Regional Anesthesia Considerations for Chronic Noncancer Pain

  • Lauren K. Eng
  • Lindsey K. Okada
  • Matthew R. Eng
Chapter

Abstract

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.

Keywords

Nonmalignant pain Noncancer pain Chronic pain Opioids Adjuvants Biopsychosocial Opioid sparing Multimodal analgesia Fibromyalgia Chronic low back pain 

References

  1. 1.
    Feinberg SD. The pain medicine specialist as a physician-healer. Clin J Pain. 1996;12(1):3–5.CrossRefPubMedGoogle Scholar
  2. 2.
    Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535–44.CrossRefPubMedGoogle Scholar
  3. 3.
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606–17.CrossRefPubMedGoogle Scholar
  4. 4.
    Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77(5):1048–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Mularski RA, White-Chu F, Overbay D, Miller L, Asch SM, Ganzini L. Measuring pain as the 5th vital sign does not improve quality of pain management. J Gen Intern Med. 2006;21(6):607–12.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Vila H Jr, Smith RA, Augustyniak MJ, Nagi PA, Soto RG, Ross TW, et al. The efficacy and safety of pain management before and after implementation of hospital-wide pain management standards: is patient safety compromised by treatment based solely on numerical pain ratings? Anesth Analg. 2005;101(2):474–80.CrossRefPubMedGoogle Scholar
  7. 7.
    Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KGM. Preoperative prediction of severe postoperative pain. Pain. 2003;105(3):415–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111(3):657–77.CrossRefPubMedGoogle Scholar
  9. 9.
    Rapp SE, Ready LB, Nessly ML. Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review. Pain. 1995;61(2):195–201.CrossRefPubMedGoogle Scholar
  10. 10.
    Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006;104(3):570–87.CrossRefPubMedGoogle Scholar
  11. 11.
    Rainer TH, Jacobs P, Ng YC, Cheung NK, Tam M, Lam PK, et al. Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial. BMJ. 2000;321(7271):1247–51.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Jackson LM, Hawkey CJ. COX-2 selective nonsteroidal anti-inflammatory drugs: do they really offer any advantages? Drugs. 2000;59(6):1207–16.CrossRefPubMedGoogle Scholar
  13. 13.
    White PF, Tang J, Wender RH, Zhao M, Time M, Zaentz A, et al. The effects of oral ibuprofen and celecoxib in preventing pain, improving recovery outcomes and patient satisfaction after ambulatory surgery. Anesth Analg. 2011;112(2):323–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Apfel CC, Turan A, Souza K, Pergolizzi J, Hornuss C. Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis. Pain. 2013;154(5):677–89.CrossRefPubMedGoogle Scholar
  15. 15.
    Menigaux C, Fletcher D, Dupont X, Guignard B, Guirimand F, Chauvin M. The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg. 2000;90(1):129–35.CrossRefPubMedGoogle Scholar
  16. 16.
    Kissin I, Bright CA, Bradley EL Jr. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioid consumption with ketamine-opioid analgesic combinations? Anesth Analg. 2000;91(6):1483–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Emerson RH, Barrington JW, Olugbode O, Lovald S, Watson H, Ong K. Comparison of local infiltration analgesia to bupivacaine wound infiltration as part of a multimodal pain program in Total hip replacement. J Surg Orthop Adv. 2015;24(4):235–41.CrossRefPubMedGoogle Scholar
  18. 18.
    Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R, et al. The impact of analgesic modality on early ambulation following total knee arthroplasty. Reg Anesth Pain Med. 2013;38(4):334–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Abdallah FW, Laffey JG, Halpern SH, Brull R. Duration of analgesic effectiveness after the posterior and lateral transversus abdominis plane block techniques for transverse lower abdominal incisions: a meta-analysis. Br J Anaesth. 2013;111(5):721–35.CrossRefPubMedGoogle Scholar
  20. 20.
    de Leon-Casasola OA, Myers DP, Donaparthi S, Bacon DR, Peppriell J, Rempel J, et al. A comparison of postoperative epidural analgesia between patients with chronic cancer taking high doses of oral opioids versus opioid-naive patients. Anesth Analg. 1993;76(2):302–7.PubMedGoogle Scholar
  21. 21.
    de Leon-Casasola OA, Lema MJ. Epidural bupivacaine/sufentanil therapy for postoperative pain control in patients tolerant to opioid and unresponsive to epidural bupivacaine/morphine. Anesthesiology. 1994;80(2):303–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lauren K. Eng
    • 1
  • Lindsey K. Okada
    • 2
  • Matthew R. Eng
    • 3
  1. 1.Tulane University School of MedicineNew OrleansUSA
  2. 2.Department of NeuroscienceUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of AnesthesiologyLouisiana State University Health Science CenterNew OrleansUSA

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