title: Managing surgical pain in long-term opioid patients.
abstract: The number of patients taking long-term opioid therapy for pain is increasing, with opioid use no longer being confined to advanced cancer patients. Challenges to peri- and postoperative pain management in chronic pain patients include complex existing drug regimens and problems arising from tolerance to opioid analgesia. Postoperatively, individualized, multimodal pain therapy involving a round-the-clock regimen of nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) inhibitors, paracetamol, and regional blocks should be used. Other considerations may include patients receiving opioids by intrathecal drug delivery systems, spinal cord stimulator (SCS), and potential substance abusers.
authors.affiliation: Center for Pain Medicine, Sourasky Medical Center, Tel Aviv, Israel. silviub@tlvmc.gov.il
authors.forename: Silviu
authors.initials: S
authors.lastname: Brill
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D016503:Drug Delivery Systems; D004361:Drug Tolerance; D006801:Humans; D007278:Injections, Spinal; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010149:Postoperative Pain / Q000188:drug therapy*; D062187:Spinal Cord Stimulation / Q000379:methods
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors