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Post operative acute pain

Updated: Apr 19, 2021

Acute pain is 7 days

Subacute pain is 7-90 days

Chronic pain is 90 days+


Factors that negatively affect postoperative pain intensity include:



Psychological factors improving acute pain include:

- Preoperative self-distraction

- Emotional support and religious-based coping

-



Opioid dose determinants in acute pain

Patient age is often a better predictor of dose requirement than weight

A two to four fold decrease in opioid requirements as age increases is usually due to pharmacodynamic (what a drug does to a body) changes rather than pharmacokinetic (what the body does to a drug) factors


Discharge factors

SR opioid formulations should not be used because of short-term titration difficulties

Transdermal patches - again - difficulty with titration makes these unhelpful

Methadone - Half-lives are very unpredictable


Driving on discharge

Health authorities often recommend that patients prescribed opioids for chronic pain or cancer pain not drive until their dose is stable (e.g. no dose change for 4 weeks) or for as long as they require a short-term opioid for treatment of acute pain.


Risk factor for prolonged opioid use

Affective distress is more predictive than length of opioid use or type of surgery performed

Particularly catastrophic thinking and depression


When are opioids contraindicated?

Misuse or abuse of drugs or alcohol, Potential interaction with other drugs, severe renal or hepatic impairment may affect use of some opioids, psychiatric comorbidities, increased falls risk, respiratory insufficiency, OSA, occupation limitations.


If opioids are not working appropriately on discharge - what next?

Assess for new red flags

Consider complication conditions such as CRPS or neuropathic pain

Consider psychological vulnerabilities

Assess for other risk factors such as tolerance, other pain locations

Check they are taking the medication

Look at non-pharm appropriate therapies


Risk factors for persistent postsurgical pain

1 in 5 patients post surgery will develop persistent postsurgical pain


References:

FPM - Better pain management



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