title: Medical management of acute pain in patients with chronic pain.
abstract: The number of patients with chronic pain has increased over the years, as well as the number of patients who manage chronic pain with opioids. As prescribed opioid use has increased, so has its abuse and misuse. It has also been estimated that the number of people using opioids illicitly has doubled worldwide over the last 20 years. Management of chronic pain with opioids is associated with pathophysiological phenomena such as tolerance, dependence and hyperalgesia. They can become a problem when chronic pain patients present for a surgical procedure. Furthermore, patients who are on opioids on a regular basis require higher amounts during the perioperative period. The perioperative management of the chronic pain patient is difficult and complex. Developing an appropriate plan that can fulfill patients' and surgical team's needs requires skills and experience. The aim of this review is to describe the options available for the optimal perioperative management of acute pain in patients with a history of chronic pain.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington, Pain Relief Service, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, Box 359724, USA. mdepinto@u.washington.edu
authors.forename: Mario
authors.initials: M
authors.lastname: De Pinto
authors.forename: Alex
authors.initials: A
authors.lastname: Cahana
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain; D006801:Humans; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid