ask a vital question when it comes to treating pain: What type of pain
is the patient having — sharp, throbbing, stabbing, burning or spasm-
like?
Surveys show that many, if not most, patients still suffer with mod-
erate to severe post-operative pain. Uncontrolled pain may have sig-
nificant clinical, psychological and socioeconomic consequences,
including increased morbidity and mortality, delayed recovery, unan-
ticipated readmissions, decreased patient satisfaction and even chron-
ic postsurgical pain.
Bu the fact is that pain, along with being one of the greatest con-
cerns of patients facing surgery, is multifactorial in nature. As such,
there isn't just one single drug we can use to adequately treat it.
That's something we need to come to grips with as we navigate the
new world of health care. With reimbursements being tied to both
outcomes and patient satisfaction, we must understand and use mul-
timodal techniques. We can't afford to neglect the best and most
appropriate ways to treat post-surgical pain.
Bad habits
The first step may be to break old habits. Traditionally, many have
turned to opioids to help manage all types of postsurgical pain.
While it's true that opioids are well suited to treat nociceptive pain,
postsurgical pain is often a combination of different types of pain,
including nociceptive, neuropathic and inflammatory. Opioids aren't
just less effective for treating other types of pain, they can also be
accompanied by a number of unwanted side effects, including seda-
tion, respiratory depression, pruritus, urinary retention and consti-
pation. Tolerance and addiction are also risks. (Very early research
in animal models suggests there may be even be a link between opi-
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