Why anesthesiologists need to care about the way chronic pain is managed

Abstract

Anesthesiologists are now frequently considered specialists in perioperative medicine. This view reflects changes in practice that have evolved over the last 20 years and are currently exemplified in many departments, including those specializing in pain medicine, pain management, and perioperative medicine. Postoperatively, many patients continue to receive inadequate analgesia, and poor pain control is the leading cause of post-discharge visits to the emergency room and early re-admission to hospital after surgery. Patients with preoperative chronic pain, especially those receiving opioids, have a high rate of unsatisfactory perioperative pain control. Chronic pain in Canada affects more than one in five Canadians. Consequently, many patients who come under our care suffer from chronic pain. These patients are more likely to be opioid-dependent and receiving one or more medications that act on the central nervous system. Patients’ complex medication profiles and their concurrent anxiety and mood disruption can have a substantial impact on the perioperative care that the anesthesiologist provides. Herein, we consider some of the special issues that anesthesiologists should understand concerning the management of patients with chronic pain in the perioperative setting. Preoperative pain, anxiety, and catastrophizing