The American Society of Anesthesiologists and 14 other medical organizations in February set seven principles for acute pain treatment in complex surgical patients, according to a March 8 news release shared with Becker's.
The ASA hosted the meeting between the organizations, which was a second-of-its-kind pain summit, the release said.
The seven new principles recommend:
1. If a patient's preoperative screening shows substance use, a more detailed assessment tool should be used to determine whether the patient needs additional support or referral for treatment.
2. If a patient is identified during the preoperative evaluation as having chronic pain, opioid tolerance or a substance use disorder, clinicians should coordinate with the patient's care team, including consultation with a pain medicine, behavioral health or addiction medicine specialist.
3. For patients on long-term opioid therapy before an operation, clinicians should coordinate with the patient's prescriber and continue the baseline opioid dose perioperatively, with supplemental analgesia as needed for postoperative acute pain.
4. Clinicians should work with patients who have opioid tolerance on a custom tapering plan for postoperative opioids, coordinating with the long-term opioid-prescribing clinician with the goal of returning to the preoperative dose or lower as soon as possible.
5. For patients prescribed opioids after surgery, clinicians should inform them and their caregivers about the risks, signs and management of opioid-induced respiratory depression. Clinicians should also advise against concurrent use of medicines with sedative effects and alcohol while taking opioids and when to call for emergency assistance.
6. For patients at significant risk of opioid-related adverse drug events or severe uncontrolled perioperative pain, clinicians should consult a pain specialist or anesthesiologist before the operation.
7. For patients identified as benefitting from additional consultation with a pain medicine, behavioral health or addiction medicine specialist, clinicians should use telehealth options if in-person consultation is not available.