Multimodal Analgesia in Spine Surgery: A Commentary

Abstract

Chronic back pain is a multifactorial issue requiring a concerted effort amongst members of the multidisciplinary team throughout a patient’s surgical course to provide the best environment for targeted therapy in order to reduce postoperative morbidity. Implementing a program designed to reduce opioid consumption and provide adequate pain control requires a commitment to a multidimensional approach involving multimodal anesthetic/analgesia (MMA) and functional restoration by all members of the multidisciplinary team. Postoperative pain involves several pathways including nociceptive, neuropathic and inflammatory pain responses. Current literature focuses on the role of neuroplasticity in pain and injury as well as management protocols designed to target several pain pathways. Using a combination of medications administered pre-, peri- and postoperatively provides the basis for multimodal analgesia (MMA) protocols, which have demonstrated more effective pain control than a single standard therapeutic measure. The preferred pain management technique is a controversial topic in orthopedic specialties, including spine surgery. However, based on current literature, a successful minimally invasive spine surgery program involves a multidisciplinary team combining several pain management therapies into multimodal analgesia resulting in the successful control of postsurgical pain