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^{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 ddickerson@northshore.org.
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

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 et al. Reg Anesth Pain Med. 2024.

. 2024 Oct 8;49(10):716-724.

doi: 10.1136/rapm-2023-104435.

Authors

Affiliations

¹ Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA ddickerson@northshore.org.
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.

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Conflict of interest statement

Competing interests: DMD receives research support from Abbott and SPR therapeutics; speaker and/or consulting fees from Abbott, SPR Therapeutics, Vertos, Pfizer, Myovant, Nalu, and Biotronik; NME receives consulting fees for legal case review and from Pacira; SS receives consulting fees from SPR Therapeutics, Masimo Corp, and Allergan. GS receives consulting fees from Pacira and holds minor stake equity (stock options) in Dorsal Health; MS receives consulting fees and research support from Saluda Medical, consulting fees from Patch technologies, Witness, etc and iVitalie, and holds stock and/or receives consulting fees from Cellarian, Spark Biomedical, Nanomedical Systems, Full Spectrum Healthcare Management, MedAnswers, Reveliance solutions, and Assurance Med Management

Comment in

Multiorganizational consensus on principles for perioperative pain management for patients with chronic pain, opioid tolerance, and substance use disorder: an infographic.
Dickerson DM, Mariano ER, Schwenk ES. Dickerson DM, et al. Reg Anesth Pain Med. 2024 Oct 8;49(10):725. doi: 10.1136/rapm-2022-103896. Reg Anesth Pain Med. 2024. PMID: 37236660 No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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Medical