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Review
. 2017 Sep 5:13:1163-1173.
doi: 10.2147/TCRM.S141332. eCollection 2017.

The challenge of perioperative pain management in opioid-tolerant patients

Flaminia Coluzzi  1 , Francesca Bifulco  2 , Arturo Cuomo  2 , Mario Dauri  3 , Claudio Leonardi  4 , Rita Maria Melotti  5 , Silvia Natoli  3 , Patrizia Romualdi  6 , Gennaro Savoia  7 , Antonio Corcione  8
Affiliations
Review

The challenge of perioperative pain management in opioid-tolerant patients

Flaminia Coluzzi et al. Ther Clin Risk Manag. .

Abstract

The increasing number of opioid users among chronic pain patients, and opioid abusers among the general population, makes perioperative pain management challenging for health care professionals. Anesthesiologists, surgeons, and nurses should be familiar with some pharmacological phenomena which are typical of opioid users and abusers, such as tolerance, physical dependence, hyperalgesia, and addiction. Inadequate pain management is very common in these patients, due to common prejudices and fears. The target of preoperative evaluation is to identify comorbidities and risk factors and recognize signs and symptoms of opioid abuse and opioid withdrawal. Clinicians are encouraged to plan perioperative pain medications and to refer these patients to psychiatrists and addiction specialists for their evaluation. The aim of this review was to give practical suggestions for perioperative management of surgical opioid-tolerant patients, together with schemes of opioid conversion for chronic pain patients assuming oral or transdermal opioids, and patients under maintenance programs with methadone, buprenorphine, or naltrexone.

Keywords: abusers; addiction; buprenorphine; methadone; opioids; postoperative pain.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

References

    1. Dowell D, Haegerich TM, Chou R. CDC Guideline for prescribing opioids for chronic pain – United States, 2016. JAMA. 2016;315(15):1624–1645. - PMC - PubMed
    1. Center for Disease Control Prescription Opioid Overdose Data. [Accessed April 2017]. Available from: https://www.cdc.gov/drugoverdose/data/overdose.html.
    1. Allegri M, Fanelli G. Opioids and chronic pain. Data from the “other side of the pond”. Minerva Anestesiol. 2017;83(1):6–8. - PubMed
    1. Maremmani I, Gerra G, Ripamonti IC, et al. The prevention of analgesic opioids abuse: expert opinion. Eur Rev Med Pharmacol Sci. 2015;19(21):4203–4206. - PubMed
    1. Thanki D, Vicente J. PDU (problem drug use) revision summary. European Monitoring Centre for Drugs and Drug Addiction; Feb 20, 2013. [Accessed February 2017]. Available from: www.emcdda.europa.eu/publications.