There are many factors that interfere with a successful response to surgery, including some medications currently used to treat pain. Some surgical patients may be asked to get a preoperative pain screening. This helps the healthcare team understand a patient’s current, presurgical pain levels so they can optimize the postsurgical pain management plan. At HSS, this screening is conducted by the Complex Pain team.
Understanding a patient’s baseline pain and how it’s treated before surgery helps us identify potential obstacles during recovery. The presurgical pain screening is a vital tool that helps the surgical team and patient develop the best approach to pain management before, during, and after surgery.
If you are scheduled to have surgery, there are many reasons why it may be appropriate for you to come in for a presurgical pain screening. Perhaps you had a negative experience with a previous post-operative pain management course or a problem with a non-opioid pain prescription. Some patients come in for this evaluation because they are anxious about pain management. Again, the goal is for you and your surgical team to set up an appropriate plan and set your expectations for that plan. It’s also a time when you can address any concerns you may have regarding postoperative pain management.
Because traditional treatments for chronic pain are usually pharmacologic, your surgical team needs to ensure that your current pain medications won’t interfere with the pain management methods used following your surgery. While it is not uncommon for patients with persistent, long-term pain (six months or more) to be prescribed pain relief medications like opioids, the frequency, timeframe and dosage of any opioid regimen must be thoroughly reviewed by the surgical team so that they may better customize an anesthetic approach that is appropriate and effective for you.
Because long-term opioid use is linked to tolerance and, in some cases, hyperalgesia or substance abuse, the more your surgical team knows about your preoperative pain regimen, the better they can optimize your postsurgical results and minimize complications associated with consistent, long-term opioid use.
You need to understand that opioids can interfere with your recovery and that they are associated with an assortment of other risks and side effects that range from nausea and vomiting to tolerance and substance abuse. In the long run, orthopedic surgery alleviates a lot of this pain, but every member of your care team at HSS needs to understand how that pain has been treated in the past.
You or a caregiver should bring a list of current medications – including any pain prescription management medications – and information on what doses you have taken, how frequently and for what length of time. The Complex Pain team needs to understand your current pain levels and medication history and coordinate with healthcare providers both inside and outside of HSS in order to identify, eliminate or overcome any problems with pain medication that could become an obstacle to your recovery.
One of the most important aspects of this evaluation is to set your expectations for surgery. Yes, there will be pain after surgery and, yes, it will go away in time. Surgical teams need to balance pain relief with rehabilitation and mobility needs. We all work together to ensure that each patient’s individual factors are taken into account within the Hospital’s best practices and policies. Presurgical screenings aren’t meant to block any patients from surgery. They are meant to help make each and every patient coming to HSS be in the best shape for their procedure.
Faye Rim, MD, is the director of presurgical chronic pain management within the Department of Anesthesiology, Critical Care & Pain Management.