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New Post-surgical Pain Management Guidelines Recommend Wider Use of Multimodal Therapies

Post-surgical Pain ManagementThe American Pain Society (APS) has released new post-surgical pain management guidelines. The evidence-based clinical guidelines recommend the wider use of multimodal therapies and advise clinicians to limit opioid administration.

Published in The Journal of Pain, the aim of the 32 recommendations is to help clinicians achieve better postoperative pain management. The APS guideline is based on a review of over 6,500 scientific abstracts and primary studies by a panel of 23 experts from specialties such as anesthesia, pain management, surgery, nursing, and more. The studies showed that most surgical patients do not receive adequate pain relief, which can increase their chances of developing post-surgical pain, mood disorders and physical impairment.

According to the lead author, the main recommendation of the guideline, which is based on scientific evidence, is the wider use of a variety of analgesic medications and techniques. The key recommendations include:

  • Use of multimodal anesthesia to target different mechanisms of actions in the peripheral and central nervous systems
  • Decreased opioid consumption compared with use of a single medication administered by one technique
  • Non-pharmacological therapies, such as cognitive behavioral therapies and transcutaneous elective nerve stimulation (TENS), can effectively support pharmacological therapies
  • Optimal pain management should start in the preoperative period and be based on assessment of the patient
  • Development of individual care plans for the surgical procedure involved
  • Physicians should consult with a pain management specialist when a patient has a tolerance for opioids, or a history of substance abuse or addiction

According to the expert, post-surgical pain management that incorporated these strategies was found to be associated with superior pain relief. The guideline’s 32 recommendations are rated as strong, moderate or weak based on scientific evidence cited as high, moderate or low quality.

A new literature review in the February issue of the Journal of the American Academy of Orthopedic Surgeons (JAAOS) also stressed the importance of managing post-surgical pain after total knee replacement (TKR) to promote early postoperative mobility, reducing medication side effects, and increasing patient satisfaction. The study noted that this can be achieved by a care approach involving the patient, family members, the orthopedic surgeon and other medical practitioners). Multispecialty healthcare centers in New York are known to utilize such an approach in their rehabilitation programs to maximize patient outcomes.

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