Regional Anesthesia Considerations for Chronic Noncancer Pain
Chronic noncancer pain in patients presents unique challenges that regional anesthesiologists may encounter in their practices. Biopsychosocial models for treatment of these patients often require a multidisciplinary and multimodal approach that often extends beyond a perioperative encounter. A thorough medication history including all analgesics, assessment of pre-existing pain, a focused physical exam, and consultations with any physicians managing a patient’s chronic pain is essential to developing an anesthetic plan. Patients with chronic noncancer pain and high chronic opioid consumption have a narrow therapeutic window for further pain control perioperatively. Thus the regional anesthesiologist must utilize opioid-sparing techniques including pharmacologic adjuvants and regional interventional procedures to reduce any adverse opioid side effects in the perioperative period.
KeywordsNonmalignant pain Noncancer pain Chronic pain Opioids Adjuvants Biopsychosocial Opioid sparing Multimodal analgesia Fibromyalgia Chronic low back pain
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