ Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
¹¹ Atlanta VA Health Care System, Decatur, Georgia, USA.
¹² American Medical Association, Chicago, Illinois, USA.
¹³ Department of Anesthesiology, PerioperativeCare and Pain Medicine, New York University School of Medicine, New York, New York, USA.
¹⁴ Department of Anesthesiology, Perioperativeand Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
¹⁵ Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan, USA.
¹⁶ Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
¹⁷ Department of Obstetrics, Gynecology, and Reproductive Sciences, Maternal Fetal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
¹⁸ Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA.
¹⁹ Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.
²⁰ Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
²¹ Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
²² Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²³ Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA.
²⁴ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA.
²⁵ Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
²⁶ Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, New York, USA.
²⁷ Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
²⁸ Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.
²⁹ Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California, USA.
³⁰ Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA.
³¹ Department of Urology Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³² Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
³³ Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
³⁴ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁵ Department of Surgery, Division of Thoracic Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA.
³⁶ Hadeed Plastic Surgery, Beverly Hills, California, USA.
³⁷ AABP Integrative Pain Care, Melville, New York, USA.
³⁸ Maimonides Medical Center, Brooklyn, New York, USA.
³⁹ Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
⁴⁰ Sprintz Center for Pain and Recovery, Shenandoah, Texas, USA.
⁴¹ Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
⁴² American Society of Anesthesiologists, Washington, District of Columbia, USA.
⁴³ Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA.

PMID: 37185214
DOI: 10.1136/rapm-2023-104435

Abstract

Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.

Keywords: acute pain; analgesics, opioid; chronic pain; opioid-related disorders; pain management.

MeSH terms

Analgesics, Opioid* / pharmacology
Analgesics, Opioid* / therapeutic use
Chronic Pain* / therapy
Consensus
Delphi Technique
Drug Tolerance
Humans
Opioid-Related Disorders* / prevention & control
Pain Management* / methods
Pain Management* / standards
Pain, Postoperative* / diagnosis
Pain, Postoperative* / prevention & control
Pain, Postoperative* / therapy
Perioperative Care* / methods
Perioperative Care* / standards
Practice Guidelines as Topic

Substances

Analgesics, Opioid